By Cory Martin 

 Medically reviewed by Marissa Sansone, MD

Osteoporosis is a bone disease that causes decreased bone mass and deterioration of bone tissue, which increases the risk of fractures. It is considered a silent disease, meaning there are no other symptoms until a fracture occurs. The increased risk of fractures with osteoporosis can make you more susceptible to chronic pain and disability.1

This article discusses the types of fractures that are most common with osteoporosis and how to prevent them.

What Causes Osteoporosis?

Osteoporosis has several different risk factors, based on the following two categories:

• Primary osteoporosis occurs in those who are postmenopausal and deficient in estrogen.

• Secondary osteoporosis can be caused by age, certain diseases such as rheumatoid arthritis, long-term use of medications like steroids, and lifestyle factors such as smoking.

If you have any of these risk factors, it’s important to talk to your healthcare provider about your risk for osteoporosis.

Osteoporosis Demographics

Osteoporosis is most common in White people, women, and older adults.1 However, it is not necessarily just a women’s disease. It can and does affect both sexes and all races.

Vertebral Fractures

Vertebral fractures, also known as spinal compression fractures, occur when bones in the spine weaken and collapse. They are the most common type of fracture that occurs with osteoporosis. In the United States, approximately 700,000 people experience vertebral fractures each year.2

These types of fractures usually occur without much incident and are often found incidentally during an X-ray or exam. Many people often mistake a vertebral fracture for back pain from other causes, but ultimately discover the real cause is osteoporosis.

Vertebral fractures can cause a variety of symptoms including, but not limited to:2

• Back pain

• Loss of height

• Kyphosis (rounding of the spine)

• Pneumonia (an infection of the lungs)

• Pressure sores (bed sores)

Fractures in the spine cause an increased risk of other fractures. Having one spinal fracture increases the risk of another spinal fracture by five times, and fractures at other sites of the body by two to three times.2

Treatment for vertebral fractures includes pain management with nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, naproxen sodium, or aspirin), neuropathic pain drugs like gabapentin, and sometimes opioids.

Other treatments include calcitonin to help with bone loss, and other medications to aid in the prevention of more fractures.

Fragility Fractures

Fragility fractures are both a sign and a symptom of osteoporosis and can occur with little or no reason. A fall from a standing height that normally wouldn’t cause a fracture does, or there may be no sign of injury and yet a fracture still occurs.3

Hip Fractures

A hip fracture is the most serious type of osteoporosis fracture.

Quality of life decreases after a hip fracture. Half of all people who experience a hip fracture will not be able to function as they used to and will likely require mobility aids to get around. Many of them will need living assistance or move to a nursing home.4

Hip fractures are also associated with other complications such as pulmonary embolism (clots in blood vessels throughout the body), blood clots in the legs, and cognitive decline, especially after surgery.5

While surgery to correct the broken bone or replace it is the most common treatment for hip fractures, there are some less-invasive options that can work for certain fractures of the hip that occur with osteoporosis.

Postsurgical care is important in the road to recovery, as is preventing future fractures.6

Arm Fractures

Arm fractures most commonly occur in the wrist and shoulders, mainly due to falls. A wrist fracture can be one of the first indications that osteoporosis has set in. Taking steps to prevent additional fractures after an initial broken bone in the arm is essential.

Treatment for an arm fracture depends on the location of the break. Sometimes no action is required, and other times surgery is required.

For immediate treatment of most arm fractures, a removable splint or full cast may be necessary to immobilize the bone and allow it time to heal. However, due to osteoporosis, the bone is not guaranteed to heal properly.

Some people will end up with deformities of the wrist or arm that can make it difficult to flex or extend the hand. These restrictions in movement are mostly tolerable and don’t affect quality of life too much.  

In some cases, surgery may be required to fix the bone or reinforce it with screws and plates.7

How to Prevent Osteoporosis Fractures

The most important step for prevention of fractures is to strengthen and protect your bones. This can be accomplished through medications and lifestyle changes, such as quitting smoking and beginning a strength-training program.

It is also important to follow your healthcare provider’s treatment plan and have regular bone density screenings. A bone mineral density (BMD) test can help your healthcare provider manage your treatment plan and determine if the medications are working.

The BMD can also help in predicting future fracture risk and assess your bone health.8

What Is the Fracture Risk Assessment Tool?

FRAX, or the fracture risk assessment tool, is an algorithm that uses bone mineral density along with significant predictive factors of fracture risk, such as age and family history, to predict the 10-year probability of future fractures.1

Treatment for osteoporosis includes lifestyle changes such as:

• Eating a healthy diet high in vitamin D and calcium

• Quitting smoking

• Exercising to improve strength and balance

Pharmaceutical treatments include but aren’t limited to:

• Vitamin D and calcium supplements

• NSAIDs like Advil or Motrin (ibuprofen) and Aleve (naproxen sodium)

• Biphosphonates, such as Fosamax (alendronate)

• Selective estrogen receptor modulators (SERMs), such as Evista (raloxifene)

• Parathyroid hormones

• Calcitonin

Due to the heightened risk of subsequent fractures after the first fracture, it is essential to prevent falls to help avoid more fractures. An occupational therapist can help you identify ways in which you can modify your life to prevent falls.

Some ways to prevent falls in your home include:

• Keeping walkways and staircases well lit

• Securing carpets or rugs that could easily move when walked on

• Rearranging furniture to remove tripping hazards8

Summary

Osteoporosis is a bone disease characterized by low bone mass and bone deterioration. This can lead to an increased risk of fractures. The most common types of fractures include vertebral (spine), hip, and arm fractures. The best way to prevent fractures is to take measures to avoid falls.

 Sources

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

McCarthy J, Davis A. Diagnosis and management of vertebral compression fractures. AFP. 2016;94(1):44-50.

van Oostwaard M. Osteoporosis and the nature of fragility fracture: an overview. In: Hertz K, Santy-Tomlinson J, eds. Fragility Fracture Nursing. Springer International Publishing; 2018:1-13. doi:10.1007/978-3-319-76681-2_1

de Joode SGCJ, Kalmet PHS, Fiddelers AAA, Poeze M, Blokhuis TJ. Long-term functional outcome after a low-energy hip fracture in elderly patients. J Orthop Traumatol. 2019;20(1):20. doi:10.1186/s10195-019-0529-z

Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: A review. World J Orthop. 2014;5(4):402-411. doi:10.5312/wjo.v5.i4.402

Wendt K, Heim D, Josten C, et al. Recommendations on hip fractures. Eur J Trauma Emerg Surg. 2016;42(4):425-431. doi:10.1007/s00068-016-0684-3

Ostergaard PJ, Hall MJ, Rozental TD. Considerations in the treatment of osteoporotic distal radius fractures in elderly patients. Curr Rev Musculoskelet Med. 2019;12(1):50-56. doi:10.1007/s12178-019-09531-z

NIH Osteoporosis and Related Bone Diseases National Resource Center. Once is enough: a guide to preventing future fractures.

Hong AR, Kim SW. Effects of resistance exercise on bone health. Endocrinol Metab. 2018;33(4):435-444. doi:10.3803/EnM.2018.33.4.435

Catalano A, Martino G, Morabito N, et al. Pain in osteoporosis: from pathophysiology to therapeutic approach. Drugs Aging. 2017;34(10):755-765. doi:10.1007/s40266-017-0492-4

By Cory Martin
Martin is the author of seven books and a patient advocate who has written about her experiences with lupus and multiple sclerosis.