What Is Osteoporosis?
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Medically reviewed by Jane Kim, MD
Osteoporosis is a disease that causes loss of bone mass over time. This condition is called a "silent" disease because it doesn't cause pain or other obvious symptoms early on. However, as it progresses, osteoporosis can lead to bone fractures, which can be extremely painful.
This article discusses osteoporosis—what it is, what causes it to occur, how it's diagnosed, and its treatment options.
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Osteoporosis Symptoms
In its early stages, osteoporosis doesn't typically cause pain or other physical symptoms; however, severe osteoporosis can lead to bone fractures that are painful. These fractures often happen after a fall or with simple daily tasks, like getting out of bed or bumping into furniture.
Fractures from osteoporosis typically affect the spine, hips, or wrists. In addition to severe pain, fractures in the spine can cause decreased height and a bent-over posture. As the disease progresses, osteoporosis can also cause changes in the way you walk and impact your balance.
Approximately 1 in 2 women and 1 in 4 men with osteoporosis will experience bone fractures.
What Causes Osteoporosis?
Bone tissue is constantly breaking down and rebuilding itself through a process called remodeling. Osteoporosis develops when bone breaks down faster than it builds back up.
Risk Factors for Osteoporosis
Various factors can increase your risk of developing osteoporosis, including:
Assigned female at birth
Older age
Thinner bones (people with a more petite build)
Too much thyroid hormone
Too little estrogen in females
Too little testosterone in males
A diet that is low in protein, vitamin D, or calcium
White or Asian descent
Heavy consumption of alcohol
Long-term use of steroid medication, antiepileptic drugs, and possibly proton pump inhibitors
Smoking
Long periods of bed rest
Family history of osteoporosis
Menopause
Related:Causes and Risk Factors of Osteoporosis
How Is Osteoporosis Diagnosed?
In many people, osteoporosis isn't diagnosed until they've experienced a bone fracture. However, a healthcare provider may recommend screening via bone mineral density testing to identify osteoporosis or osteopenia (a precursor to osteoporosis).
Healthcare providers commonly use central dual-energy X-ray absorptiometry (DEXA scan) to test bone mineral density. Bones in the hip and spine are typically scanned, and results are given as a T-score. Here is what T-score results mean:
A normal T-score is between plus 1 (+1) and negative 1 (-1)
Low bone mass is represented by a T-score between -1 and -2.5
A score that is lower than -2.5 indicates osteoporosis.
Fragility fractures (broken bones from low-impact trauma) that occur from osteoporosis are diagnosed with imaging tests, such as:
Osteopenia vs. Osteoporosis
Osteopenia is a condition caused by less than average bone mass, but not to the point that the bone can be easily fractured. It is similar to osteoporosis in that it affects bone mineral density. Osteopenia is less severe than osteoporosis but should be taken seriously since it can progress to osteoporosis. If you have osteopenia, a healthcare provider will probably recommend bone density testing every two to five years.
Osteoporosis screening is often recommended for woman over age 65 or for people with risk factors for this condition.
How Is Osteoporosis Treated?
Treatment for osteoporosis focuses on stopping (or slowing) bone loss and reducing the risk of bone fractures. Treatment can include:
Medications
Healthy lifestyle behaviors
However, osteoporosis cannot be fully reversed.
Related:Can Osteoporosis Be Reversed?
Osteoporosis Medications
Medications for osteoporosis can either slow bone loss or help rebuild bone.
Bisphosphonates are often used first to treat bone loss. These can include:
Fosamax (alendronate)
Boniva (ibandronate)
Actonel, Atelvia (risedronate)
Reclast (zoledronic acid)
Other osteoporosis medications include:
Prolia (denosumab)
Evenity (romosozumab)
Evista (raloxifene)
Forteo (teriparatide)
Tymlos (abaloparatide)
Physical Therapy
Physical therapy exercises address many issues that occur with osteoporosis—decreased balance, posture changes, decreased flexibility, and risk of fractures.
Examples include:
Weight-bearing exercises—such as walking—to build bone density
Strengthening exercises to improve posture
Proprioception exercises to improve balance
A physical therapist can also determine whether you need an assistive device (such as a cane or walker) to improve safety with walking.
Perhaps most importantly, a physical therapist can teach you which exercises to avoid—specific movements, such as twisting your spine—can increase your risk of fractures when you have osteoporosis.
Lifestyle Behaviors
Simple changes in your lifestyle, including the following, can improve your overall bone health if you have osteoporosis:
Avoid (or quit) smoking.
Limit alcohol consumption.
Eat adequate amounts of foods high in protein.
Consider taking calcium or vitamin D supplements (if recommended by your healthcare provider).
See your healthcare provider regularly.
How to Prevent Osteoporosis
Staying active and eating a diet that includes adequate protein, calcium, and vitamin D can help maintain healthy bones early in life, which could ultimately help increase bone density and prevent osteoporosis.
Talk to a healthcare provider about screening for osteoporosis—particularly if you have risk factors for this condition. Early detection and treatment can help slow bone loss and reduce the risk of fractures.
Ways to Prevent Osteoporosis Fractures
While you can't always prevent osteoporosis, there are things you can do to reduce the risk of fractures if you've been diagnosed with this condition.
In addition to medications and exercise, consider these steps to improve safety at home and reduce the risk of falls, which can lead to fractures:
Remove throw rugs.
Keep walkways clear of clutter.
Install grab bars in the shower and next to the toilet.
Wear shoes with nonslip soles (even inside).
Install handrails in stairways.
Place night-lights in rooms and hallways.
Use a shower chair.
Keep your cell phone within reach.
Outlook for Osteoporosis: Support and Resources
Living with osteoporosis can significantly impact your quality of life. Consider joining a support group, such as the Online Osteoporosis Community through American Bone Health, to connect with others with the same condition. Additional resources for living well with osteoporosis can be found online through the Bone Health & Osteoporosis Foundation.
