By Sarah Bence, OTR/L 

 Medically reviewed by Marissa Sansone, MD

Osteoporosis is sometimes called a "silent disease" because it often has no symptoms. In many cases, osteoporosis has been progressing for years, but a person is only diagnosed when they break a bone.

However, there are some early warning signs of osteoporosis. Awareness of these subtle signs could help lead to an earlier diagnosis and proper treatment to prevent further bone loss or fractures.

This article teaches about the early warning signs of osteoporosis, osteoporosis stages, diagnosis, and whether you can reverse it.

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Risk Factors vs. Warning Signs

Risk factors are characteristics, conditions, or events that indicate someone is more likely to develop osteoporosis. Warning signs are more immediate. They suggest someone could have existing osteoporosis that requires prompt diagnosis and treatment.

Osteoporosis risk factors include:1

  • Older than 50

  • Female sex

  • Post-menopause

  • History of broken bones

  • Small stature (build) and low body weight

  • Family history of osteoporosis

  • Lack of vitamin D and calcium

  • Lack of exercise or being inactive

  • Smoking

  • Drinking alcohol in excess

  • Significant weight loss

  • Consuming too much sodium, caffeine, and/or protein

  • Not eating enough fruits and vegetables

Signs of Early Osteoporosis Changes

There are many early warning signs of osteoporosis. If you experience bone fractures, low bone density, a curved upper spine, or sudden back pain (among others), speak to your healthcare provider about prevention and treatment.

Low Bone Density

A low bone density diagnosis does not mean you have osteoporosis, but it is an early warning sign.

Low bone density caused by a loss of bone is called osteopenia. This is sometimes considered a precursor to more severe osteoporosis, but not everyone with osteopenia will develop osteoporosis.

If you have osteopenia, it is crucial to be aware of other signs of osteoporosis and keep on top of any recommended lifestyle changes or medications to prevent further bone loss.

Osteopenia vs. Osteoporosis

Bone density loss exists on a spectrum and is measured by a bone density score called a T-score. The lower the T-score, the greater the bone loss. Osteoporosis involves more significant bone density loss than osteopenia.

The diagnostic criteria for bone density scanning include the following:2

  • Osteopenia: T-score between -1 and -2.5

  • Osteoporosis: T-score ≤ -2.5

Bone Fractures (Especially From Mild Trauma)

Breaking a bone is one of the most prominent warning signs that you may have osteoporosis. About 50% of women and 25% of men will break a bone due to osteoporosis during their lifetime.3

The most common locations of osteoporosis bone fractures are the hip, spine, and wrist, but fractures can occur in any bone.4

Additionally, bone fractures from mild trauma—such as activities of daily living, including a small bump, coughing, or bending to pick something up—can signify osteoporosis.

Losing Height

One of the first complaints someone with undiagnosed osteoporosis might have is that they are losing height. It is common to get a little shorter as you age, but losing more than 1.5 inches in height could be a warning sign of osteoporosis.5

People with osteoporosis lose height due to the fragility of their spinal vertebrae (back bones) and compression fractures (in which the vertebrae press and collapse against each other)

Curved Upper Back

A hunched upper back, also sometimes called a dowager's hump or dorsal kyphosis may be another warning sign of osteoporosis.4 Compression fractures may cause the upper back vertebrae to collapse, resulting in this stooped posture.

Though dorsal kyphosis is common among people with osteoporosis, it can also be a sign of other medical conditions.5

Sudden Back Pain

Sudden, severe back pain is a symptom of compression fractures.6 You will most likely experience back pain in the mid or lower back where compression fractures most commonly occur.7 Talk to your healthcare provider about your back pain, especially if there is an unknown or mild cause and you have risk factors for osteoporosis.

Breaking a Bone During Pregnancy

It's normal to lose some bone density during pregnancy and lactation. However, an actual bone fracture is uncommon and could signify a rare type of osteoporosis called pregnancy and lactation-associated osteoporosis (PLO).4

Most people with PLO don't know they have osteoporosis before they get pregnant. The most common site of PLO is a spinal compression fracture, which may feel like bad back pain.4

Gastrointestinal Issues

Having gastrointestinal issues could be a warning sign of osteoporosis.5 These symptoms include:

  • Reduced appetite

  • Feeling full quickly

  • Constipation

  • Bloating

  • Abdominal (belly) pain

This is because lumbar (lower back) fractures, which can result from osteoporosis, reduce the space in the abdomen by bringing the ribs close to the pelvis. This smaller, cramped space can lead to the previously mentioned symptoms.

Dental Issues

Problems with your teeth could be a sign of osteoporosis. Like other bones in the body, the jawbone can lose bone density, resulting in dental issues such as:8

  • Receding gums

  • Loose teeth

  • Loose-fitting dentures

Talk to your healthcare provider about a bone density scan if you have new dental issues and osteoporosis risk factors.

Certain Medications

Some medications are known to cause bone loss. If you're taking these, particularly in higher doses or for prolonged periods, you may want to speak to your healthcare provider about your risks for osteoporosis.

Some of the medications that cause bone density loss include:4

  • Aluminum-containing antacids

  • Some anti-seizure medicines

  • Aromatase inhibitors

  • Chemotherapy drugs

  • Cyclosporin A and FK506

  • Gonadotropin-releasing hormone (GnRH)

  • Heparin

  • Lithium

  • Medroxyprogesterone acetate

  • Methotrexate

  • Proton pump inhibitors (PPIs)

  • Selective serotonin reuptake inhibitors (SSRIs)

  • Steroids (glucocorticoids)

  • Thiazolidinediones

  • Thyroid hormones in excess

Osteoporosis Staging

Your body slowly loses bone density, often over many years. There are different stages of osteoporosis as you progress from average bone density to osteoporosis.9

  • Stage 1: Around age 30, it's normal for your body to stop adding bone density. Your T-score is in the normal range, between +1 to -1.

  • Stage 2: As you naturally lose bone density with age, you might be diagnosed with osteopenia. Your T-score will dip into the range of -1 to -2.5.

  • Stage 3: If you continue to lose bone density, you will enter the diagnosable range of osteoporosis. During this stage, you will often have no apparent symptoms, but you may exhibit some of the warning signs of osteoporosis. Your T-score at this stage is -2.5 or lower.

  • Stage 4: If your osteoporosis progresses, especially if you remain undiagnosed or untreated, you may develop severe osteoporosis. You are at high risk of bone fractures from mild or low-impact activities, which often cause chronic pain and limited movement. Your T-score is significantly lower than -2.5, and you've probably had multiple fractures.

Can You Reverse Osteoporosis?

Osteoporosis is a progressive condition that gets more dangerous as it increases in severity. Unfortunately, you cannot reverse bone loss from osteoporosis. However, there are steps you can take to prevent further bone loss. Knowing the early warning signs of osteoporosis can help you get an earlier diagnosis and prompt treatment.

How to Confirm Suspected Osteoporosis

To be officially diagnosed with osteoporosis, you will undergo a bone density screening via a dual-energy X-ray absorptiometry (DEXA) scan. Based on the T-score results of this scan, you may be diagnosed with osteoporosis.

What Happens After Diagnosis 

After you are diagnosed with osteoporosis, your healthcare provider will provide treatment recommendations. These treatments can't reverse existing bone loss, but they are beneficial for preventing future bone loss.

Treatments for osteoporosis include a combination of medications, vitamins, and supplements and lifestyle modifications, such as osteoporosis-friendly exercise, diet changes, and more.

Summary

Osteoporosis is a "silent" disease that progresses over many years. You may not know you have it until it is already severe, often after you fracture a bone. That is why it is essential to understand the subtle early warning signs of osteoporosis.

Early warning signs of osteoporosis include low bone density, bone fractures, lost height, a curved upper back, sudden back pain, gastrointestinal issues, dental problems, and a fracture while pregnant. If you experience these warning signs, speak with your healthcare provider about a bone density test.

 Sources

Bone Health and Osteoporosis Foundation. Are you at risk?

Berger A. Bone mineral density scans. BMJ. 2002;325(7362):484. doi:10.1136/bmj.325.7362.484

Bone Health and Osteoporosis Foundation. Osteoporosis fast facts.

Bone Health and Osteoporosis Foundation. What is osteoporosis and what causes it?

Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46-56. doi:10.5152/eurjrheum.2016.048

Cedars Sinai. Compression fracture.

American Association of Neurological Surgeons. Vertebral compression fractures.

Kumar DP, Jayachandran S, Thilagavathy N. Diagnostic validity of orthopantomogram compared to dual energy x-ray absorptiometry scan in detecting osteoporosis. Ann Natl Acad Med Sci. 2021;57(2):100-107. doi:10.1055/s-0041-1724462

National Institutes of Health. Bone mass measurement: what the numbers mean.


By Sarah Bence, OTR/L
Bence is an occupational therapist with a range of work experience in mental healthcare settings. She is living with celiac disease and endometriosis.