Keywords: Osteoporosis, early detection, FRAX, bisphosphonates, bone mineral density, fracture prevention, primary care

Review:

Osteoporosis (OP) is the most common metabolic bone disease, characterized by an imbalance between bone resorption and formation, leading to decreased bone density and increased fracture risk. It often progresses silently for years, becoming clinically evident only after low-trauma fractures, such as those of the vertebrae, proximal femur, or distal forearm. Among the most severe complications are hip fractures, which result in disability and a high mortality rate within the first year for more than 20% of patients. OP is categorized into primary and secondary types, with primary OP including postmenopausal, senile (involutional), and idiopathic forms, while secondary OP is associated with other underlying conditions like endocrine disorders, malabsorption syndromes, and long-term medication use.
Since April 2023, the Czech Republic has implemented a nationwide early detection program for OP, accessible to general practitioners and gynecologists. The program aims to identify at-risk patients and manage their care, significantly reducing the incidence of OP fractures. Risk assessment tools, such as the FRAX questionnaire, are used to determine fracture risk, guiding the decision to perform dual-energy X-ray absorptiometry (DXA) to assess bone mineral density (BMD). Treatment primarily involves bisphosphonates, which inhibit bone resorption and are available in oral and intravenous forms. The program also emphasizes lifestyle modifications, including fall prevention, vitamin D and calcium supplementation, and physical activity.
The management of OP is multifaceted, with a focus on preventing fractures and preserving quality of life. Monitoring and adjusting treatment based on BMD changes, as well as addressing any underlying conditions, are critical to effective long-term care. The early detection program enhances the ability of primary care physicians to diagnose and manage OP, thereby improving patient outcomes and reducing the burden of osteoporosis-related fractures.