Osteoporosis weakens bones so gradually that many people do not know they have it until a bone breaks from a minor fall, or even a cough or bend. It is common, especially in women after menopause, but it can be detected early with a simple scan and is both preventable and treatable.
What is osteoporosis?
Bone is living tissue that is constantly broken down and rebuilt. In osteoporosis, bone is lost faster than it is replaced. Bones become less dense and more porous, making them fragile. The most common fracture sites are the hip, spine and wrist.
Hip fractures are particularly serious in older adults and can lead to loss of independence. Spinal fractures can cause back pain, loss of height and a stooped posture.
Who is at risk?
Risk factors you cannot change
- Female sex: women have smaller, thinner bones and lose bone rapidly after menopause as estrogen falls.
- Older age
- Family history, especially a parent who had a hip fracture
- Small, thin body frame
- Ethnicity: White and Asian women are at highest risk, but osteoporosis affects all groups.
Risk factors you can influence
- Low calcium and vitamin D intake
- Physical inactivity
- Smoking
- Drinking more than two alcoholic drinks a day
- Low body weight or eating disorders
Medical conditions and medicines
- Long-term use of glucocorticoids (steroids) such as prednisone
- Some anti-seizure medicines, aromatase inhibitors for breast cancer and androgen-deprivation therapy for prostate cancer
- Rheumatoid arthritis, celiac disease, inflammatory bowel disease, an overactive thyroid or parathyroid, and early menopause
Symptoms
Osteoporosis is often called a “silent disease” because there are no symptoms until a fracture occurs. Possible signs include:
- A fracture from a fall from standing height or less
- Loss of height of more than about 1.5 inches
- A stooped or curved upper back
- Sudden back pain, which may signal a spinal fracture
How osteoporosis is diagnosed
The standard test is a bone mineral density (BMD) scan, also called a DXA scan. It is quick, painless and uses a very low dose of X-rays. Results are reported as a T-score, which compares your bone density with that of a healthy young adult.
| T-score | What it means |
|---|---|
| −1.0 and above | Normal bone density |
| Between −1.0 and −2.5 | Low bone mass (often called osteopenia) |
| −2.5 and below | Osteoporosis |
Osteoporosis can also be diagnosed in someone who has had a fragility fracture of the hip or spine, regardless of their T-score.
Clinicians often use the FRAX tool, which combines risk factors with bone density, to estimate a person’s 10-year chance of a major fracture and decide whether treatment is needed.
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Who should be screened?
The U.S. Preventive Services Task Force recommends bone density screening for:
- All women aged 65 and older
- Postmenopausal women younger than 65 who are at increased risk of fracture
Men with risk factors, such as long-term steroid use or a previous fragility fracture, should ask their clinician about testing.
Preventing bone loss
Get enough calcium
| Group | Daily calcium |
|---|---|
| Women 19–50, men 19–70 | 1,000 mg |
| Women 51+ and men 71+ | 1,200 mg |
Good sources include dairy products, fortified plant milks and juices, canned salmon or sardines with bones, tofu made with calcium, and leafy greens such as kale and bok choy. Food is the best source; supplements can fill gaps.
Get enough vitamin D
Adults need 600 IU a day up to age 70 and 800 IU a day after 70. Vitamin D helps the body absorb calcium.
Exercise regularly
- Weight-bearing exercise: walking, jogging, dancing and stair climbing
- Muscle-strengthening exercise: lifting weights, resistance bands and body-weight exercises
- Balance training: tai chi and yoga can reduce falls
People with osteoporosis should ask a physical therapist which movements are safe, as some forward-bending and twisting exercises may raise the risk of spinal fracture.
Other habits
- Do not smoke.
- Limit alcohol.
- Eat enough protein.
Preventing falls
Most fractures happen after a fall. Simple steps help:
- Remove loose rugs and clutter.
- Install grab bars and use night lights.
- Wear supportive, non-slip shoes.
- Have your vision checked regularly.
- Review medicines that may cause dizziness.
Treatment options
If you have osteoporosis or a high fracture risk, medicine can substantially reduce the chance of fractures.
- Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid): the most commonly used first-line medicines; taken as weekly or monthly tablets or a yearly infusion.
- Denosumab: an injection every six months. It should not be stopped without a plan from your clinician, because bone loss and fractures can increase rapidly after stopping.
- Bone-building medicines (teriparatide, abaloparatide, romosozumab): used for people at very high risk, often followed by another medicine to maintain gains.
- Hormone therapy: may be considered in some younger postmenopausal women, weighing benefits and risks.
The Bone Health & Osteoporosis Foundation and NIH have more information.
Frequently asked questions
Can osteoporosis be reversed?
Treatment can increase bone density and greatly reduce fracture risk, although bones may not return fully to their youthful density.
Do men get osteoporosis?
Yes. Up to one in four men over 50 will break a bone due to osteoporosis, and men are less likely to be diagnosed and treated.
Is osteopenia a disease?
Osteopenia means bone density is lower than normal but not low enough to be osteoporosis. Whether treatment is needed depends on your overall fracture risk.
The bottom line
Osteoporosis is silent until a bone breaks. If you are a woman aged 65 or older, or have risk factors, ask about a DXA scan. Calcium, vitamin D, exercise, fall prevention and, when needed, medicine can protect your bones.
This article is for general information and is not a substitute for advice from a qualified healthcare professional.