Comprehensive clinical review of osteoporosis in older adults: Diagnosis, management, and a UAE primary care perspective

ABSTRACT

Osteoporosis is a progressive skeletal disorder characterized by reduced bone strength and an increased risk of fragility fractures, particularly among older adults. With rising life expectancy, osteoporosis has become a significant public health concern. In the United Arab Emirates (UAE), factors such as vitamin D deficiency, sedentary lifestyles, and a high prevalence of chronic diseases contribute substantially to disease burden. To provide a comprehensive, primary care–focused narrative review of osteoporosis in older adults, emphasizing diagnosis, fracture risk assessment, and evidence-based management strategies relevant to ambulatory care settings in the UAE. This narrative review synthesizes evidence from international clinical guidelines, systematic reviews, and peer-reviewed literature related to osteoporosis screening, diagnosis, and management. Particular emphasis is placed on approaches applicable in primary care practice. Osteoporosis often remains clinically silent until a fragility fracture occurs. Diagnosis relies on bone mineral density assessment using dual-energy X-ray absorptiometry (DEXA), supported by clinical risk evaluation tools such as FRAX. Effective management includes pharmacological therapy, optimization of calcium and vitamin D intake, lifestyle modification, and fracture prevention strategies. Early identification and proactive management of osteoporosis in primary care are essential to reduce fracture risk and preserve functional independence in older adults. Primary care physicians play a pivotal role in screening, prevention, and long-term management within the UAE healthcare system.

Introduction

Osteoporosis is one of the most common metabolic bone diseases affecting older adults and is associated with substantial morbidity, mortality, and healthcare utilization.[1] Fragility fractures, particularly of the hip and vertebrae, are linked to chronic pain, disability, loss of independence, and increased mortality.[2] Despite its clinical significance, osteoporosis remains underdiagnosed and undertreated, especially in primary care settings.[3]

Primary care physicians are ideally positioned to identify individuals at risk of osteoporosis through routine consultations, chronic disease management, and opportunistic screening.[4] Early diagnosis enables timely intervention and fracture prevention, thereby improving patient outcomes and reducing healthcare burden.

In the UAE, osteoporosis presents unique challenges due to widespread vitamin D deficiency, reduced sun exposure, sedentary lifestyle, and high prevalence of diabetes mellitus.[5] As the population continues to age, integrating osteoporosis screening and management into routine primary care practice is essential. This review aims to support primary care clinicians by providing a practical, evidence-based framework tailored to the UAE healthcare context.

Diagnosis and Risk Assessment

Osteoporosis diagnosis is primarily based on bone mineral density (BMD) measurement using dual-energy X-ray absorptiometry (DEXA). According to World Health Organization criteria, a T-score of − 2.5 or below confirms osteoporosis.[6] Clinical risk assessment tools such as FRAX are widely used to estimate 10-year fracture probability and support treatment decisions, particularly in individuals with osteopenia.[7,8]

Management Strategies

Management of osteoporosis involves both pharmacological and nonpharmacological interventions. First-line pharmacological therapy includes bisphosphonates, while alternative agents such as denosumab and selective estrogen receptor modulators may be considered based on patient profile and tolerance.[9]

Nonpharmacological measures include adequate calcium and vitamin D intake, weight-bearing exercise, smoking cessation, and fall risk assessment. Primary care physicians play a central role in coordinating these interventions and ensuring adherence to long-term therapy.[10,11]

Limitations and Future Directions

This review is limited by its narrative design and reliance on previously published literature rather than original data. There is also a lack of large-scale, region-specific epidemiological data on osteoporosis in the UAE.[12] Future research should focus on prospective studies, evaluation of fracture prevention programs, and cost-effectiveness analyses of screening strategies in primary care settings.

Conclusion

Osteoporosis in older adults is a major yet preventable cause of morbidity and mortality. Early identification and comprehensive management in primary care settings can significantly reduce fracture risk and improve quality of life. Primary care physicians play a critical role in implementing effective osteoporosis prevention and management strategies within the UAE healthcare system.[13,14]

Author contributions

Single author.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.