Osteoporosis in Women

Definition

Osteoporosis is a systemic skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures. It is especially common in postmenopausal women due to estrogen deficiency.

Epidemiology

• More common in women, especially postmenopausal (estrogen deficiency accelerates bone loss)
• Prevalence increases with age: 1 in 3 women over 50 affected globally
• Higher incidence in Caucasian and Asian women compared to African or Hispanic women
• Fractures commonly occur in spine, hip, and wrist
• Associated with significant morbidity, mortality, and healthcare costs
• Genetic predisposition and family history increase risk

Etiology

• Primary osteoporosis: age-related and postmenopausal estrogen deficiency
• Secondary osteoporosis: chronic diseases (e.g., rheumatoid arthritis, thyroid disorders, malabsorption syndromes)
• Medications: long-term glucocorticoids, anticonvulsants, aromatase inhibitors
• Lifestyle factors: low calcium/vitamin D intake, sedentary lifestyle, smoking, excessive alcohol consumption
• Hormonal changes: menopause, premature ovarian insufficiency, hypogonadism

Pathophysiology

• Estrogen deficiency leads to increased osteoclast activity and bone resorption
• Reduced osteoblast function results in impaired bone formation
• Net loss of bone mass and deterioration of trabecular and cortical bone microarchitecture
• Altered calcium and phosphate homeostasis further compromise bone strength
• Increased risk of fragility fractures even with minimal trauma