Osteoporosis

Definition

Osteoporosis is a disease in which bones become fragile and more likely to break (fracture).

Alternative Names

Thin bones; Low bone density; Metabolic bone disease; Hip fracture - osteoporosis; Compression fracture - osteoporosis; Wrist fracture - osteoporosis

Causes

Osteoporosis is the most common type of bone disease.

Osteoporosis increases the risk for breaking a bone. About one half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebrae (bones of the spine) during their lifetime. Spine fractures are the most common.

Your body needs the minerals calcium and phosphate to make and keep healthy bones.

Sometimes, bone loss occurs without any known cause. Other times, bone loss and thin bones run in families. In general, white, older women are the most likely to have bone loss.

Brittle, fragile bones can be caused by anything that makes your body reabsorb too much bone, or keeps your body from making enough new bone. As you age, your body may reabsorb calcium and phosphate from your bones instead of keeping these minerals in your bones. This makes your bones weaker.

A major risk is not consuming enough calcium to build new bone tissue. It is important to eat/drink enough high-calcium foods. You also need vitamin D, because it helps your body absorb calcium. Your bones may become brittle and more likely to fracture if:

Other causes of bone loss include:

Other risk factors include:

Symptoms

There are no symptoms in the early stages of osteoporosis. Many times, people will have a fracture before learning they have the disease.

Fractures of the bones of the spine can cause pain almost anywhere in the spine. These are called compression fractures. They often occur without an injury. The pain may occur suddenly or slowly over time.

There can be a loss of height (as much as 6 inches or 15 centimeters) over time. A stooped posture or a condition called a dowager's hump may develop.

Exams and Tests

A DEXA scan is a low-radiation x-ray that measures the density of the minerals in your bones. Most often, it measures density in the spine and hip bones. Your health care provider uses this test to:

The US Preventive Services Task Force recommends this screening test at least once for women age 65 and older, and for some women younger than age 65 who have an increased risk for osteoporosis. So far, research does not show a need for repeating screening after the test at age 65.

A simple spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of other bones are not very accurate in predicting whether you are likely to have osteoporosis. A low-radiation spine x-ray called a vertebral fracture assessment (VFA) can be done with a DEXA to better identify fractures that do not have any symptoms. Trabecular bone score (TBS) can also be performed to gauge bone quality and help evaluate fracture risk.

You may need blood and urine tests if your provider thinks the cause of your osteoporosis is a medical condition, rather than the slow bone loss that occurs with aging.

DEXA scan results compare your bone mineral density with both a young adult who has no bone loss and with people your age and sex. This means that at age 80, almost one third of women with normal age-related bone loss would have osteoporosis, based on their DEXA scan results.

Treatment

Treatment for osteoporosis may involve:

Medicines may be used to strengthen bones when:

Medicines used to treat osteoporosis include:

The length of time a woman should take these medicines depends on her level of risk. Recommendations include:

Exercise plays a key role in preserving bone density in older adults. Some of the exercises recommended to reduce your chance of a fracture include:

Avoid any exercise that presents a risk of falling. Also, do not do high-impact exercises that can cause fractures in older adults.

Follow these guidelines for getting enough calcium and vitamin D:

(Note: Some expert groups are not sure the benefits and safety of these amounts of vitamin D and calcium outweigh their risks. Be sure to discuss with your provider whether supplements are a good choice for you.)

Stop unhealthy habits:

It is important to prevent falls by older people. These suggestions can help:

Surgery to treat severe, disabling pain from spinal fractures due to osteoporosis includes:

Outlook (Prognosis)

Medicines to treat osteoporosis can help prevent future fractures. Spine bones that have already collapsed can't be made stronger.

Osteoporosis can cause a person to become disabled from weakened bones. Hip fractures are one of the main reasons people are admitted to nursing homes.

Prevention

Be sure you get enough calcium and vitamin D to build and maintain healthy bones. Following a healthy, well-balanced diet can help you get these and other important nutrients.

Other tips for prevention:

Medicines can treat osteoporosis and prevent fractures. Your provider can tell you if any are right for you.

References

Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364-376. PMID: 30696576 pubmed.ncbi.nlm.nih.gov/30696576/.

De Paula FJA, Black DM, Miller PD, Rosen CJ. Osteoporosis: basic and clinical aspects. In: Melmed S, Auchus, RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 29.

Kemmler W, Bebenek M, Kohl M, von Stengel S. Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int. 2015;26(10):2491-2499. PMID: 25963237 pubmed.ncbi.nlm.nih.gov/25963237/.

LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022; 33(10):2049-2102. PMID: 35478046 pubmed.ncbi.nlm.nih.gov/35478046/.

Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society guideline update. J Clin Endocrinol Metab. 2020;105(3):587-594. PMID: 32068863 pubmed.ncbi.nlm.nih.gov/32068863/.

US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(15):1592-1599. PMID: 29677309 pubmed.ncbi.nlm.nih.gov/29677309/.

US Preventive Services Task Force website. Osteoporosis to prevent fractures: screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening. Published June 26, 2018. Accessed November 12, 2024.


Review Date: 1/25/2023
Reviewed By: Neil J. Gonter, MD, Assistant Professor of Medicine, Columbia University, NY and private practice specializing in Rheumatology at Rheumatology Associates of North Jersey, Teaneck, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 01/25/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 11/15/2024.
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