Osteoporosis is often called a “silent” disease because people typically do not have any symptoms. Many people don't even know that they have this bone disease until they break a bone.

Over half of American adults age 50 and older have osteoporosis or have a high risk of developing it.  Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Learning about osteoporosis, and how to prevent it, can reduce your risk of bone fractures.

What is osteoporosis?

Osteoporosis is a condition that causes bones to become weaker and more likely to break. Healthy bones are constantly renewing themselves by replacing old bone with new bone. Osteoporosis develops when the body breaks down bone faster than it can build new bone. Over time, bones lose density and strength, making them more fragile.

What are fragility fractures?

People with osteoporosis can break a bone from a minor fall or even everyday activities that would not normally cause a fracture. These injuries are called fragility fractures because they happen after little or no trauma, such as a fall from standing height. 

A fragility fracture is often the first sign of osteoporosis and can increase the risk of future fractures, making early evaluation and treatment important.

How common is osteoporosis?

• Over 10 million Americans age 50 or older have osteoporosis and more than 40 million have low bone mass (osteopenia). That means your bone mineral density is lower than normal but has not become osteoporosis yet.
• About 2 million broken bones in the U.S. are caused by osteoporosis each year.
• Falls are the leading cause of fatal and non-fatal injuries for adults age 65 and older. Over 14 million older Americans report falling every year. That’s one in four older adults in the U.S.
• Falls cause about 300,000 hip fractures every year. Twenty-five percent of older people with hip fractures die within a year.

Who gets osteoporosis?

Anyone can develop osteoporosis, but the risk increases with age. Women are more likely to develop osteoporosis, especially after menopause. When estrogen levels drop during menopause, bone loss speeds up.

Men can also develop osteoporosis. The risk increases with age, particularly after 70. In men, osteoporosis may be related to other health conditions or factors, such as low testosterone, smoking, heavy alcohol use or certain medications.

Your age, sex, family history, health conditions, medications and other risk factors can all affect your bone health. If you have risk factors for osteoporosis or have had a fragility fracture, your doctor may recommend a bone density test to check your bone health.

Osteoporosis risk factors

Some factors can make you more likely to develop osteoporosis or lose bone density. These include:

• Getting older
• Menopause
• Having a family history of osteoporosis or fractures
• Having had a previous fracture
• Having a low body weight or small body frame
• Smoking
• Drinking a lot of alcohol
• Not getting enough calcium or vitamin D
• Not getting enough physical activity
• Taking certain medications, such as long-term steroids
• Having certain health conditions, such as rheumatoid arthritis or thyroid or parathyroid disorders
• Having frequent falls, which can increase your risk of breaking a bone

Having one or more of these risk factors does not mean you will develop osteoporosis. Your doctor can help you understand your risk and whether you should have a bone density test.

How osteoporosis is diagnosed

Osteoporosis often has no symptoms until a bone breaks. If your provider thinks you may be at risk, they will ask about your health history, family history, medications and any past fractures or falls.

They may recommend a bone density test, called a DXA (DEXA) scan. This quick, painless, low-dose X-ray measures bone strength, usually in the hip and spine, and helps estimate your risk of future fractures. It’s recommended for women by age 65 and men by age 70. Ask for a DEXA scan as early as age 50 if you have high risk factors.

Your provider may also order blood tests to check for health conditions that can cause bone loss, such as low vitamin D levels or certain hormone disorders. Your DEXA results, along with your age, medical history, and other risk factors, help determine whether you have osteoporosis or osteopenia (lower-than-normal bone density).

FRAX score

Your doctor may use your DEXA scan and risk factors to assess your risk of a break in the next decade. This Future Risk Assessment Tool, or FRAX, gives two numbers. One is your risk of hip fracture, which has the toughest recovery. The other shows your chances of a hip, spine, wrist, forearm, shoulder or upper arm break.

The FRAX score is important because it weighs risk factors, not just DEXA results. You may need treatment even if your DEXA results show only mild bone loss.

Fragility fractures and osteoporosis

A fragility fracture can be a sign that your bones have become weaker from osteoporosis. These fractures can happen from a minor fall or an everyday activity, such as lifting something lightweight. Because a fragility fracture can be an early warning sign of osteoporosis, your doctor may recommend testing to check your bone health and understand your risk for future fractures.

Fragility fractures can occur in several parts of the body, including:

• Hip
• Spine
• Pelvis
• Wrist
• Ribs
• Ankle
• Shoulder

A fracture of the hip or spine may be considered related to osteoporosis even when a DEXA scan does not show osteoporosis. Your doctor will consider your fracture, bone density and other risk factors when evaluating your bone health.

Treating fragility fractures

Treatment for a fragility fracture depends on where the bone is broken and how severe the break is. Some fractures heal without surgery, while others need an operation to repair the bone. Your care may include:

• X-rays or other imaging
• A brace or cast
• Stitches, if needed
• Physical therapy
• Surgery, for some fractures

Treating hip fractures

Hip fractures usually need surgery. Whether or not you need surgery, your care team will also focus on protecting your bones and lowering your risk of another fracture.

At OHSU, people age 50 and older who have a hip fracture may receive an IV medicine called zoledronate during their hospital stay. This medicine slows bone breakdown and helps strengthen bones, which can lower the risk of future fractures.

This approach grew out of OHSU research and is designed to make osteoporosis treatment easier to start after a hip fracture. Zoledronate is given through an IV and can protect your bones for about a year. After that, your primary care doctor or other health care provider can help you decide whether to have another IV treatment or switch to an oral osteoporosis medicine.

How to make lifestyle changes after an osteoporosis diagnosis

Healthy habits are an important part of treating osteoporosis. Along with medication, lifestyle changes can help slow bone loss, improve strength and balance, and lower your risk of fractures.

Your care team may recommend that you:

• Stop smoking.
• Limit alcohol.
• Eat a healthy diet with enough calcium and vitamin D.
• Stay physically active with weight-bearing, strength-training and balance exercises.
• Review your medications with your provider to identify any that may increase your risk of falls or bone loss.

If you've had a fracture or are at risk of falling, you can also help prevent future injuries by:

• Keeping walkways free of clutter and removing loose rugs
• Using night lights to improve visibility
• Wearing supportive shoes with non-slip soles
• Installing handrails on stairs and grab bars in bathrooms
• Having regular vision checks
• Using a cane or walker if your provider recommends one

Preventing osteoporosis

It's never too early—or too late—to support your bone health. Healthy habits throughout adulthood can help reduce bone loss and lower your risk of osteoporosis and fractures.

To help keep your bones strong:

• Get enough calcium and vitamin D through food and supplements, if recommended by your doctor.
• Stay active with weight-bearing, muscle-strengthening and balance exercises.
• Don't smoke.
• Limit alcohol.
• Maintain a healthy weight.
• Talk with your provider about your risk factors and whether a bone density (DXA) scan is right for you.

Regular exercise is one of the best ways to support bone health. Weight-bearing activities, such as walking, hiking, dancing and climbing stairs, can help keep bones strong. Strength training builds muscle and supports healthy bones, while balance exercises such as tai chi or yoga can help reduce the risk of falls as you age.

Learn more about osteoporosis and fragility fractures

Learn more about bone health from these Bone Health & Osteoporosis Foundation resources:

• Tips for preventing falls and broken bones
• Foods rich in vitamin D and calcium
• Simple exercises for strong bones