Osteoporosis and Bone Health in Southlake, TX

Osteoporosis is silent until something breaks, and the treatment gap in this country is enormous. Most people who fracture a wrist or a vertebra never get scanned, never get diagnosed and never get treated. We screen on schedule, calculate real fracture risk, and start treatment when it is indicated.

Screening

DEXA scanning at 65 for women and 70 for men without risk factors, earlier when risk factors are present. We order it and we track the result, so it does not disappear into a stack of paperwork.

The scan alone is not the whole answer. We run a FRAX fracture risk calculation, which combines your density with age, weight, prior fractures, family history, steroid use, smoking, alcohol and rheumatoid arthritis.

Plenty of people with osteopenia rather than frank osteoporosis still carry a fracture risk high enough to warrant treatment, and that group is the one most often missed. Treating on the T-score alone means undertreating exactly the people who go on to break something.

Finding what is causing it

Secondary causes are common and worth ruling out before committing to years of therapy.

We check vitamin D, calcium, kidney function and TSH, and add testing for celiac disease, hyperparathyroidism, multiple myeloma or low testosterone when the picture suggests it.

Overtreated thyroid disease is a genuine and fixable contributor. A suppressed TSH from too much levothyroxine accelerates bone loss, which is one reason we are careful with dosing. See thyroid disorders.

Treatment

Oral bisphosphonates are first line for most people, taken weekly or monthly on an empty stomach while sitting upright for half an hour.

Yearly intravenous zoledronic acid is a good alternative when the oral form causes reflux or when the dosing routine is unrealistic. For very high risk patients, or those who fracture while on treatment, denosumab and anabolic agents like teriparatide or romosozumab are options and we coordinate those.

One important detail: denosumab cannot simply be stopped. Discontinuing it without transitioning to another agent causes rapid bone loss and a spike in vertebral fractures. If you are on it, do not let it lapse.

Calcium and vitamin D come alongside, not instead.

Preventing the fall

Fractures require both bone loss and a fall, and we work on both halves.

We review your medications for anything causing dizziness or sedation, check blood pressure sitting and standing, ask about vision and footwear and stairs and rugs, and talk about balance work.

Strength and balance training does more to prevent hip fractures than most people expect, and it connects directly to the mobility work covered under knee and joint pain.

After a fracture

A fracture from a standing-height fall after age 50 is osteoporosis until proven otherwise, regardless of what a DEXA says.

This is the single largest gap in care nationally. Most people who break a wrist get a cast and no bone workup, and the wrist fracture was the warning that the hip fracture is coming.

Follow-up

Repeat DEXA every one to two years while on treatment, then reassess whether to continue at the five year mark.

Bone health runs through our preventive screening program. See our primary care Southlake practice overview.