Osteoporosis

What is Osteoporosis?

"Osteoporosis" comes from the Greek words for "porous bone." "Osteopenia" means less bone — a milder degree of bone loss than osteoporosis. Both conditions increase the risk of breaking a bone from minor injuries such as a trip and fall, or even from everyday activities like coughing, sneezing, or bending over.

Osteoporosis has sometimes been called the "silent disease" because most people with the condition experience no symptoms until a fracture occurs. In fact, about two-thirds of spinal fractures caused by osteoporosis go undiagnosed because they cause no obvious symptoms or are mistaken for ordinary back pain.

Bone is a living tissue that is constantly being broken down and rebuilt by the body. Osteoporosis develops when the body breaks down bone faster than it can rebuild it, leading to bones that are thinner, weaker, and more likely to fracture. The bones most commonly affected include the hip, spine, wrist, shoulder, and pelvis. 

How is Bone Density Change Over Time?

Throughout childhood and young adulthood, the body builds bone faster than it breaks it down. Most people reach their peak bone strength — the strongest their bones will ever be — by their late 20s to early 30s. After that, bone density gradually declines.

For women, bone loss accelerates significantly after menopause (typically around age 50) due to the drop in estrogen, a hormone that helps maintain bone strength. This accelerated bone loss can also occur earlier in women who have had their ovaries surgically removed or who experience premature menopause for other reasons.

Men can also develop osteoporosis, though it is less common. About 1 in 5 men over age 50 will experience an osteoporotic fracture in their lifetime. Fractures in men are associated with higher rates of complications and death compared with women.

What Are the Risk Factors?

Many factors can increase the risk of developing osteoporosis. Some cannot be changed, while others can be managed:

Risk factors you cannot change:

• Age (risk increases as you get older)

• Female sex

• Family history, especially a parent who fractured a hip

• Small body frame or low body weight

• Race/ethnicity (White and Asian women are at highest risk, though osteoporosis affects all groups)

• Early menopause (before age 45) or surgical removal of the ovaries

Risk factors you can manage or treat:

• Low calcium or vitamin D intake

• Lack of physical activity

• Smoking

• Excessive alcohol use (3 or more drinks per day)

• Long-term use of certain medications, especially corticosteroids (such as prednisone)

• Certain medical conditions, including rheumatoid arthritis, thyroid disorders, celiac disease, inflammatory bowel disease, chronic kidney disease, and eating disorders

One of the strongest risk factors is having already broken a bone as an adult, especially from a minor fall or injury. A prior fracture nearly doubles the risk of having another fracture.

How is Osteoporosis Diagnosed?

The primary tool for diagnosing osteoporosis is a DXA scan (dual-energy X-ray absorptiometry, sometimes written as "DEXA"). This painless, low-radiation scan measures bone mineral density, usually at the hip and spine. The test takes about 10 to 15 minutes and requires no special preparation.

Results are reported as a T-score, which compares your bone density to that of a healthy young adult:

• A T-score of −1.0 or above is considered normal bone density

• A T-score between −1.0 and −2.5 indicates osteopenia (low bone mass)

• A T-score of −2.5 or lower indicates osteoporosis

Osteoporosis can also be diagnosed if you have had a fracture of the hip, spine, or multiple bones from a minor fall, even without a DXA scan.

Regular X-rays are not sensitive enough to detect bone loss until 30% to 50% of bone has already been lost, which is why a DXA scan is so important for early detection.

Who Should be Screened?

The U.S. Preventive Services Task Force (2025) recommends:

• All women aged 65 and older should have a DXA scan

• Postmenopausal women younger than 65 who have risk factors for osteoporosis should also be screened

• For men, there is currently not enough evidence to make a universal screening recommendation, but many medical organizations recommend screening men aged 70 and older, or younger men with significant risk factors

After the initial scan, a repeat DXA is typically recommended every 2 years to monitor changes in bone density.

Fracture Risk Assessment (FRAX)

In addition to the DXA scan, your provider may use a tool called FRAX (Fracture Risk Assessment Tool). FRAX uses your personal risk factors — with or without your DXA results — to estimate your chance of breaking a bone in the next 10 years. This helps your provider decide whether you would benefit from medication, even if your bone density is only mildly reduced (osteopenia). Treatment is generally recommended if your 10-year risk of a hip fracture is 3% or higher, or your risk of any major osteoporotic fracture is 20% or higher.

Dr. Datta took the time to thoroughly explain his findings from my MRI and explained in a way I could understand. He did not rush through my appointment and made sure he answered all my questions. He and his staff were kind, caring, and professional.

Warning Signs of Osteoporosis

Because osteoporosis is often silent, it is important to be aware of subtle signs that may indicate bone loss or an undiagnosed spinal fracture:

• Loss of height (more than 1.5 inches over time)

• A stooped or hunched posture (kyphosis)

• Sudden or unexplained back pain

• A fracture that occurs from a minor fall, bump, or even routine activity

If you notice any of these signs, talk to your provider about getting evaluated.

How is Osteoporosis Treated?

Treatment for osteoporosis has advanced significantly. The goal is to strengthen bones, slow bone loss, and reduce the risk of fractures. Treatment is tailored based on how high your fracture risk is.

Lifestyle and Non-Drug Measures (for everyone)

These steps are recommended for all people with osteoporosis or at risk for it:

• Calcium and vitamin D: Getting enough calcium and vitamin D is important for bone health. Good dietary sources of calcium include dairy products, fortified beverages, canned fish with bones, and leafy greens. Vitamin D can be found in fortified milk, eggs, and fatty fish. Talk to your provider about whether your diet provides enough calcium and vitamin D or whether a supplement might be appropriate for you — the right amount varies from person to person, and taking too much can carry risks.

• Exercise: Regular weight-bearing exercise (such as walking, jogging, dancing, or stair climbing) and muscle-strengthening exercises (such as squats, push-ups, or resistance bands) help maintain bone strength and reduce fall risk. Balance exercises (such as standing on one foot or heel raises) are also important.

• Fall prevention: Have your vision checked regularly, remove tripping hazards at home, use handrails, ensure good lighting, and consider physical therapy or balance training if you are unsteady.

• Quit smoking and limit alcohol to no more than 2 drinks per day.

Medications

Your provider will choose a medication based on your level of fracture risk. There are two main categories of osteoporosis drugs:

Antiresorptive medications — these slow down bone loss:

• Bisphosphonates are the most commonly prescribed first-line treatment. They reduce the risk of spinal fractures by 36% to 56% and hip fractures by 26% to 42%. Options include:

  • Alendronate (Fosamax) — a weekly pill

  • Risedronate (Actonel) — a weekly or monthly pill

  • Zoledronic acid (Reclast) — an intravenous infusion given once a year

  • Oral bisphosphonates must be taken on an empty stomach with a full glass of water, and you must remain upright for at least 30 minutes afterward to prevent irritation of the esophagus.

• Denosumab (Prolia) — an injection given under the skin every 6 months. It is an option for people who cannot take bisphosphonates. It reduces spinal fractures by about 68% and hip fractures by about 40%. Important: if denosumab is stopped, bone loss can occur rapidly, so transitioning to another medication is essential.

Bone-building (anabolic) medications — these stimulate new bone growth and are reserved for people at very high fracture risk (such as those with recent spinal or hip fractures, multiple fractures, or very low bone density):

• Teriparatide (Forteo) — a daily self-injection for up to 2 years

• Abaloparatide (Tymlos) — a daily self-injection for up to 2 years

• Romosozumab (Evenity) — a monthly injection for 1 year. This medication should not be used in people who have had a heart attack or stroke within the past year.

After completing a course of a bone-building medication, it is essential to follow up with an antiresorptive medication (such as a bisphosphonate or denosumab) to maintain the bone gains. Research shows that starting with a bone-building drug first, then switching to an antiresorptive, produces better results than the reverse order.

Calcitonin (Miacalcin) is an older medication that is now considered a last resort, used only when all other treatments have caused side effects. It is much less effective than the medications listed above.

What Happens After a Fracture?

If you have already had a fracture, it is critically important to be evaluated and treated for osteoporosis. Having one fracture significantly increases the risk of having another — this risk is highest in the first 1 to 2 years after a fracture.

Spinal compression fractures are the most common type of osteoporotic fracture. They can be triggered by ordinary activities such as lifting a light object, turning in bed, or even coughing. While many are painless, they can cause back pain, loss of height, a hunched posture, and reduced ability to perform daily activities. Treatment usually involves pain management, physical rehabilitation, and osteoporosis medication. In cases where pain persists despite conservative treatment, procedures such as vertebroplasty or kyphoplasty may be considered.

Key Takeaways

• Osteoporosis is common — 1 in 3 women and 1 in 5 men over age 50 will experience an osteoporotic fracture in their lifetime

• It is a silent condition — screening with a DXA scan is the best way to detect it early

• Effective treatments are available that can significantly reduce fracture risk

• Lifestyle measures — adequate calcium and vitamin D, regular exercise, fall prevention, and avoiding smoking and excessive alcohol — are the foundation of bone health at every age

• If you have had a fracture, talk to your provider about osteoporosis evaluation and treatment right away — the risk of another fracture is highest in the first 1 to 2 years

Contact a Spine Specialist for Osteoporosis Treatment

Our osteoporosis specialists in Arizona provide diagnosis and treatment for osteoporosis so that you can live a more comfortable and mobile life. Contact Sonoran Spine Center and make an appointment to see a doctor for your osteoporosis.