By Jonathan Cluett, MD 

 Medically reviewed by Amy Kwan, PT

Osteoporosis is a medical condition that leads to weakening of the bone structure in your body. Also called "brittle bone disease," osteoporosis makes bone more fragile and increases your chance of sustaining a broken bone. Bone has a lattice-shaped structure, much like a honeycomb. When osteoporosis is a problem, there is less supporting bone and larger gaps in the lattice, leading to a weaker structure. Because of this weakening, bones can be broken with minimal trauma.1

Broken bones can be a serious problem; while some of these fractures can be managed with simple treatments, others may require surgery and prolonged rehabilitation. Because of these concerns, everyone should understand their chance of developing osteoporosis and what steps they can take to prevent the development or progression of osteoporosis.2

Four Important Things to Know About Osteoporosis

  • Osteoporosis is common; about 50 million Americans have it.3 Osteoporosis is most common in women, as there is accelerated loss of bone following menopause. The two most critical factors in determining who gets osteoporosis are how much bone mass an individual accumulates in their teens and twenties, and how quickly they lose it thereafter.

  • Half of women over age 50 will sustain a broken bone resulting from osteoporosis.4 The major complication of osteoporosis is a fractured bone. Many fractures resulting from osteoporosis can have major health implications. Spine and hip fractures are notorious for leading to significant declines in function and overall health.

  • After the age of 30, you lose bone rather than gain it. That said, there are steps that you can take to slow the rate of bone loss. This is why bone health in young people, particularly young women, is so critical. If they don't build bone in their teenage years, they will have a much higher chance of developing osteoporosis later in life.1

  • There are ways to control osteoporosis. While some aspects that determine bone density are out of your control (race, gender, etc.), there are others that you can influence (diet, exercise, etc.) Studies show that factors you can't control account for 75 percent of the condition, but the other 25 percent is up to you.5

Osteoporosis Symptoms

Osteoporosis is a silent disease, meaning it can occur with few or no symptoms. Unless a complication such as a fracture occurs, there is little warning that osteoporosis exists.6 There are signs that you can look out for to help determine the likelihood that you might develop osteoporosis, however. These signs are known as risk factors for the development of osteoporosis.

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Causes

Risk factor for osteoporosis include:

  • Female gender

  • Caucasian race

  • Advanced age

  • Slender build or fair skin

  • Poor nutrition

  • Tobacco use

  • Some specific medications (e.g. steroids)

  • Some medical conditions (e.g. thyroid abnormalities)7

Diagnosis

If osteoporosis is suspected, or if an individual is determined to have a high risk for the development of bone thinning, a test called a bone density test can be performed to assess the bone density. Typical X-rays are not a very good test for determining bone density. While you may hear a healthcare provider stating the bone looks thin on an X-ray, the bone density test is a much more accurate test to assess bone health.8

Bone density tests use radiation exposure to assess bone. But rather than generating a picture of the bone, they actually measure how much of the X-ray beam is absorbed by the bone. By doing so, they can determine the density of the bone and compare this to expected bone density levels. Bone density tests are painless and non-invasive. They can be used to help guide treatments and help predict the likelihood of fracture.8

Treatment

One of the challenges of bone loss is that the condition can't easily be reversed, but it can be slowed down. Treatments are focused on efforts to maintain bone density and prevent continued loss of bone. There are some instances where bone density can actually increase, but again, the emphasis is usually placed on efforts to prevent further bone loss.9

A number of lifestyle modifications are effective. These are steps everyone can take to improve their bone health:

  • Participating in regular exercise, preferably weight-bearing activity where you are up on your feet

  • Quitting smoking

  • Eating a healthy diet

  • Ensuring you have an adequate intake of essential nutrients, including calcium and Vitamin D, or taking supplements if you don't consume an adequate amount of these nutrients9

Medications can be effective treatments for osteoporosis, and there are a number of options for different situations. The options include:

  • Estrogen-replacement therapy

  • Bisphosphonates

  • Calcitonin

  • Estrogen receptor modulators

The ideal medication may be different for different individuals. While these medications can be effective at increasing bone density, they also have possible side effects. Because of these potential side effects, the downside of the drug must be carefully weighed against the need to increase bone density to determine the safest treatment plan. An open discussion with your healthcare provider can help you understand the pros and cons for your specific situation.2

Preventing Complications

Broken bones are the often the end result of osteoporosis. The goal of treatment is to prevent sustaining a broken bone, especially a broken hip. Some of the more common fractures that occur as a result of osteoporosis include:

  • Wrist fractures

  • Spine compression fractures

  • Shoulder fractures

  • Pelvis fractures

  • Hip fractures

  • Tibial plateau fractures

  • Ankle fractures

Any broken bone can be the result of osteoporosis. While broken bones are typically the result of major trauma to the body, such as automobile collisions or falls off a ladder, in people with osteoporosis, these fractures can occur with much less energy.

Depending on the severity of osteoporosis, people can sustain broken bones by falling from a standing position—or even with no known trauma at all.10

The major problem with osteoporosis is that it increases your chance of sustaining a fracture. Fortunately, there are steps you can take to prevent the progression of osteoporosis and your risk of sustaining a fractured bone.

Most osteoporosis-related fractures occur as the result of injuries and falls around the house. In addition to taking the above steps to improve bone health, you can also take precautions to prevent the likelihood of sustaining an injury that leads to a fracture

Setting up your house to minimize your chances of a fall, having your vision checked, and ensuring medications are administered correctly can all be helpful.1

Sources

Compston JE, Mcclung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364-376. doi:10.1016/S0140-6736(18)32112-3

Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785-95. doi:10.1001/jama.285.6.785

National Osteoporosis Foundation. What is Osteoporosis and What Causes It?

National Osteoporosis Foundation. What Women Need to Know.

National Institutes of Health. Osteoporosis: Peak Bone Mass in Women.

Varner JM. Osteoporosis: a silent disease. Ala Nurse. 2012;39(3):10-1.

Cauley JA. Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res. 2011;469(7):1891-9. doi:10.1007/s11999-011-1863-5

Lewiecki EM. Clinical applications of bone density testing for osteoporosis. Minerva Med. 2005;96(5):317-30.

Demontiero O, Vidal C, Duque G. Aging and bone loss: new insights for the clinician. Ther Adv Musculoskelet Dis. 2012;4(2):61-76. doi:10.1177/1759720X11430858

Warriner AH, Patkar NM, Curtis JR, et al. Which fractures are most attributable to osteoporosis?. J Clin Epidemiol. 2011;64(1):46-53. doi:10.1016/j.jclinepi.2010.07.007

Additional Reading

  • American Academy of Orthopedic Surgeons. OthoInfo: Osteoporosis. http://www.orthoinfo.org/topic.cfm?topic=A00232

  • National Osteoporosis Foundation. What is Osteoporosis and What Causes It? https://www.nof.org/patients/what-is-osteoporosis/


By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.