By Heather Jones 

 Medically reviewed by Anita C. Chandrasekaran, MD

Bone density loss is a normal part of aging, but osteoporosis is not. Osteoporosis can occur when bone tissue breaks down faster than expected, resulting in porous and brittle bones that are vulnerable to fracture.

Bone tissue is renewed through a cycle in which bone cells break down and are replaced. This process becomes less efficient with age, particularly for people who have been through menopause. When the bone tissue breaks down faster than it can regenerate, bone density loss occurs.1

The risk of receiving a diagnosis of osteoporosis doubles every five years between the ages of 40 and 60.1

This article will discuss the symptoms and effects of osteoporosis and how they change over time.

wutwhanfoto / Getty Images

Low Bone Density

Low bone density occurs when bone tissue breaks down more quickly than it can be replaced. With osteoporosis, this bone tissue loss happens more rapidly than it normally does with aging alone. When bones have low density, they are thinner and weakened, increasing the risk of fractures.1

Low bone density often has no symptoms for many years, and people with osteoporosis may not realize there is a problem until a fracture occurs.

Osteoporosis Risk Factors

Osteoporosis can occur at any age and in people of any sex, but it tends to be more common in women (particularly those who have gone through menopause) and older adults.1 (When health authorities and research are cited, the terms for sex and gender from those sources are used.)

In addition to age and sex, other factors increase the risk of osteoporosis, including:21

• Nutritional deficiencies or a diet low in calcium, vitamin D, and other nutrients that affect bone health

• Low body weight or a loss of more than 10% body weight documented at age 25

• A lack of regular physical activity, especially a lack of weight-bearing exercise

• Smoking

• Consuming more alcohol than two to three drinks per day

• Consuming more than four cups a day of caffeinated beverages

• Having had a fragility fracture (a fracture that would be unlikely to occur from the same event in people who do not have low bone density) after age 40

• Having a parent who had a hip fracture

• Hormonal deficits, such as those caused by menopause or lowered hormone secretion in the ovaries or testes

• Long-term use of certain medications, such as glucocorticoids

• Some medical conditions, such as hyperthyroidism, hyperparathyroidism, chronic inflammatory conditions, rheumatoid arthritis, chronic liver or kidney disease, and conditions that involve malabsorption (like celiac disease)

Early Signs and Symptoms of Osteoporosis

It's common for people with osteoporosis to notice no signs of their condition early on, but there can be symptoms present.

Low Bone Density 

Low bone density is common in older adults, affecting more than half of the people in the United States who are older than 50.3 Whether a person has osteoporosis depends on the degree of low bone density.

Bone density is measured using a bone density scan. The results produce a T-score classification, which denotes the number of standard deviations from peak bone density:2

• Normal: Minus 1 and above

• Osteopenia: Minus 1.1 to minus 2.4

• Osteoporosis: Minus 2.5 and below

• Severe or established osteoporosis: Minus 2.5 or below and at least one prevalent low-trauma fracture

Fractures and Broken Bones

A fractured bone is often the first noticeable indication of osteoporosis. About 40% to 50% of females and 13% to 22% of males experience one or more osteoporotic fractures in their lifetime.4

About 2 million osteoporotic fractures occur in the United States each year.3

The most common places for osteoporosis-related fractures to occur are:13

• Forearm

• Hip

• Spine

• Humerus (the bone that runs from shoulder to elbow)

• Pelvis

These fractures can have serious effects on a person's health. Hip fractures, most common in those aged 80 and older, often cause a loss of mobility in older adults. Up to 36% of older adults who experience a hip fracture die within a year.51

Back Pain

Back pain in people with osteoporosis can be the result of a loss of bone mass or an indication of a compression fracture in the vertebrae of the spine.

Back pain related to vertebral compression fracture may:3

• Have an acute (sudden) onset

• Be low-grade or more severe

• Increase with postural changes

• Decrease with lying on your back

• Feel tender when the affected area is touched

• Cause a decrease in spinal mobility

Receding Gums

The jaw is less dense than other bones in the body, so bone loss can occur there first. A loss of bone mass in the jaw can cause gums to recede.6 A decrease in jaw bone density can also cause problems with teeth, gum disease, difficulty speaking, and/or trouble chewing food.

Weaker Grip

A decrease in grip strength can be a sign of muscle weakening and osteoporosis developing.7 If this is occurring, it's important to be mindful of falls, as this can make you more prone to having a fall and potentially experiencing a fracture.

Brittle Fingernails

There appears to be a correlation between fingernail health and bone health, but fingernails alone are not enough to determine the presence of osteoporosis.8 Brittle nails may be a sign of hormonal changes and nutritional deficiency, both of which are risk factors for osteoporosis.

Why Is Osteoporosis Called the “Silent Thief”?

Osteoporosis is sometimes called "the silent thief" because bone loss can occur for many years before symptoms begin to show. Often the first sign of osteoporosis is a broken bone after significant bone loss has occurred.15

Long-Term Osteoporosis Complications

Osteoporosis can have serious long-term effects, primarily due to fractures.

Loss of Height

Loss of height can indicate a fracture in the spine or the collapse of vertebrae. Spinal bone fractures are often painless, so a loss of height may be the only indication it has occurred.5910

People over age 50 should have their height measured annually by their healthcare provider. A loss of 0.75 inches or more is a cause to explore the possibility of a fracture.

Stooped Posture

Collapsed/fractured vertebrae can cause a stooped, or hunched, posture. This can lead to kyphosis, a curvature of the spine which produces a hump-like appearance.5

These changes in posture can cause problems in other areas of the body, such as shortness of breath.11

Back and Neck Pain

The spine is made up of 33 bony segments. Fracture and/or collapse of any of these bones may lead to back or neck pain, depending on where it occurs.5

Diagnosing and Treating Osteoporosis

The earlier treatment for osteoporosis starts, the more effective it is. Getting a proper diagnosis and establishing a treatment plan are key.

Diagnosis

Before a diagnosis of osteoporosis is made, a healthcare provider often assesses a person's risk for low bone density and fractures. As part of this assessment, the healthcare provider might use a fracture-risk algorithm (FRAX) developed by the World Health Organization (WHO). This tool gives an estimated 10-year absolute hip/fragility fracture score.3

Bone density needs to be measured, and a T-score assigned to confirm a diagnosis of osteoporosis. Dual-energy x-ray absorptiometry (DEXA), a low-dose X-ray, measures bone mineral density in the spine, hip, and/or wrist. This test can also detect bone loss before it develops into osteoporosis and can predict the likelihood of future fractures.12513

Noting early signs or risks of osteoporosis lets you and your healthcare provider make decisions about prevention and treatment before the condition becomes severe.

Treatment

The best "treatment" for osteoporosis is prevention. Adopting regular bone-health-promoting practices early on helps achieve as high a peak bone mass as possible and helps slow bone loss once bone density levels have peaked.

Treatment and prevention of osteoporosis involve a combination of lifestyle choices and medical treatment.

Nutrition

Getting enough calcium and vitamin D is crucial for bone health. Getting enough of these important nutrients through diet alone can be difficult, so your healthcare provider may recommend taking supplements.1

Other nutrients that help promote bone health include:

• Dietary proteins

• Magnesium

• Vitamin K

Talk to your healthcare provider about whether you need to take supplements or if you are getting enough of these nutrients on your own.

Exercise

Physical activity is important for strengthening muscles, improving bone strength, and maintaining overall health. Weight-bearing exercises (activities that make your body work against gravity) stimulate bone growth activity, making bones stronger and denser.1

Examples of weight-bearing exercise include:

• Walking, jogging, or hiking

• Dancing

• Tennis

• Resistance training, such as lifting weights

• Yoga

• Tai-chi

Yoga and tai-chi are also great balance exercises that help reduce the risk of falls. An exercise program that includes both weight-bearing and balance exercises is ideal. Some yoga poses (such as those that twist or flex the spine) are not appropriate for people with osteoporosis, so be sure to check which are safe and which to avoid.

Always check with your healthcare provider before starting a new activity or exercise regime.

Avoid Smoking and Limit Alcohol Intake

Smoking and excess alcohol are both linked to an increased risk of osteoporosis. Alcohol can also create a fall risk.1 Don't smoke, and avoid or limit alcohol to no more than two or three units per day.

Medication

Several medications are available for treating osteoporosis, including:5

• Menopausal hormone therapy: Estrogen or an estrogen-progesterone combo, primarily given to people who have been through menopause in the past 10 years

• Bisphosphonates: Including Fosamax (alendronate), Boniva (ibandronate), Actonel (risedronate), and Reclast (zoledronic acid)

• Selective estrogen receptor modifiers (SERMs): Including Evista (raloxifene)

• Miacalcin (calcitonin)

• Forteo (parathyroid hormone)

• Monoclonal antibodies: Prolia (denosumab) and Evenity (romosozumab-aqqg)

These medications work in varying ways to slow down bone loss.

Surgery

Surgeries such as the following are available to help mitigate the effects of collapsed vertebrae:5

• Kyphoplasty: Using a needle, a balloon is inserted into the collapsed vertebra and then expanded to restore the height of the vertebra. Bone cement is then injected to hold the vertebra in place.

• Vertebroplasty: Cement is injected into the vertebra to help reinforce it. It is similar to kyphoplasty but without the use of a balloon.

Preventing Falls

Falls put you at risk for fracture, so taking steps to lessen your chances of falling is imperative. These include:11

• Keeping your home well-lit

• Keeping floors clutter-free

• Removing rugs or using non-skid rugs

• Wearing shoes with non-slip bottoms

• Installing railings on stairs and grab bars in the bathroom and shower

• Wearing up-to-date eyeglass prescriptions

• Using assistive devices (such as a stair lift) if necessary

An occupational therapist can help you recognize and address the fall hazards in your home.

When to Seek Care

Even if you don't have symptoms, if you have risk factors for osteoporosis, such as being postmenopausal, it's a good idea to talk to your healthcare provider about bone mineral density testing and ways to slow bone loss.

Summary

Bone loss is normal with age, but when it happens too fast, it can lead to osteoporosis. Osteoporosis often has no early symptoms, but can lead to complications over time such as fractures, changes in posture, pain, and loss of height.

Osteoporosis treatment involves lifestyle practices such as getting enough calcium, vitamin D, and exercise. Medication may also be prescribed if needed. It's never too early to take steps to strengthen your bones.

Sources

Government of Canada. Osteoporosis and related fractures in Canada: report from the Canadian Chronic Disease Surveillance System 2020.

Government of British Columbia. Osteoporosis: diagnosis, treatment and fracture prevention.

Varacallo MA, Fox EJ. Osteoporosis and its complications. Medical Clinics of North America. 2014;98(4):817-831. doi:10.1016/j.mcna.2014.03.007

Liu R, Chao A, Wang K, Wu J. Incidence and risk factors of medical complications and direct medical costs after osteoporotic fracture among patients in China. Arch Osteoporos. 2018;13(1):12. doi:10.1007/s11657-018-0429-5

Mount Sinai. Osteoporosis.

Preda SA, Comanescu MC, Albulescu DM, et al. Correlations between periodontal indices and osteoporosis. Exp Ther Med. 2022;23(4):254. doi:10.3892/etm.2022.11179

Luo Y, Jiang K, He M. Association between grip strength and bone mineral density in general US population of NHANES 2013-2014. Arch Osteoporos. 2020;15(1):47. doi:10.1007/s11657-020-00719-2

Saeedi P, Shavandi A, Meredith-Jones K. Nail properties and bone health: a review. J Funct Biomater. 2018;9(2):31. doi:10.3390/jfb9020031

Osteoporosis Canada. Risk factors.

Osteoporosis Canada. Signs and symptoms.

National Council on Aging. What is osteoporosis and how does It impact older adults?

Endocrine Society. Osteoporosis.

By Heather Jones
Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism.