What Is Osteoporosis?

Osteoporosis is a condition that causes porous, weak bones that break easily. In some cases, osteoporosis does not cause any symptoms until you have a break or fracture. Other times, the condition causes severe pain that impacts your daily activities. 

Under a microscope, healthy bones look like a honeycomb. But with osteoporosis, your bones can't hold onto enough calcium and minerals, causing the natural holes in your bone structure to become noticeably large. Those spaces decrease bone strength and stability and raise your risk of breaks and fractures.

Osteoporosis mostly affects older women. During and around menopause, the body produces less and less of the hormone estrogen than usual. Some evidence suggests estrogen protects bone density. So, decreasing estrogen levels cause people to lose bone mass, which increases the risk of osteoporosis.

In the United States, nearly 10 million people have osteoporosis. Eighty percent of those cases affect women. About one in four women aged 65 and older have osteoporosis.

Types of Osteoporosis

There are three different types of osteoporosis, depending on the cause of your bone loss.

Primary Osteoporosis

Primary osteoporosis is the most prevalent type of bone loss that occurs naturally in aging. A lack of estrogen—in both women and men—often leads to bone loss. When your body makes less estrogen than usual, your bone cells break down more rapidly than they should. 

Secondary Osteoporosis

A health condition or medication causes secondary osteoporosis by reducing your bone density. Some of the health conditions that may cause secondary osteoporosis include:

• Eating disorders
• Hormone disorders
• Diabetes
• Gastrointestinal disorders, such as Celiac disease and inflammatory bowel disease (IBD)
• Autoimmune disorders like multiple sclerosis (MS) and rheumatoid arthritis (RA)
• Illnesses affecting the blood, such as multiple myeloma and human immunodeficiency virus (HIV)

Additionally, the prolonged use of some medications may cause secondary osteoporosis. Those medications include corticosteroids, thyroid hormone, gonadotropin-releasing hormone (GnRH) agonists and antagonists, selective serotonin reuptake inhibitors (SSRIs), and antiretroviral therapy.

Idiopathic Osteoporosis

Although rare, idiopathic osteoporosis can affect premenopausal women, men under 50, adolescents, and children. Idiopathic osteoporosis means that the condition does not have a known cause.

Osteoporosis Symptoms

The Office on Women's Health defines osteoporosis as a "silent" disease. Some people may not notice any symptoms until they have a break or fracture. But as the condition progresses, you may notice symptoms, which include:

• Sudden back pain
• A feeling that you've gotten shorter
• Change in posture
• A hunched upper back
• Your bones break more easily than they used to or take longer to heal.

You could also start to have "fragility fractures," which come from a minor injury that usually wouldn't break a bone. Those fractures are most likely to happen in your upper arm, spine, wrist, and hip. Once you have an osteoporotic fracture, you're likely to have more.

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What Causes Osteoporosis?

Osteoporosis happens when you lose bone density, which causes weak bones that are prone to breaks or fractures. One of the most common causes of bone loss is decreased estrogen levels. Some evidence suggests that estrogen is key in keeping your bones strong. A decline in estrogen happens naturally during and around menopause, which occurs between ages 45 to 55. 

Other causes of low bone density include eating disorders, nutritional deficiencies, a lack of exercise, or other health conditions that weaken the bones. In girls, about 90% of bone mass develops before 18. So, any of those causes may significantly stunt bone mass development in young girls. 

Osteoporosis Risk Factors

Additionally, several risk factors increase your chance of developing osteoporosis. Those risk factors include:

• Family history
• Early menopause, which occurs before age 45
• Tobacco use
• Alcohol consumption
• Exposure to air pollution
• Stress
• History of falls or fractures
• Prolonged use of some medications, like corticosteroids 
• Certain health conditions, like rheumatoid arthritis (RA), heart disease, and diabetes

How Is Osteoporosis Diagnosed?

The U.S. Preventative Services Task Force recommends that women aged 65 and older and postmenopausal women younger than 65 receive a bone density test to screen for osteoporosis. A bone density test measures the amount of bone mineral you have throughout your skeleton. Low bone density makes your bones more likely to be weak and prone to breaks or fractures. 

Healthcare providers commonly use dual-energy x-ray absorptiometry (DXA) to measure bone density and diagnose osteoporosis. A DXA uses low-energy X-rays to scan the bones.

Sometimes, other tests are done to look for fractures. Those include traditional X-rays of your upper and lower spine and special CT scans, which can provide cross-sections of some of your vertebrae. However, unlike a DXA, those tests cannot diagnose osteoporosis. 

A healthcare provider may also order blood tests to check your vitamin D, calcium, and hormone levels.

Treatments for Osteoporosis

One of the most common treatments for osteoporosis is medications. A healthcare provider may recommend or prescribe one of the following medications to avoid worsening bone loss:

• Bisphosphonates: This medication slows the speed at which your body breaks down old bone cells.
• Calcitonin: This hormone helps your body use calcium efficiently. A healthcare provider may administer calcitonin via injection or as a nose spray.
• Estrogen therapy: Healthcare providers commonly prescribe estrogen therapy to some postmenopausal women. But some evidence suggests that estrogen therapy may raise your risk of other blood clots, breast cancer, and stroke. A healthcare provider may modify your dose or type of estrogen therapy to mitigate those adverse side effects.
• Selective estrogen receptor modulators (SERMs): Like estrogen therapy, SERMs treat bone loss among postmenopausal women.
• Denosumab: This drug helps slow bone loss and strengthens bones in postmenopausal women via injection. A healthcare provider may recommend denosumab if you have a high risk of osteoporosis. 
• Teriparatide: This is a synthetic form of parathyroid hormone, which builds new bone quicker than old bone breaks down. A healthcare provider administers teriparatide via injection.

In addition to medications, increasing your intake of calcium and vitamin D may help support your bones. Also, regular physical activity is essential to strengthening your musculoskeletal system. 

How To Prevent Osteoporosis

Taking steps to ensure strong, healthy bones during your 20s, 30s, and 40s can help stave off bone loss that causes osteoporosis later in life. Incorporating some of the following tactics into your life may help prevent osteoporosis:

• Weight-bearing exercises: Weight-bearing exercises are particularly good for your bones. Try brisk walking, hiking, jogging, stair-climbing, dancing, or tennis. Those exercises push you to work against gravity, which helps strengthen your bones.
• Resistance-training: Work out with an opposing force like weights, an elastic exercise band, or water. Try swimming, biking, or lifting weights. Those exercises help preserve bone and muscle mass.
• Cut out smoking: Tobacco use is a risk factor for osteoporosis. Some evidence suggests a relationship between smoking and low bone density. If you need help quitting smoking, consult a healthcare provider for suggestions.
• Increase your calcium intake: Calcium-rich foods include dairy products; dark, leafy greens like spinach and kale; soy; and fortified products like cereal and orange juice. If you're under 50, you need 1,000 milligrams of calcium daily. Women over 50 and men over 70 need 1,200 milligrams of calcium daily. Talk to a healthcare provider about supplements if you're not getting enough calcium from food.
• Don't forget vitamin D: Sources of vitamin D include fortified non-dairy milk and fatty fish like trout, salmon, tuna, and mackerel. People younger than 50 aim for 400 to 800 international units (IUs) of vitamin D daily. And people older than 50 should up their intake to 800 to 1,000 IUs of vitamin D daily. If a blood test shows a vitamin D deficiency, a healthcare provider may suggest you increase your intake. 
• Maintain a healthy weight. Being underweight is a risk factor for osteoporosis. Being overweight or obese increases your risk of fractures, as well. 
  

Comorbid Conditions

Some of the most common health conditions that occur alongside osteoporosis include:

• Inflammatory bowel disease (IBD): IBD includes Crohn's disease and ulcerative colitis, both of which cause inflammation in the digestive tract. Often, IBD causes diarrhea, abdominal pain, fever, and weight loss. Some people with IBD have trouble absorbing calcium and vitamin D, leading to nutritional deficiencies that increase the risk of osteoporosis. Additionally, glucocorticoids, medications that treat IBD, may accelerate bone loss.
• Rheumatoid arthritis (RA): RA is an autoimmune disorder that causes painful, swollen, and stiff joints. With RA, the body mistakenly targets and attacks healthy cells and tissues. Like with osteoporosis, people with RA have an increased risk of breaks and fractures. Glucocorticoids are also a treatment for RA, which contributes to bone loss.
• Eating disorders: One of the most common disorders impacting osteoporosis risk is anorexia nervosa. Anorexia nervosa is a fear of weight gain, which can lead to nutritional and hormonal imbalances. For example, underweight people may not produce enough estrogen, often exemplified by the absence of periods. And decreased estrogen levels are one of the leading causes of bone loss and osteoporosis.
• Breast cancer: In the United States, breast cancer is one of the leading cancers affecting women. Some treatments for breast cancer result in lost ovarian function and, as a result, decreased estrogen levels. Low estrogen levels increase the risk of osteoporosis.
• Type 1 diabetes: Type 1 diabetes is a metabolic disorder in which the body does not produce any or enough insulin, which causes high blood sugar. Like osteoporosis, type 1 diabetes may cause bone loss and weak bones. People with untreated type 1 diabetes have an increased risk of fractures.
• Celiac disease: People with Celiac disease cannot tolerate gluten, found in wheat, rye, barley, farina, and bulgur. Due to food restrictions, some people with Celiac disease are calcium deficient. If untreated, Celiac disease may cause osteoporosis. 

Living With Osteoporosis

It's not uncommon for people with osteoporosis to experience anxiety about breaking or fracturing a bone. If you experience a fragility fracture, you may avoid things you normally enjoy out of fear of hurting yourself. That anxiety can adversely affect your mental health, causing depression and low self-esteem.

Here are some things that may help living with osteoporosis feel less overwhelming:

• Try light physical activity: Exercise is good for your musculoskeletal and overall health. Light physical activity can help strengthen your bones and slow bone loss. But it's important that you take precautions to avoid falls or accidents.
• Say positive affirmations: Leaving uplifting notes for yourself around your house or workspace or repeating phrases ("I will take care of bones and make them strong") can help change your mindset. Also, reminding yourself that you're working to stay healthy can ease some anxiety.
• Stay social: Spending time with family and friends may help your condition feel less overwhelming. But, understandably, you may want to avoid crowded areas like malls and movie theaters. Instead, visit your favorite social spots during the least busy times.
• Manage your pain: As osteoporosis progresses, the condition may cause painful symptoms. If pain crops up, there are techniques you can use to alleviate discomfort. Try hot or cold compresses, acupuncture, or massage.

A Quick Review

Osteoporosis is a condition that causes porous, weak bones that break easily. One of the most common causes of bone loss that leads to osteoporosis is decreased estrogen levels. During and around menopause, the body makes less and less estrogen than usual. Therefore, osteoporosis mostly affects older women.

There are several medications available to treat osteoporosis. Also, a healthcare provider may recommend upping your calcium and vitamin D intake. Regular weight-bearing exercises and resistance training can also help strengthen your bones and preserve muscle mass.