AGE Burden and Response to Antiresorptive Therapy in Osteoporosis

Inclusion Criteria: * Age ≥ 50 years * Diagnosis of osteoporosis based on dual-energy X-ray absorptiometry (DXA) criteria (T-score ≤ -2.5 at the lumbar spine, total hip, or femoral neck) or presence of a prior fragility fracture * Planned initiation of antiresorptive therapy (denosumab or bisphosphonate) as part of routine clinical care * Ability to undergo DXA measurements at baseline and during follow-up * Ability and willingness to provide written informed consent Exclusion Criteria: * Diagnosis of diabetes mellitus (type 1 or type 2) * Chronic kidney disease with estimated glomerular filtration rate (eGFR) \< 60 mL/min/1.73 m² * Active malignancy or history of malignancy within the past 5 years * Secondary causes of osteoporosis (including hyperparathyroidism, hyperthyroidism, Cushing's syndrome, malabsorption syndromes, or chronic liver disease) * Use of medications known to significantly affect bone metabolism other than antiresorptive therapy (e.g., long-term systemic glucocorticoids, anabolic osteoporosis agents) * Prior treatment with denosumab or bisphosphonates within the last 12 months * Inflammatory rheumatic diseases or chronic inflammatory conditions that may affect bone metabolism * Pregnancy or breastfeeding * Inability to comply with study procedures or follow-up visits