Osteoporosis

Osteoporosis weakens your bones, making them fragile and more likely to break from even a minor fall or bump. Often called a “silent disease,” it develops slowly over many years without obvious symptoms, and many people only discover they have it after breaking a bone.

Table of contents

• What is osteoporosis?
• How common is osteoporosis?
• Symptoms and warning signs
• What causes osteoporosis?
• Risk factors
• How is osteoporosis diagnosed?
• Treatment options
• Prevention and healthy living
• Living with osteoporosis

What is osteoporosis?

Osteoporosis is a disease that causes your bones to become weak and brittle. The name literally means “porous bone.” When you look at healthy bone under a microscope, it resembles a honeycomb. When osteoporosis occurs, the holes and spaces in this honeycomb become much larger than normal. The bones lose density and mass, and their internal structure becomes abnormal^[2][3].

Your bones are made of living tissue that constantly breaks down old bone and replaces it with new bone. This process is called bone remodeling, which means your bones are continuously renewing themselves. When you’re young, your body makes new bone faster than it breaks down old bone, so your bone mass increases. Most people reach their peak bone mass around age 30. After that, bone breakdown begins to happen faster than your body can replace it^[1][6].

Osteoporosis develops when more bone is broken down than replaced. This makes bones gradually become thinner, less dense, and much weaker. As bones weaken, they become fragile and are much more likely to break^[3][11].

How common is osteoporosis?

Osteoporosis is extremely common, affecting millions of people. About 54 million Americans have osteoporosis or low bone mass that puts them at increased risk for the disease. Of these, approximately 10 million people have osteoporosis, while about 44 million have osteopenia, which is lower than normal bone density^[2][8].

The disease affects far more women than men. At least 80% of people with osteoporosis are women. Studies suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis. About one in five women over age 50 already have osteoporosis^[2][6][8].

Women who are white or of Asian descent are at highest risk, although the disease affects people of all races and ethnic groups. African American and Mexican American women and men have a lower risk compared to white populations^[1][9].

Symptoms and warning signs

Osteoporosis is often called a “silent disease” because it usually doesn’t cause symptoms until something serious happens. Most people don’t know they have osteoporosis until they suffer a broken bone. You won’t feel pain or notice changes that signal something is wrong with your bones until they’ve already become quite weak^[3][6][11].

The most common first sign of osteoporosis is breaking a bone from a minor fall or accident that normally wouldn’t cause such an injury. These breaks most commonly occur in the hip, wrist, or spine. However, osteoporosis can make any bone more likely to break. Sometimes even a cough or sneeze can cause a broken rib or partial collapse of a bone in the spine^[1][4].

Even though osteoporosis doesn’t directly cause symptoms you can feel, you might notice a few changes in your body that can indicate your bones are losing strength. These warning signs include losing an inch or more of your height over time, changes in your posture such as stooping or bending forward more than before, shortness of breath if the disks in your spine are compressed enough to reduce your lung capacity, and lower back pain^[11].

When osteoporosis affects the bones of the spine, it often leads to a stooped or hunched posture. This happens when bones in the spine break, making it difficult to support the body’s weight. It might be hard to notice these changes in yourself, but a loved one may be more likely to see changes in your height or posture^[1][2][11].

What causes osteoporosis?

Losing some bone is a normal part of aging. However, some people lose bone much faster than normal, which leads to osteoporosis and an increased risk of breaking bones^[4].

As you age, your bones naturally lose some of their density and their ability to regrow themselves. Osteoporosis develops when more bone is broken down than replaced. This happens because bone remodeling can result in more bone being lost than created^[1][11].

Women experience more rapid bone loss than men, especially during the first few years after menopause. This happens because their bodies produce less of the hormone estrogen as they age. Estrogen appears to help keep calcium in the bones. Women can lose up to 7% of their bone mass every year after menopause. Men also lose bone when their bodies have less of the hormone testosterone, but this bone loss is more gradual^[1][5].

How likely you are to develop osteoporosis depends partly on how much bone mass you built up when you were young. The higher your peak bone mass by age 30, the more bone you have stored up, and the less likely you are to develop osteoporosis as you age^[1][8].

Risk factors

Anyone can develop osteoporosis, but certain factors make you more likely to develop the disease. Some of the most important risk factors include being female, being over age 50, being white or of Asian descent, having a family history of osteoporosis (especially if your mother or father had a hip fracture), being thin or having a small frame, and going through early menopause^[1][6][9].

Women are at much higher risk than men, particularly older women who are past menopause. Women who went through early menopause before age 45 or had their ovaries removed are at especially high risk^[1][4].

Your lifestyle choices can also affect your bone health. Smoking cigarettes, drinking alcohol heavily, not exercising regularly, and having a diet low in calcium or vitamin D all increase your risk. Physical inactivity or prolonged periods of bed rest can also lead to bone loss^[4][6][9].

Certain medical conditions and medications can increase your risk. Taking high-dose steroid tablets for more than three months, having certain hormone-related conditions, inflammatory conditions, or problems absorbing nutrients from food can all contribute to bone loss. Long-term use of certain medicines such as corticosteroids, proton pump inhibitors (medicines for acid reflux), and anti-seizure drugs can also affect bone strength^[4][6][9].

Other conditions that may increase risk include having or having had an eating disorder such as anorexia or bulimia, certain types of cancer, kidney or liver disease, an overactive thyroid or parathyroid gland, and low body weight or having a low body mass index^[4][7].

How is osteoporosis diagnosed?

Healthcare providers often diagnose osteoporosis during routine screening for the disease. It’s also commonly diagnosed when you break a bone and have an X-ray taken^[9][10].

Screening for osteoporosis is recommended for all women age 65 and older, and for postmenopausal women under age 65 who have factors that increase their chance of developing osteoporosis. For men, it isn’t yet clear whether regular screening is helpful, and more research is needed^[9].

To find out if you have osteoporosis, your healthcare provider will ask about your medical history, including whether you have ever broken a bone. They may do a physical exam to check for loss of height, changes in your posture, balance and the way you walk, and your muscle strength^[9][10].

The main test for osteoporosis is a bone density scan, also called dual-energy X-ray absorptiometry or DEXA scan. This test measures the proportion of mineral in your bones using low levels of X-rays. It’s a short, painless procedure that takes 10 to 20 minutes, depending on which part of the body is being scanned. During the test, you lie on a padded table as a scanner passes over your body. In most cases, only certain bones are checked, usually those in the hips and spine^[4][9][10].

Your bone density is compared to that of a healthy young adult, and the difference is calculated as a number called a T-score. A T-score above -1 is normal. A T-score between -1 and -2.5 shows bone loss and is defined as osteopenia. A T-score below -2.5 shows significant bone loss and is defined as osteoporosis^[4][7].

Your provider may also do a fracture risk assessment, which is a short questionnaire that helps estimate your risk of breaking a bone in the next 10 years^[9].

Treatment options

The goals for treating osteoporosis are to slow or stop bone loss, prevent fractures, and maintain bone strength. Your treatment plan will depend on your individual risk of breaking a bone, which is based on factors such as your age, sex, the results of your bone density scan, and whether you have already had a fracture^[9][10].

If you need treatment, several types of medications are available. The most widely prescribed medicines for osteoporosis are bisphosphonates. These medicines work by preventing bones from getting weaker, slowing the natural breakdown of bone. They can be taken as pills daily, weekly, or monthly, or given as an injection into a vein. Common bisphosphonates include alendronate, risedronate, ibandronate, and zoledronic acid. Most people take oral bisphosphonates for up to five years or receive intravenous bisphosphonates for up to three years^[10][15][16].

Another treatment option is denosumab, which is given as an injection every six months. This medicine improves bone density more quickly than bisphosphonates. However, bone density improvements fade within months after you stop taking it unless you start bisphosphonates afterward^[16][17].

For people at very high risk of fractures, medicines called parathyroid hormone analogs may be prescribed. These include teriparatide and abaloparatide, which are given as daily injections for up to two years. These medicines dramatically improve bone density and reduce fractures. After stopping these treatments, you need to take bisphosphonates to maintain the benefit^[15][16].

A newer medicine called romosozumab may be used for one year, followed by one year of alendronate. This combination reduces fracture risk more than two years of alendronate alone^[16][17].

Other treatment options include raloxifene and calcitonin. Menopausal hormone therapy may be used for younger postmenopausal women who need treatment for menopausal symptoms, but it’s not a primary treatment for osteoporosis^[15][17].

Like all medications, osteoporosis treatments can have side effects. Common side effects of bisphosphonates include nausea, abdominal pain, and heartburn-like symptoms. Very rare complications can include breaks in the thighbone and problems with the jaw bone. However, for people at high risk of fracture, the benefit of treatment in decreasing the risk of fracture far outweighs the rare occurrence of serious side effects^[10][15][17].

It’s important to take your osteoporosis medication exactly as prescribed. Studies show that up to half of patients stop their treatment after only one year. If you keep taking your medicine as directed, you can benefit from larger increases in bone density, lose less bone mass, and reduce your fracture risk. If you have concerns about your medication, talk to your healthcare provider rather than stopping it on your own^[17].

Prevention and healthy living

There is a lot you can do to protect your bones throughout your life. Osteoporosis prevention should begin in childhood, but it’s never too late to take steps to improve bone health. Whatever your age, the habits you adopt now can affect your bone health for the rest of your life^[22].

Getting enough calcium and vitamin D is essential for building and maintaining strong bones. Calcium is the main building block of bones and teeth. Many older people eat fewer foods rich in calcium, often because milk, cheese, or yogurt become harder to digest. Fortunately, many lactose-free dairy products are now available, and certain aged cheeses and yogurts are naturally low in lactose. Most healthcare professionals recommend getting at least 1,200 mg of calcium every day^[13][14][22].

Vitamin D helps your body absorb calcium. Your body makes vitamin D when your skin is exposed to sunlight, but many people don’t get enough this way. You can also get vitamin D from foods like fatty fish, egg yolks, and fortified milk, or from supplements. Most experts recommend a daily supplement containing at least 10 micrograms of vitamin D if you’re at risk for osteoporosis^[4][22].

Regular exercise is one of the most important things you can do for bone health. Exercise makes bones stronger by putting healthy stress on them. There are two types of exercises that are especially important: weight-bearing exercises and muscle-strengthening exercises. Weight-bearing exercises work against gravity and include activities like walking, dancing, climbing stairs, jogging, and hiking. Muscle-strengthening exercises, also called resistance exercises, include lifting weights, using weight machines, or using your own body weight. Try to do weight-bearing exercise for 30 minutes most days of the week and muscle-strengthening exercises two or three times per week^[14][22].

Balance exercises are also important because they can help prevent falls and fractures. These include activities like Tai Chi and yoga. Exercises that improve your posture can straighten rounded shoulders and reduce the risk of spine fractures. If you already have osteoporosis or significant bone loss, check with your healthcare provider before starting any exercise program to make sure your choices won’t harm you^[14].

Making healthy lifestyle choices can also protect your bones. Avoid smoking and limit alcohol to no more than 2 to 3 drinks per day. Smoking and excessive alcohol use both harm bone health^[4][22].

Eating a well-balanced diet with plenty of fruits and vegetables provides other nutrients that are important for bone health. Foods that are good for your bones include those rich in protein, vitamin K, magnesium, and other minerals^[22].

Living with osteoporosis

Having osteoporosis doesn’t mean you’ll definitely break a bone. There are many steps you can take to reduce your risk and live well with the condition. It’s natural to be concerned about how osteoporosis will affect your daily life, but in general, life should be able to go on as normal, perhaps with just a few adjustments^[18][21].

Not everyone with osteoporosis will break a bone. If you don’t break a bone, you won’t have pain or other long-term problems. Even if you do break a bone, pain and other ongoing problems aren’t inevitable^[21].

Preventing falls is one of the most important things you can do. Make your home safer by checking for hazards you might trip over, such as trailing wires or loose rugs and carpets. Make sure they’re secure, and use rubber mats by the sink and in the bath to prevent slipping. Have regular sight tests and hearing tests, as problems with vision or hearing can increase fall risk. Some older people may benefit from wearing special protectors over their hips to cushion a fall^[18].

Maintaining regular exercise and a healthy diet remains important even after diagnosis. This helps keep your bones as strong as possible and supports your overall health^[18].

If you do break a bone, recovery time depends on the type of fracture you have. Some fractures heal more easily than others. Hip fractures often require surgery and may need a hip replacement. Recovery may take weeks or months. During the healing process, you may need help from a physical therapist or occupational therapist to make as full a recovery as possible^[18].

Pain management is important if you experience ongoing pain from osteoporosis or fractures. Different approaches work for different people, including pain medicines, heat or cold treatment, relaxation techniques, and massage. You can use more than one method at the same time^[18].

You should be able to continue working if you have osteoporosis, and staying physically active is very important for bone health. However, if your work involves risk of falling or breaking a bone, talk with your employer and healthcare provider about how to limit your risk^[18].

Many people find it helpful to talk with others who have osteoporosis, either at local support groups or online. Your healthcare provider or nurse can answer questions and provide reassurance. Some organizations also offer free telephone helplines run by nurses with specialist knowledge of osteoporosis and bone health^[18].

The most important thing is to work closely with your healthcare provider to develop a comprehensive treatment plan that includes the right medications for you, lifestyle changes, and strategies for preventing falls. Taking these steps can help you live well with osteoporosis and reduce your risk of fractures^[13].