Bone mass accumulates during growth and peaks at approximately 30 years of age, thereafter remaining relatively stable. In postmenopausal women, however, an accelerated annual bone mineral density (BMD) loss of 2-4% is observed, and a cumulative 25-30% reduction in BMD over 10 years significantly increases the risk for major osteoporotic fracture (MOF) (Figure 1). Furthermore, data suggest that BMD loss may be even greater in postmenopausal women who are HIV-infected than those who are not.

Clinical research and practice often focus heavily on cardiology, which may lead to the underdiagnosis of conditions like osteoporosis. Osteoporosis, a common metabolic bone disease, is underdiagnosed and affects one in three women and one in five men over 50. The 2024 Osteoporosis Masterclass by NOFSA explores various diagnostic methods and emphasises the importance of recognising and treating osteoporosis across all population groups in South Africa.

In this fourth National Osteoporosis Foundation of South Africa (NOFSA) 2024 Masterclass series, Professor Conradie considers the need for screening of the patient who presents with skeletal fragility and without a known or clinically overt secondary cause of osteoporosis. She provides guidance and a practical framework for appropriate use of available screening modalities in patients younger than or older than 40 years.