Osteoporosis Risk Factors, Testing, Treatment & Prevention

This guide covers osteoporosis, including its risk factors, testing, treatment, and prevention.

Osteoporosis often causes no symptoms until a bone breaks ^2,4. Testing can find bone loss and help estimate future fracture risk ¹.

This guide covers screening, bone density tests, medicines, food, exercise, and fall safety. Use it to prepare for a talk with your healthcare professional.

Bones absorb old tissue and make new tissue throughout life ¹. Healthy bones need a balance between these two processes ¹.

Bone loss starts when old bone disappears faster than new bone forms ¹. This process lowers bone mass and can change bone structure ^2,4.

These changes make bones weaker and more likely to break ^1,4. Age can speed bone loss while slowing new bone growth ⁴.

Bone loss happens more quickly as people age ^2,4. Lower estrogen levels play a major role in this change ^2,4.

Early osteoporosis typically causes no symptoms ^1,2. A fracture may be the first clear sign of weak bones ^1,4.

Fragile bones may break after a fall from standing height ⁴. They may also break during bending, lifting, or coughing ^2,4.

Osteoporosis-related fractures can occur after minimal or no trauma ³. Such fractures can cause major personal and medical burdens ³.

Treatment can lower the risk of more fractures after the first break ³. This benefit makes proper testing and care important.

Osteoporosis can affect any bone. The hip, spine, and wrist are common fracture sites ^2,4.

Spinal bones are called vertebrae. Weak vertebrae may compress or collapse without a clear injury ¹.

Spinal fractures can cause pain anywhere along the spine ¹. That pain may start at once or develop over time ¹.

Compression fractures may cause height loss and a stooped posture ^1,4. A hunched spine is also called kyphosis ⁴.

Osteoporosis may remain unnoticed for years ^2,4. Changes in bone strength can leave bones brittle and more likely to fracture ¹.

Possible warning signs include the following changes:

A family member may notice changes in height or posture first ⁷. These changes are reasons to visit a provider for a bone density test ⁷.

A fracture does not always mean osteoporosis. However, a fracture without major injury may lead a provider to consider osteoporosis medicine ⁵.

Some risk factors cannot be changed. Other risks involve habits, health problems, or long-term medicines.

Risk rises with age as bone growth slows and bone loss speeds up ⁴. Women have smaller bones and lower peak bone mass than men ⁴.

Men can also develop osteoporosis, especially later in life ^2,4. The disease affects every racial and ethnic group ⁴.

Important personal risk factors include these well-known traits:

These patterns describe risk across groups. Anyone can develop osteoporosis ⁴.

Several daily habits can affect bone health. Some of these risks can be changed.

Common lifestyle and food risks include the following factors:

The body needs vitamin D to absorb calcium ¹. Poor absorption may limit both calcium and vitamin D ¹.

This problem can occur after gastric bypass surgery ¹. Certain digestive diseases can also increase osteoporosis risk ^1,4.

Low estrogen can occur after menopause ^2,4. It may also follow long gaps without menstrual periods ^1,4.

Hormone disorders or extreme exercise may cause abnormal menstrual changes ⁴. Low testosterone can also affect bone health in men ⁴.

Inflammatory diseases may raise osteoporosis risk ^1,4. Examples include rheumatoid arthritis and Crohn disease ^1,4.

Digestive diseases can affect bone health and nutrient absorption. Some endocrine and hormone disorders can also increase risk ⁴.

Anorexia nervosa is linked with osteoporosis risk ^1,4. Poor food intake may reduce calcium, vitamin D, protein, and total calories ^4,8.

Some long-term medicines can increase the chance of osteoporosis ⁴. The risk depends on the medicine and the person.

Medicines linked with bone loss include these treatments:

Do not stop prescribed medicine on your own. Discuss bone risks and other options with the prescriber.

Many factors are associated with an increased risk of osteoporosis-related fractures ³. Bone strength and fall risk both matter during a health review.

Important fall risks include these health and safety concerns:

Testing can find low bone density before a fracture occurs ⁷. Age, risk factors, and fracture history help guide screening decisions ^1,3.

The USPSTF recommends screening women age 65 and older ¹. It also recommends screening some younger women with increased risk ¹.

FDA guidance also supports screening women over age 65. It advises younger women with added risk to ask about testing.

A clinician guide calls for risk review in all postmenopausal women ³. The same guide calls for review in men age 50 and older ³.

That review helps determine the need for bone density testing ³. It may also show whether spine imaging is useful ³.

Risk review is also important after a low-injury fracture. Low weight, smoking, and long-term steroid use may influence risk ^1,4.

DXA means dual-energy X-ray absorptiometry. This bone density test uses low levels of radiation ^1,6.

During the painless test, the person lies on a padded table. A scanner passes over the body.

DXA commonly measures bone mineral density in the hip and spine ^1,6. The test does not require needles or injections ⁷.

DXA can diagnose bone loss and osteoporosis ¹. It can also help predict future fracture risk ¹.

Ultrasound can provide information about bone condition. However, ultrasound alone cannot confirm an osteoporosis diagnosis.

An ultrasound result suggesting bone loss must be followed by DXA.

DXA compares bone density with a young adult without bone loss ¹. It also compares results with people of the same age and sex ¹.

The young-adult comparison is reported as a T-score. A T-score from minus 1.0 through minus 2.5 indicates osteopenia ³.

Osteopenia means low bone mass ³. A healthcare professional combines the score with other fracture risks ³.

A scan result is only one part of the assessment. Fracture history and a physical exam may add important information ³.

FRAX is a tool that estimates fracture risk over the next 10 years. Treatment advice often considers both DXA results and the FRAX score.

One clinician guide lists fracture-risk thresholds for medication treatment ³. These apply to postmenopausal women and men age 50 or older ³.

The guide lists a hip fracture risk of at least 3% ³. It also lists a major fracture risk of at least 20% ³.

These thresholds use the U.S.-adapted FRAX model ³. A healthcare professional should apply them within a full risk review.

Blood or urine tests may be needed in some cases ¹. They can help find health conditions causing bone loss ¹.

Treatment may slow bone loss or help increase bone density ^1,2. The main goal is to reduce the chance of fractures ⁵.

Medicine may be prescribed when testing shows osteoporosis and fracture risk is high ^1,5. It may also follow a fracture with low bone density ⁵.

A fracture without significant injury is also listed in a discussion of osteoporosis medicines ⁵. Treatment advice often uses DXA results and FRAX risk.

Benefits and risks should be reviewed before treatment starts ³. Personal concerns and expectations should shape the final choice ³.

Diet and exercise alone may not treat advanced bone loss. People with high fracture risk will likely need medicine.

Antiresorptive medicines slow the loss of old bone. Bisphosphonates and denosumab are common options ^1,6.

Bisphosphonates are widely used to prevent and treat bone loss ^1,5. They come as pills or medicines given through a vein ^1,5.

Examples include alendronate, risedronate, ibandronate, and zoledronic acid ^3,6. Treatment may include a medicine holiday after about five years ^5,9.

Oral bisphosphonates can cause heartburn, nausea, or stomach pain ^5,6. Use instructions include taking oral bisphosphonates with plain water and staying upright for at least 30 minutes ^5,9.

Rare risks include unusual thighbone fractures ^5,6. Slow healing of the jawbone is another rare risk ^5,6.

Denosumab reduces bone loss and raises bone density ¹. It is given under the skin every six months ^5,6.

Denosumab may suit some people with reduced kidney function. Medicine choice still requires an individual health review.

Do not stop or delay denosumab without a transition plan. Stopping it may increase the risk of spinal fractures.

A prescriber may use another medicine after denosumab. Consistent timing is important during treatment.

Some patients may receive other medicines. Each option has its own benefits and risks.

Selected choices include the following treatments:

Hormone therapy may suit some younger women ^5,6. It may also help women who need care for menopause symptoms.

Bone-building medicines help the body form new bone. Medicines may be used to strengthen bones when osteoporosis is diagnosed and fracture risk is high ^1,6.

Teriparatide is similar to a hormone made by the body ^1,6. It stimulates new bone growth and is given under the skin ^5,6.

Abaloparatide is another medicine related to that hormone ^1,6. It is listed with teriparatide as a medicine that increases bone density ^1,6.

Romosozumab is used for more severe bone thinning ^1,5. It is given once a month for one year ^5,6.

Low blood calcium is listed as a rare side effect of an osteoporosis medicine ⁵. An osteoporosis medicine may increase heart attack or stroke risk ⁵.

Another osteoporosis medicine generally follows bone-building treatment. Follow-up medicine helps maintain the new bone growth.

Osteoporosis risk should not go unassessed in primary care ³. Treatment length depends on the drug and personal fracture risk ³.

A clinician may suggest a bisphosphonate holiday after several years. This is a planned pause from that medicine.

The effects of bisphosphonates can remain after treatment stops. A holiday may reduce rare risks linked with long use.

Decisions about this pause should not overlook each patient's concerns and expectations. Treatment length and later choices must remain personal.

Daily habits can support bone health and medical treatment ^2,4. They also address risks linked with falls.

Calcium and vitamin D help maintain bone formation and density. Vitamin D helps the body absorb calcium ¹.

A bone-friendly diet also provides enough protein and calories. Strict diets and low protein intake may increase bone loss ⁴.

Useful calcium sources include dairy foods and soy products. Calcium-fortified cereal and juice are other choices.

Supplements may help when food does not provide enough calcium. Vitamin D supplements may help when other sources are not enough.

Discuss supplements with a healthcare professional before taking them. Supplements may affect other medicines.

Weight-bearing activity supports bone health ^2,4. Walking is one common form of weight-bearing exercise ^2,4.

Regular activity is part of osteoporosis prevention. Exercise plans should consider the person’s current health and abilities.

Balance training can help address fall risk ³. It may be offered alongside a home safety assessment ³.

Preventing further fractures is a key part of fracture care ³. A safety review can address both health and home risks.

A fall-safety plan may include these practical steps:

Smoking raises the chance of osteoporosis ^1,2. Quitting supports a wider bone-health plan.

Heavy alcohol use also raises osteoporosis risk ^1,2. Limiting alcohol is part of prevention guidance ^2,4.

Healthy habits may not replace medicine for high-risk patients. Take prescribed bone medicine as directed to help prevent fractures ⁴.

Ask about screening at age 65 if you are a woman ^1,2. Earlier testing may be advised when added risks are present ⁵.

Height loss or posture changes are reasons to visit a provider ⁷. A bone density test may be useful during that visit ⁷.

Severe back pain can be a sign of a spinal fracture ⁴. A fracture after little or no injury may also signal weak bones ^2,4.

Contact the prescriber for swallowing problems or lasting heartburn ⁵. Also report new thigh, hip, or jaw pain ⁵.

Blood in the stool, leg swelling, or a fast heartbeat also need medical advice ⁵. Do not stop bone medicine without speaking with the prescriber.

This warning is vital for denosumab. Another antiresorptive medicine may be needed during the change.

Bone care can help people act before a disabling fracture occurs. Osteoporosis may stay silent until a bone breaks ^2,4.

Review personal risks with a healthcare professional. A plan may include testing, healthy meals, exercise, fall safety, and medicine.

Screening can find bone loss before a fracture ⁷. Proper treatment can reduce the risk of future fractures ^2,3.