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Osteoporosis

Osteoporosis At A Glance

  • Osteoporosis is a disease that weakens bones and makes them easier to break because the body loses too much bone, makes too little new bone, or both.
  • It is often called a “silent disease” because it usually causes no symptoms until a fracture occurs.
  • Fractures commonly affect the hip, spine, and wrist and may occur after relatively minor falls or everyday movements.
  • Risk factors include older age, menopause, low testosterone, family history, low body weight, poor nutrition, inactivity, smoking, heavy alcohol use, steroids, and certain medical conditions.
  • A DXA or DEXA scan of the hip and spine is the most common test used to diagnose osteoporosis and assess bone density.
  • Treatment focuses on preventing fractures through medication when appropriate, adequate calcium and vitamin D, strength and weight-bearing exercise, and fall prevention.

Table of Contents

Table of Contents

What Is Osteoporosis?

Osteoporosis is a disease that makes bones weak and easier to break. It develops when the body loses too much bone, makes too little new bone, or both. Bone strength depends on bone density as well as the quality and structure of the bone.

Osteoporosis is often called a “silent disease” because it usually causes no symptoms until a fracture occurs. Fractures are most common in the hip, spine, and wrist, but any bone can break. Screening, healthy habits, fall prevention, and medicine can lower fracture risk.

Learn More

Osteoporosis – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis

Explains osteoporosis symptoms, causes, risk factors, fractures, and steps that support bone health.

Osteoporosis – NIH MedlinePlus
https://medlineplus.gov/osteoporosis.html

Offers patient-friendly information about bone loss, diagnosis, treatment, exercise, nutrition, and fracture prevention.

How Common Is Osteoporosis?

Osteoporosis is common, especially after menopause and with older age. It is a major cause of fractures in postmenopausal women and older men.

The USPSTF recommends screening women age 65 and older and postmenopausal women younger than 65 who have increased fracture risk. Evidence is not sufficient for one universal screening rule for men, so clinicians use age, fractures, medicines, and other risks to decide.

Learn More

Osteoporosis Screening Recommendation – USPSTF
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

Provides the 2025 U.S. recommendation for screening women age 65 and older and younger postmenopausal women at increased risk.

Osteoporosis in Men – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis-men

Explains risk factors, diagnosis, prevention, and treatment of osteoporosis in men.

What Symptoms Might You Notice?

Most people notice nothing until a bone breaks. Possible signs include:

  • A fracture after a minor fall, bump, cough, bend, or normal daily movement
  • Sudden or ongoing back pain from a spinal compression fracture
  • Loss of height over time
  • A stooped or hunched upper back
  • Reduced movement or difficulty with daily activities after a fracture
  • Hip, wrist, shoulder, pelvis, or other bone pain after a fall

Osteoporosis itself does not usually cause aching throughout the body. New pain should be evaluated for a fracture or another condition.

Learn More

Osteoporosis – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis

Explains osteoporosis symptoms, causes, risk factors, fractures, and steps that support bone health.

How Is Osteoporosis Diagnosed?

A clinician reviews fractures, falls, height loss, diet, exercise, menopause or hormone history, medicines, family history, smoking, alcohol, and medical conditions. They may check height, posture, balance, strength, spine tenderness, and fall risk.

A central DXA or DEXA scan of the hip and spine is the most common diagnostic test. Osteoporosis may also be diagnosed after certain low-trauma hip or spine fractures even when a DXA result is not in the osteoporosis range.

Learn More

Osteoporosis: Diagnosis, Treatment, and Steps to Take – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take

Reviews DXA testing, medicines, nutrition, exercise, fall prevention, and follow-up.

Bone Density Scan – NIH MedlinePlus
https://medlineplus.gov/lab-tests/bone-density-scan/

Explains why DXA scans are performed, how to prepare, what happens, and what results can mean.

Osteoporosis infographic – click to enlarge

What Causes Osteoporosis?

Bone is living tissue that is constantly removed and rebuilt. With aging, bone removal may happen faster than bone formation. Risk increases with:

  • Older age and menopause-related estrogen loss
  • Low testosterone or other hormone disorders
  • A parent with osteoporosis or hip fracture
  • A previous low-trauma fracture
  • Low body weight, poor nutrition, or an eating disorder
  • Low calcium or vitamin D intake
  • Little weight-bearing activity
  • Smoking or heavy alcohol use
  • Long-term corticosteroids and some seizure, cancer, acid-reflux, or hormone-blocking medicines
  • Rheumatoid arthritis, celiac disease, kidney or liver disease, and some endocrine disorders

Osteoporosis can affect people of every sex and background. Some risk factors cannot be changed, but many fracture risks can be lowered.

Learn More

Osteoporosis – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis

Explains osteoporosis symptoms, causes, risk factors, fractures, and steps that support bone health.

Osteoporosis in Men – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis-men

Explains risk factors, diagnosis, prevention, and treatment of osteoporosis in men.

What Can Make Osteoporosis Worse?

Bone loss or fracture risk may increase with:

  • Missing osteoporosis medicine doses or stopping treatment without a plan
  • Stopping denosumab late or abruptly without follow-on therapy
  • Continued smoking or heavy alcohol use
  • Poor nutrition, low protein, or untreated vitamin D deficiency
  • Long periods of inactivity or bed rest
  • Repeated falls or unsafe home conditions
  • Untreated vision, balance, muscle, or blood-pressure problems
  • Long-term steroid use without bone protection
  • Not evaluating a fracture that occurred after a minor injury

A first fragility fracture strongly predicts another fracture. Prompt bone-health evaluation can prevent future injury.

Learn More

Preventing Another Broken Bone – NIH NIAMS
https://www.niams.nih.gov/health-topics/preventing-another-broken-bone

Explains why a fracture may signal osteoporosis and how treatment can help prevent another fracture.

Prevention

Bone health is built across the lifespan. Helpful steps include:

  • Get recommended osteoporosis screening based on age and risk.
  • Eat enough calcium, vitamin D, protein, and total calories.
  • Perform weight-bearing, strength, posture, and balance exercise.
  • Avoid smoking and limit alcohol.
  • Prevent falls at home and outdoors.
  • Review long-term steroid and other bone-affecting medicines.
  • Treat low hormones, digestive disease, and other causes when appropriate.
  • Use protective equipment and safe technique during activities.
  • After a low-trauma fracture, ask whether osteoporosis caused it.
  • Take prescribed treatment consistently and keep monitoring appointments.

Supplements cannot make up for untreated high fracture risk. Prevention may require both healthy habits and medicine.

Learn More

Osteoporosis – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis

Explains osteoporosis symptoms, causes, risk factors, fractures, and steps that support bone health.

Osteoporosis Screening Recommendation – USPSTF
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

Provides the 2025 U.S. recommendation for screening women age 65 and older and younger postmenopausal women at increased risk.

Preventing Another Broken Bone – NIH NIAMS
https://www.niams.nih.gov/health-topics/preventing-another-broken-bone

Explains why a fracture may signal osteoporosis and how treatment can help prevent another fracture.

Learn More About Osteoporosis

The following video content is provided to help you better understand this condition. These resources are intended for educational purposes and should not replace personalized medical advice from your healthcare provider.

Labs

Blood and urine tests do not measure bone density, but they may look for causes and guide safe treatment:

  • Calcium, Phosphorus, and Vitamin D: Check nutrients and mineral balance.
  • Kidney and Liver Tests: Help identify disease and guide medicine choice.
  • Thyroid and Parathyroid Tests: Look for hormone causes of bone loss.
  • Blood Count and Metabolic Panel: Check anemia and other medical problems.
  • Testosterone or Other Hormone Tests: Used when symptoms or history suggest deficiency.
  • Celiac or Protein Studies: May be ordered for poor absorption or another suspected condition.
  • Bone-Turnover Markers: Sometimes used by specialists to assess response or adherence.

Testing is individualized. Normal lab results do not rule out osteoporosis.

Learn More

Osteoporosis: Diagnosis, Treatment, and Steps to Take – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take

Reviews DXA testing, medicines, nutrition, exercise, fall prevention, and follow-up.

Diagnostics

Tests used to assess bones and fracture risk include:

  • Central DXA Scan: A painless, low-radiation scan of the hip and spine that reports bone density and T-scores.
  • Fracture-Risk Calculator: Estimates the chance of a major fracture using clinical risks, sometimes with DXA results.
  • Vertebral Fracture Assessment or Spine X-Ray: Looks for silent compression fractures when height loss, pain, or risk is present.
  • X-Ray, CT, or MRI: Evaluates a suspected fracture or another cause of pain; routine X-rays are not sensitive enough for early osteoporosis.
  • Peripheral Bone Test: Heel or wrist testing may estimate risk but does not replace central DXA for diagnosis or treatment monitoring.

T-scores compare bone density with a healthy young adult. A T-score of −2.5 or lower generally meets the densitometric definition of osteoporosis in postmenopausal women and men age 50 or older. Results must be interpreted in context.

Learn More

Bone Density Scan – NIH MedlinePlus
https://medlineplus.gov/lab-tests/bone-density-scan/

Explains why DXA scans are performed, how to prepare, what happens, and what results can mean.

Bone Mineral Density – NIH MedlinePlus
https://medlineplus.gov/bonedensity.html

Provides information about bone-density measurement, strong-bone habits, and related health resources.

Treatment & Management

Treatment Options

Treatment aims to prevent fractures, maintain function, and protect quality of life. A plan may include:

  • Antiresorptive Medicine: Slows bone breakdown and reduces fracture risk.
  • Bone-Building Medicine: Stimulates new bone formation for very high-risk or severe disease.
  • Calcium and Vitamin D: Corrects inadequate intake or deficiency; supplements alone do not replace osteoporosis medicine when fracture risk is high.
  • Strength, Weight-Bearing, and Balance Exercise: Supports bone, muscle, posture, and fall prevention.
  • Fall Prevention: Addresses vision, footwear, medicines, home hazards, and balance.
  • Treatment of Underlying Causes: Manages hormone, digestive, kidney, or medicine-related bone loss.

Choice depends on fracture history, DXA results, kidney function, calcium level, swallowing or stomach problems, cancer or clot history, pregnancy potential, cost, preferences, and ability to follow the dosing schedule.

Learn More

Osteoporosis: Diagnosis, Treatment, and Steps to Take – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take

Reviews DXA testing, medicines, nutrition, exercise, fall prevention, and follow-up.

Medicines for Osteoporosis – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000502.htm

Describes common osteoporosis medicines, how they are taken, side effects, and safety precautions.

Lifestyle Changes

Daily habits can strengthen muscles and reduce falls:

  • Do regular weight-bearing activity such as walking, dancing, or stair climbing.
  • Add resistance exercise for the legs, hips, back, arms, and core.
  • Practice balance exercises such as tai chi when safe.
  • Eat enough protein and calcium-rich foods.
  • Maintain adequate vitamin D as advised.
  • Stop smoking and avoid nicotine.
  • Limit alcohol.
  • Use supportive shoes and assistive devices when recommended.
  • Avoid high-impact exercise or repeated deep bending and twisting if fracture risk is high unless cleared by a professional.

A physical therapist can adapt exercise after a spine fracture, with severe osteoporosis, or when balance is poor.

Learn More

Osteoporosis: Diagnosis, Treatment, and Steps to Take – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take

Reviews DXA testing, medicines, nutrition, exercise, fall prevention, and follow-up.

Osteoporosis – NIH MedlinePlus
https://medlineplus.gov/osteoporosis.html

Offers patient-friendly information about bone loss, diagnosis, treatment, exercise, nutrition, and fracture prevention.

Medications

Common osteoporosis medicines include:

  • Bisphosphonates: Alendronate, risedronate, ibandronate, or zoledronic acid slow bone loss; oral products require careful dosing, and IV products may cause short-term flu-like symptoms.
  • Denosumab: An injection every six months that slows bone loss; doses should not be delayed or stopped without a transition plan because rebound spine fractures can occur.
  • Teriparatide or Abaloparatide: Daily injections that build bone for selected high-risk patients.
  • Romosozumab: Monthly injections for a limited course in selected very high-risk patients; cardiovascular history affects whether it is appropriate.
  • Raloxifene: Lowers spine-fracture risk in selected postmenopausal patients but can increase blood-clot risk.
  • Menopausal Hormone Therapy: May prevent bone loss in selected patients when benefits outweigh risks; it is not the best choice for everyone.

Rare but important antiresorptive risks include jaw osteonecrosis and unusual thigh-bone fractures. These are much less common than osteoporotic fractures in appropriately selected high-risk patients. Report new thigh or groin pain and tell your dentist about treatment.

Learn More

Medicines for Osteoporosis – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000502.htm

Describes common osteoporosis medicines, how they are taken, side effects, and safety precautions.

FDA Safety Warning for Denosumab in Advanced Kidney Disease
https://www.fda.gov/drugs/drug-safety-communications/fda-adds-boxed-warning-increased-risk-severe-hypocalcemia-patients-advanced-chronic-kidney-disease

Explains the risk of severe low calcium with denosumab in advanced chronic kidney disease and needed monitoring.

Procedures

Osteoporosis itself is treated with medicine and prevention, but fractures may require procedures:

  • Casting, Splinting, or Bracing: Stabilizes selected wrist, arm, ankle, or spine fractures.
  • Hip-Fracture Surgery: Usually repairs or replaces part of the hip and should be treated urgently.
  • Other Fracture Fixation: Pins, plates, screws, rods, or joint replacement may restore alignment and function.
  • Rehabilitation: Physical and occupational therapy rebuild strength, mobility, and independence.
  • Vertebral Augmentation: Vertebroplasty or kyphoplasty is considered only in selected painful compression fractures after specialist review.

After any fragility fracture, ask for an osteoporosis evaluation or fracture-liaison service. Fixing the broken bone alone does not treat the underlying bone weakness.

Learn More

Preventing Another Broken Bone – NIH NIAMS
https://www.niams.nih.gov/health-topics/preventing-another-broken-bone

Explains why a fracture may signal osteoporosis and how treatment can help prevent another fracture.

What Should You Expect Long-Term?

Osteoporosis is usually a long-term condition, but fracture risk can be reduced. Medicines may improve bone density or prevent further loss even when the scan does not return to a normal range.

Follow-up timing depends on risk and treatment. Clinicians periodically review fractures, falls, height, adherence, side effects, labs, and DXA results. Some bisphosphonate users may later qualify for a supervised treatment pause, but denosumab should not be paused in the same way.

Learn More

Osteoporosis: Diagnosis, Treatment, and Steps to Take – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take

Reviews DXA testing, medicines, nutrition, exercise, fall prevention, and follow-up.

Medicines for Osteoporosis – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000502.htm

Describes common osteoporosis medicines, how they are taken, side effects, and safety precautions.

What Can You Do At Home?

Protect your bones and prevent falls by:

  • Remove loose rugs, clutter, and electrical cords from walking paths.
  • Install bright lighting, stair rails, and bathroom grab bars.
  • Use nonslip mats and keep frequently used items within easy reach.
  • Have vision and hearing checked.
  • Rise slowly if you become dizzy and review fall-causing medicines.
  • Take osteoporosis medicine exactly as directed.
  • Follow oral bisphosphonate instructions about fasting, water, and staying upright.
  • Use calcium or vitamin D supplements only in the advised amount.
  • Keep a phone or alert device accessible if you live alone.

Do not continue walking on a painful hip or leg after a fall. Some fractures allow limited movement at first but worsen without care.

Frequently Asked Questions

Is osteoporosis the same as osteoarthritis?

No. Osteoporosis weakens bones; osteoarthritis damages joint cartilage. A person can have both.

Does osteoporosis cause pain?

Usually not until a fracture occurs. Sudden back pain, height loss, or pain after a minor fall may signal a fracture.

Is osteopenia the same as osteoporosis?

Osteopenia means bone density is below normal but not as low as osteoporosis. Treatment depends on total fracture risk, not the T-score alone.

Can calcium cure osteoporosis?

No. Calcium and vitamin D support bone health but do not replace prescription treatment when fracture risk is high.

Can men develop osteoporosis?

Yes. Older age, low testosterone, steroids, medical conditions, smoking, alcohol, and other factors can increase risk in men.

Are osteoporosis medicines more dangerous than the disease?

Serious side effects are uncommon. For people at high fracture risk, the benefit of preventing a hip or spine fracture usually outweighs medicine risks.

Can I stop medicine when my scan improves?

Not on your own. Some medicines remain in bone and may allow a planned pause, while stopping denosumab without another treatment can rapidly increase fracture risk.

Will lifting weights break my bones?

Appropriate resistance exercise is helpful, but the program should match your fracture risk, balance, and spine health. Ask for physical-therapy guidance when unsure.

Questions To Ask Your Provider

Consider asking:

  • Do I need a DXA scan or fracture-risk calculation?
  • What do my T-score and overall fracture risk mean?
  • Could a medicine or medical condition be causing bone loss?
  • How much calcium, vitamin D, and protein do I need?
  • Which exercises are safe for my spine and hips?
  • Do I need medication, and which option best fits my risks?
  • How should I take it, and what side effects should I report?
  • What dental care do I need before or during treatment?
  • When will labs or DXA be repeated?
  • How long should I stay on treatment?
  • What is the plan if denosumab is delayed or stopped?

Can I be referred to physical therapy or a fracture-liaison service?

Specialist Referrals

Primary care can manage many cases. Referral may be made to:

  • Endocrinologist: For severe disease, unusual lab results, early osteoporosis, or complex medicine choices.
  • Rheumatologist: For inflammatory disease, steroid-related bone loss, or difficult osteoporosis.
  • Geriatrician: For falls, multiple medicines, frailty, or complex older-adult care.
  • Orthopedic Surgeon: For hip or other fractures needing repair.
  • Physical or Occupational Therapist: For safe exercise, posture, balance, mobility aids, and home safety.
  • Dietitian: For low weight, poor intake, digestive disease, or nutrition planning.
  • Nephrologist: For advanced kidney disease and mineral-bone disorders.
  • Dentist or Oral Surgeon: For significant dental disease or planned invasive dental work.

Learn More

Osteoporosis: Diagnosis, Treatment, and Steps to Take – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take

Reviews DXA testing, medicines, nutrition, exercise, fall prevention, and follow-up.

FDA Safety Warning for Denosumab in Advanced Kidney Disease
https://www.fda.gov/drugs/drug-safety-communications/fda-adds-boxed-warning-increased-risk-severe-hypocalcemia-patients-advanced-chronic-kidney-disease

Explains the risk of severe low calcium with denosumab in advanced chronic kidney disease and needed monitoring.

Is Osteoporosis Curable?

Osteoporosis is usually managed rather than permanently cured. Treatment can strengthen bone, slow loss, lower fracture risk, and sometimes improve bone density enough that the T-score no longer falls in the osteoporosis range.

Fracture risk may remain higher because age, prior fractures, and other risks still matter. Continuing exercise, nutrition, fall prevention, and follow-up remains important even after a better scan.

Learn More

Osteoporosis – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis

Explains osteoporosis symptoms, causes, risk factors, fractures, and steps that support bone health.

Emergency Symptoms / When To Seek Immediate Help

Seek urgent or emergency care for:

  • Hip, groin, thigh, wrist, or shoulder pain after a fall, especially with inability to stand or use the limb
  • A shortened or outward-turned leg after a fall
  • Sudden severe back pain, new weakness or numbness, loss of bladder or bowel control, or numbness around the groin
  • Head injury, confusion, fainting, vomiting, or severe headache after a fall
  • An open wound with visible bone or heavy bleeding
  • Jaw swelling with fever or drainage during antiresorptive treatment
  • Muscle spasms, confusion, seizure, or an irregular heartbeat that may signal severe low calcium
  • A severe allergic reaction after medicine or infusion

Do not move someone with a possible hip, spine, or neck fracture unless there is immediate danger. Call emergency services and keep the person warm and still.

Learn More

Preventing Another Broken Bone – NIH NIAMS
https://www.niams.nih.gov/health-topics/preventing-another-broken-bone

Explains why a fracture may signal osteoporosis and how treatment can help prevent another fracture.

FDA Safety Warning for Denosumab in Advanced Kidney Disease
https://www.fda.gov/drugs/drug-safety-communications/fda-adds-boxed-warning-increased-risk-severe-hypocalcemia-patients-advanced-chronic-kidney-disease

Explains the risk of severe low calcium with denosumab in advanced chronic kidney disease and needed monitoring.

CALL 911

APNS does not provide emergency medical services. If you believe you are experiencing a medical emergency, including (but not limited to) chest pain, difficulty breathing, stroke symptoms, severe allergic reactions, anaphylaxis, uncontrolled bleeding, seizures, loss of consciousness, or any other potentially life-threatening condition, you are instructed to call 911 immediately or go immediately to the nearest emergency department.

Official Resources / External Links

Osteoporosis – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis

Explains osteoporosis symptoms, causes, risk factors, fractures, and steps that support bone health.

Osteoporosis: Diagnosis, Treatment, and Steps to Take – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take

Reviews DXA testing, medicines, nutrition, exercise, fall prevention, and follow-up.

Osteoporosis Screening Recommendation – USPSTF
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

Provides the 2025 U.S. recommendation for screening women age 65 and older and younger postmenopausal women at increased risk.

Osteoporosis – NIH MedlinePlus
https://medlineplus.gov/osteoporosis.html

Offers patient-friendly information about bone loss, diagnosis, treatment, exercise, nutrition, and fracture prevention.

Bone Density Scan – NIH MedlinePlus
https://medlineplus.gov/lab-tests/bone-density-scan/

Explains why DXA scans are performed, how to prepare, what happens, and what results can mean.

Medicines for Osteoporosis – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000502.htm

Describes common osteoporosis medicines, how they are taken, side effects, and safety precautions.

Osteoporosis in Men – NIH NIAMS
https://www.niams.nih.gov/health-topics/osteoporosis-men

Explains risk factors, diagnosis, prevention, and treatment of osteoporosis in men.

Preventing Another Broken Bone – NIH NIAMS
https://www.niams.nih.gov/health-topics/preventing-another-broken-bone

Explains why a fracture may signal osteoporosis and how treatment can help prevent another fracture.

FDA Safety Warning for Denosumab in Advanced Kidney Disease
https://www.fda.gov/drugs/drug-safety-communications/fda-adds-boxed-warning-increased-risk-severe-hypocalcemia-patients-advanced-chronic-kidney-disease

Explains the risk of severe low calcium with denosumab in advanced chronic kidney disease and needed monitoring.

Bone Mineral Density – NIH MedlinePlus
https://medlineplus.gov/bonedensity.html

Provides information about bone-density measurement, strong-bone habits, and related health resources.

This guide is for education only and does not replace professional medical care. Osteoporosis often has no symptoms until a fracture occurs. Seek urgent care after a fall with severe pain, deformity, inability to stand, neurologic symptoms, an open fracture, or a serious medicine reaction. Do not change osteoporosis treatment without your clinician’s guidance.

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