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This topic talks about osteoporosis, including how to help prevent it and also how it is diagnosed and treated. For more information about how osteoporosis affects men see the topic Osteoporosis in Men.
What is osteoporosis?
Osteoporosis is a disease that affects your bones. It means that you have bones that are thin and brittle with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, and wrist. These fractures can be disabling and may make it hard for you to live on your own.
Osteoporosis affects millions of older adults. It usually strikes after age 60. It's most common in women, but men can get it too.
What causes osteoporosis?
It's caused by a lack of bone strength or bone density. As you age, your bones get thinner naturally. But some things can make you more likely to have the severe bone thinning of osteoporosis. These things are called risk factors.
Age, gender, and body type risks
- Your age. Your risk goes up as you get older.
- Being a woman who has gone through menopause. After menopause, the body makes less estrogen. Estrogen protects the body from bone loss.
- Having a slender body frame
Family history risks
- Your family background. Osteoporosis tends to run in families.
- Your race. People of European and Asian background are most likely to get osteoporosis.
- Not getting enough weight-bearing exercise
- Drinking too much alcohol
- Not getting enough calcium and vitamin D
What are the symptoms?
Osteoporosis can be very far along before you notice it. Sometimes the first sign is a broken bone in your hip, spine, or wrist after a bump or fall.
As the disease gets worse, you may have other signs, such as pain in your back. You might notice that you are not as tall as you used to be and that you have a curved backbone.
How is osteoporosis diagnosed?
Your doctor will ask about your symptoms and do a physical examination. You may also have a test that measures your bone thickness (bone density test) and your risk for a fracture.
If the test finds that your bone thickness is less than normal but is not osteoporosis, you may have low bone density (sometimes called osteopenia). It's a less severe type of bone thinning.
It's important to find and treat osteoporosis early to prevent bone fractures. Osteoporosis Canada advises routine bone density testing for all women and men who are age 65 or older. If you have a higher risk for fractures, it's best to start getting the test sooner.
How is it treated?
Treatment for osteoporosis includes medicine to reduce bone loss and build bone thickness. Medicine can also give you relief from pain caused by fractures or other changes to your bones.
It's important to get enough calcium and vitamin D and take prescribed medicine for the disease. You need calcium and vitamin D to build strong, healthy bones.
You can slow osteoporosis with new, healthy habits. If you smoke, quit. Get plenty of exercise. Walking, jogging, dancing, and lifting weights can make your bones stronger. Eat a healthy mix of foods that include calcium and vitamin D. Try yogurt, cheese, milk and fortified soy or other plant based beverages for calcium. Eat eggs, fatty fish, and soft margarine for vitamin D. In Canada, most people don't get enough vitamin D from food only. Osteoporosis Canada recommends that all Canadian adults take daily vitamin D supplements. Talk to your doctor about how much you need.
Making even small changes in how you eat and exercise, along with taking medicine, can help prevent a broken bone.
When you have osteoporosis, it's important to protect yourself from falling. Reduce your risk of breaking a bone by making your home safer. Make sure there's enough light in your home. Remove throw rugs and clutter that you may trip over. Put sturdy handrails on stairs. Try exercises to increase your strength and balance.
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As a natural part of aging, bone tissue breaks down. It is absorbed faster than new bone is made, and bones become thinner. You are more likely to have osteoporosis if you did not reach your ideal bone thickness (bone density) during your childhood and teenage years.
In women, bone loss increases around menopause, when ovaries decrease production of estrogen, a hormone that protects against bone loss. So the older you get, the more likely you are to have osteoporosis.
Not getting enough calcium and vitamin D contributes to bone thinning. Also, thin bones may run in families.
In the early stages of osteoporosis, you probably won't have symptoms. As the disease progresses, you may have symptoms related to weakened bones, including:
- Back pain.
- Loss of height and stooped posture.
- A curved upper back (dowager's hump).
- Broken bones (fractures) that might occur with a minor injury, especially in the hip, spine, and wrist.
- Compression fractures in the spine that may cause severe back pain. But sometimes these fractures cause only minor symptoms or no symptoms at all.
In a normal, healthy adult, bone is constantly absorbed into the body and then rebuilt. During childhood and the teenage years, new bone tissue is added faster than existing bone is absorbed. As a result, your bones become larger and heavier until about age 30 when you reach peak bone mass (density). The more bone mass you developed early in life, the less likely you are to get osteoporosis.
After age 30, people lose a small amount of bone each year.
A person with thinning bones may be diagnosed with low bone density (sometimes called osteopenia). Low bone density sometimes progresses to osteoporosis.
When bones thin, they lose strength and break more easily. The bones that break most often due to osteoporosis are:
. About half of broken bones caused by osteoporosis are bones in the spine.footnote 1 Vertebrae that are weak because of osteoporosis may break and collapse on top of each other. (This is called a compression fracture.) These fractures of the spine can cause back pain, stooped posture, loss of height, and a curved upper back (dowager's hump).
- The hip. Hip fractures are often caused by a fall. They can make it very hard for you to move around. And they usually require major surgery. After a hip fracture, you may have medical complications such as blood clots, pressure injuries, or pneumonia. To learn more, see the topic Hip Fracture.
- The wrist and forearm. Wrist fractures can make you less active and independent.footnote 2
In women, bone loss increases when the ovaries reduce production of estrogen, a hormone that protects against bone loss.
What Increases Your Risk
The risk of osteoporosis increases with age as bones naturally become thinner. But it usually doesn't affect people until they are 60 or older.
Family and personal history
Things that increase the risk of osteoporosis include:
- Having a family history of osteoporosis. If your mother, father, or a sibling has been diagnosed with osteoporosis or has had broken bones from a minor injury, you are more likely to get osteoporosis.
- Completing menopause. Estrogen protects women from bone loss, and estrogen levels drop after menopause. Women whose ovaries aren't working properly or have been removed also are at risk because of lower estrogen levels.
- Smoking. People who smoke lose bone thickness faster than non-smokers.
- Alcohol use. Heavy alcohol use can decrease bone formation, and it increases the risk of falling. Osteoporosis Canada recommends drinking no more than 2 standard alcohol drinks a day.
- Getting little or no exercise. Weight-bearing exercises include walking, jogging, stair climbing, dancing, and lifting weights. They keep bones strong and healthy by working the muscles and bones against gravity. Exercise may improve your balance and decrease your risk of falling.
- Poor diet. A diet low in foods containing calcium and vitamin D increases your risk of thinning bones.
Other things that increase risk
Other risk factors include:
- Breaking a bone after age 40 doing something that would not normally cause a broken bone, such as a simple fall from standing-height or less.
- Taking corticosteroids or certain other medicines.
- Being inactive or bedridden for long periods of time.
- Dieting excessively or having an eating disorder, such as anorexia nervosa.
- Being a female athlete if you have few or irregular menstrual cycles due to low body fat.
Find out your fracture risk
Your doctors might use the FRAX tool to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool too. Go to the website at www.shef.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can enter your score. If you haven't had that test, you can leave the score blank.
The Canadian Association of Radiologists and Osteoporosis Canada also have a tool to help predict your risk of having a fracture in the next 10 years. This tool is online at www.osteoporosis.ca.
When should you call your doctor?
Call your doctor now if you:
- Think you have a broken bone or notice a deformity after a fall.
- Have sudden, severe pain when bearing weight.
Call your doctor for an appointment if you:
- Want to discuss your risk for osteoporosis.
- Have symptoms of menopause or have completed menopause and want to discuss whether you should take medicine to prevent osteoporosis.
- Have been treated for a fracture caused by a minor injury, such as a simple fall, and want to discuss your risk of osteoporosis.
If you are nearing age 65, have low bone density, or think that you are at high risk for osteoporosis, talk with your doctor about your concerns.
If you don't have any risk factors for osteoporosis and you are already taking preventive measures, such as taking adequate calcium and vitamin D, you may only need routine screening.
Examinations and Tests
A diagnosis of osteoporosis is based on your medical history, a physical examination, and a test to measure your bone thickness (density).
Medical history and physical examination
Your doctor will:
- Take a medical history by asking questions about your family's health history and your own.
- Measure your height and compare the results with past measurements.
- Examine your body for signs of previous broken bones, such as changes in the shape of your long bones and spine.
You may have a bone density test. It helps your doctor estimate the strength of your bones.
Routine urine and blood tests can rule out other medical conditions, such as hyperparathyroidism, hyperthyroidism, and Cushing's syndrome. These conditions can cause bone loss.
If you or your doctor thinks that you may be at risk for osteoporosis, you may have a screening test to check your bone thickness. A screening test may be a good idea if you have:
- A fracture after age 40 from a minor injury that wouldn't normally cause a broken bone.
- Another medical condition that is known to cause bone thinning.
- Risk factors for or symptoms that suggest osteoporosis.
Osteoporosis Canada recommends that all women and men age 65 and older routinely have a bone density test to screen for osteoporosis. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner. Osteoporosis Canada recommends that you and your doctor check your fracture risk using a tool such as FRAX or CAROC to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.footnote 3
Using the FRAX tool
The FRAX tool can help predict your risk of having a fracture related to osteoporosis in the next 10 years. The tool is meant for people who are not already being treated with medicine for osteoporosis. You can use this tool. Go to the website at www.shef.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.
Screening in younger women
Most experts recommend that the decision to screen younger women be made on an individual basis. The need for testing will depend on the risk for osteoporosis and whether the test results will help with treatment decisions.
Ultrasound is sometimes offered at events such as health fairs as a quick screening for osteoporosis. Ultrasound by itself is not a reliable test for diagnosing osteoporosis. But if results of an ultrasound screening find low bone density, your doctor can help you decide whether you should have a bone density test.
Treatment for osteoporosis is important to prevent fractures and help you get around and function well. It usually includes lifestyle changes and medicine. It is never too late to build and then keep healthy habits that can slow bone thinning.
Take calcium and vitamin D
Your doctor likely will recommend that you eat foods rich in calcium and vitamin D and take daily vitamin D supplements. These nutrients keep bones healthy and strong.
Your bones need vitamin D to absorb calcium. Getting more vitamin D may help prevent falls in older people who are low in vitamin D.footnote 4 And some studies show that taking vitamin D may reduce the chances of breaking a bone.footnote 5 Talk to your doctor about how much vitamin D you should take to be sure you are getting enough.
Get weight-bearing exercise
Get regular weight-bearing exercise, such as walking, jogging, stair climbing, dancing, lifting weights, aerobics, and resistance exercises. These activities keep bones healthy by working the muscles and bones against gravity. To be most effective, weight-bearing exercises should be done for at least 150 minutes each week. Resistance exercises should be done 2 or 3 days a week.
Limit alcohol, and don't smoke
Along with exercise and diet, your doctor will recommend that you not smoke. And it's best to limit alcohol to no more than 2 drinks a day. For help with quitting smoking, see the topic Quitting Smoking.
In some cases, your doctor will prescribe medicines such as bisphosphonates to protect against bone loss.
After you have been diagnosed with bone loss, you will need to have regular follow-up tests to monitor the disease.
If you've had a fracture, speak to your health care provider about available fracture, osteoporosis or physiotherapy programs.
Treatment for compression fractures
Compression fractures from osteoporosis can cause significant back pain that lasts for several months. Treatments to relieve your pain include over-the-counter medicines such as acetaminophen and non-steroidal anti-inflammatory drugs as well as stronger prescription medicine.
If you have a fractured bone related to osteoporosis, treatment to slow your bone thinning becomes very important. If you have had a spinal fracture, you are at risk of having another.
You can maintain strong bones and help prevent osteoporosis with weight-bearing exercise and a diet rich in calcium and vitamin D. Young women in particular need to be aware of their risk for osteoporosis. They can take steps early to slow its progress and prevent complications.
A lot of physical activity during the preteen and teenage years increases bone mass and greatly reduces the risk of osteoporosis in adulthood.
Along with diet and exercise, prevention includes not smoking and limiting alcohol. For more information, see Home Treatment.
You can do a lot to slow bone loss and prevent broken bones.
Get enough calcium and vitamin D
Getting enough calcium and vitamin D is one of the first steps toward preventing or reducing the effects of osteoporosis. Vitamin D helps your body absorb calcium. Calcium is found in many foods such as milk, yogurt, canned salmon with bones, and fortified soy and other plant-based beverages.
If you think you may not be getting enough calcium in your diet, check with your doctor about taking calcium supplements.
Many Canadians do not get enough vitamin D from food only, and may need to take supplements. Osteoporosis Canada recommends that all Canadian adults take daily vitamin D supplements. Talk to your doctor about how you can get the right amount through supplements and what you eat.
The U.S. Food and Drug Administration (FDA) has taken action against companies that praise the benefits of coral calcium as a superior source of calcium and a cure for disease. There is no scientific proof to support these claims.
Weight-bearing exercises (walking, jogging, stair climbing, dancing, or weight lifting), aerobics, and resistance exercises (using weights or elastic bands to help improve muscle strength) are all effective in preventing osteoporosis. These kinds of exercise may also help reduce the risk of falling or of breaking a bone. For more information, see the topic Fitness.
Limit alcohol use
Heavy alcohol use can decrease bone formation. It also increases the risk of falling. Limit alcohol to no more than 2 drinks per day.
Smoking reduces your bone density and speeds up the rate of bone loss. For information on how to stop, see the topic Quitting Smoking.
Learn ways to prevent falls that might result in broken bones. Have your vision and hearing checked regularly. Wear slippers or shoes that have non-skid soles. Exercises that improve balance and coordination, such as tai chi, can also reduce your risk of falling. You can also make changes in your home to prevent falls.
Medicines are used to both prevent and treat osteoporosis. Some medicines slow the rate of bone loss or increase bone thickness.
Medicine for treatment and prevention
- Bisphosphonates. These include alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Aclasta).
- Denosumab (Prolia). It's used to treat people who are at high risk for bone fractures related to decreased bone density.
- Raloxifene (Evista). This medicine is a selective estrogen receptor modulator (SERM).
- Teriparatide (Forteo). It's used for the treatment of men and post-menopausal women who have severe osteoporosis and who are at high risk for bone fracture.
Hormone therapy is typically not recommended for most women who have osteoporosis. But if you are at high risk and cannot take other medicines, your doctor may recommend it under certain circumstances.
Hormone therapy for osteoporosis in women includes:
- Estrogen. Estrogen without progestin (estrogen therapy, or ET) may be used to treat osteoporosis in women who have gone through menopause and do not have a uterus. Because taking estrogen alone increases the risk for cancer of the lining of the uterus (endometrial cancer), ET is only used if a woman has had her uterus removed (hysterectomy).
- Estrogen and progestin. In rare cases, the combination of estrogen and progestin (hormone therapy, or HT) is recommended for women who have osteoporosis.
Medicine for pain from fractures
Compression fractures and other broken bones resulting from osteoporosis can cause significant pain that lasts for several months. Medicines to relieve this pain include:
- Non-prescription acetaminophen, such as Tylenol.
- Non-prescription non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. If you take NSAIDs regularly, your doctor may recommend that you also take a medicine such as a proton pump inhibitor (PPI) to protect your digestive system. But there is also a chance that PPIs can help cause osteoporosis. Talk to your doctor about taking NSAIDs and PPIs for long periods of time.
- An opioid pain reliever, such as codeine or morphine.
If spinal compression fractures are causing nerve roots to be compressed, your doctor may talk with you about having surgery to stabilize the crushed spinal bones (vertebrae).
If you get a hip fracture because of osteoporosis, you may need surgery to repair your hip. For more information, see the topic Hip Fracture.
Soy products have been tried to help reduce the chance of broken bones due to osteoporosis, but there is not strong evidence that these products help. But soy is a good source of non-dairy protein, so many people still choose to include it in their diets. (For example, 1 cup of soy beverage contains 7 to 11 grams of soy protein.)
There is not enough evidence to show if other natural products, such as black cohosh, work to reduce bone loss.
- Chapman-Novakofski K (2012). Nutrition and bone health. In LK Mahan, S Escott-Stump, eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 531–546. St. Louis: Saunders.
- Edwards BJ, et al. (2010). Functional decline after incident wrist fractures—Study of Osteoporotic Fractures: Prospective cohort study. BMJ. Published July 8, 2010 (doi:10.1136/bmj.c3324).
- Papaioannou A, et al. (2010). 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. Canadian Medical Association Journal, 182(17): 1864–1873. DOI: 10.1503/cmaj.100771. Accessed October 28, 2014.
- Gillespie LD, et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (11).
- Bischoff-Ferrari HA, et al. (2009). Prevention of nonvertebral fractures with oral vitamin D and dose dependency. Archives of Internal Medicine, 169(6): 551–561.
Other Works Consulted
- Avenell A, et al. (2014). Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database of Systematic Reviews (4). DOI: 10.1002/14651858.CD000227. Accessed October 22, 2014.
- Bell KJL, et al. (2009). Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: Secondary analysis of trial data. BMJ. Published online June 23, 2009 (doi:10.1136/bmj.b2266).
- Heiss G, et al. (2008). Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA, 299(9): 1036–1045.
- Howe TE, et al. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews (7).
- National Osteoporosis Foundation (2014). Clinician's guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation. http://nof.org/hcp/clinicians-guide. Accessed October 22, 2014.
- National Osteoporosis Foundation (accessed November 2012). Exercise for strong bones. Available online: http://www.nof.org/articles/238.
- Nelson HD, et al. (2010). Screening for osteoporosis: An update for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 153(2): 99–111.
- Newberry SJ, et al. (2012). Treatment to Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report. Comparative Effectiveness Review No. 53 (AHRQ Publication No. 12-EHC023-EF). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1006&pageaction=displayproduct.
- North American Menopause Society (2010). Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause, 17(1): 23–54. Also available online: http://www.menopause.org/aboutmeno/consensus.aspx.
- Qaseem A, et al. (2008). Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 149(6): 404–415. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.
Adaptation Date: 4/28/2022
Adapted By: HealthLink BC
Adaptation Reviewed By: HealthLink BC
Adaptation Date: 4/28/2022
Adapted By: HealthLink BC
Adaptation Reviewed By: HealthLink BC
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