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.
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
affects millions of older adults. It usually strikes after age 60. It's most
common in women, but men can get it too.
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.
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
Your doctor will ask about your symptoms and do a physical exam. 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
osteopenia. It's a less severe type of bone thinning.
It's important to find and treat osteoporosis early to prevent
bone fractures. Experts advise bone density testing for women age 65 and older. If you have a higher
risk for fractures, it's best to start getting the test sooner.
Treatment for osteoporosis includes medicine to reduce bone loss and to
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, and milk (for calcium). Eat
eggs, fatty fish, and fortified cereal (for vitamin D).
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.
Learning about osteoporosis:
Living with osteoporosis:
Health Tools help you make wise health decisions or take action to improve your health.
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
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
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,
In a normal, healthy adult,
bone is constantly absorbed into the body and then
rebuilt. During childhood and the teen 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
After age 30, people lose a small amount of bone each year.
A person with thinning bones may be diagnosed with lower-than-normal bone
mass (osteopenia). Osteopenia sometimes
progresses to osteoporosis.
When bones thin, they lose strength
and break more easily. The bones that break most often due to osteoporosis are:
In women, bone loss increases when the ovaries reduce
estrogen, a hormone that protects against bone loss.
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.
Things that increase the risk of osteoporosis include:
Other risk factors include:
The World Health Organization (WHO) has created a tool called FRAX. 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.sheffield.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.
Call your doctor right away if you:
Call your doctor for an appointment if you:
If you are nearing age 65, have
osteopenia, or think that you are at high risk for
osteoporosis, talk with your doctor about your concerns.
If you do not 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
Health professionals who can evaluate your symptoms
and risk of osteoporosis include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
A diagnosis of
osteoporosis is based on your
medical history, a physical exam, and a test to
measure your bone thickness (density).
You will 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
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:
Experts recommend that all women 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.3 The U.S. Preventive Services Task Force (USPSTF) recommends that you and your doctor check your fracture risk using a tool such as FRAX 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.
The FRAX tool was developed by the World Health Organization to 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.sheffield.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.
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.
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
Your doctor likely will recommend that you eat foods rich in
vitamin D. 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.4 And some studies show that taking vitamin D may reduce the chances of breaking a bone.5 Talk to your doctor about measuring your vitamin D to be sure you are getting enough.
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 30 minutes most days of the week. Resistance exercises should be done 2 or 3 days
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 men and no more than 1 drink a day for women. For help with
quitting smoking, see the topic
In some cases,
your doctor will prescribe medicines such as bisphosphonates or hormones 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.
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 nonsteroidal anti-inflammatory drugs as well as stronger prescription medicine.
Your doctor may also suggest a back brace or corset to support your
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 build 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
A lot of physical activity during the preteen and teen 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.
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, including dairy products such as milk
If you think you may not be getting enough calcium in your diet, check with your doctor about taking
Experts recommend that you choose supplements that
are known brand names with proven reliability. Most brand-name calcium products
are absorbed easily by the body. 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 increasing bone
density and strength. These kinds of exercise may also help reduce the risk of falling or of breaking a bone. For more information, see the topic
Heavy alcohol use
can decrease bone formation. It also
increases the risk of falling. Heavy alcohol use is more than 2
drinks a day for men and more than 1 drink a day for women.
Smoking reduces your bone density
and speeds up the rate of bone loss. For information on how to stop, see the
Learn ways to prevent falls that might result in broken bones. Have your vision and
hearing checked regularly. Wear slippers or shoes that have nonskid 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
osteoporosis. Some medicines slow the rate of bone
loss or increase bone thickness. Even small amounts of new bone growth can
reduce your risk of broken bones.
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. If you continue to
have bone loss while taking a bisphosphonate, such as alendronate (Fosamax) or risedronate
(Actonel), you may need to take both bisphosphonate
medicine and hormone therapy.
Hormone therapy for osteoporosis
in women includes:
and other broken
bones resulting from osteoporosis can cause significant pain that lasts for
several months. Medicines to relieve this pain include:
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
If you get a hip fracture because of osteoporosis,
you may need surgery to repair your hip. For more information, see the topic
Your doctor may recommend
physical therapy. Your physical therapist may teach
you how to safely do
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 nondairy protein, so many people still choose to include it in their diets. (For example, 1 cup of soy milk contains 7 to 11 grams of soy protein.)
not enough evidence to show if other natural products, such as black cohosh,
work to reduce bone loss.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
The National Institute on Aging (NIA), one of the
centers of the U.S. National Institutes of Health, leads a broad scientific
effort to understand the nature of aging and to extend the healthy, active
years of life. The NIA funds research and provides information about health and
research advances to the public and interested groups.
The National Osteoporosis Foundation (NOF) funds
research and publishes educational material about osteoporosis for consumers
and health professionals. The NOF also provides information about bone density
testing sites, new treatment, and local groups interested in osteoporosis. The
foundation's mission is to prevent osteoporosis, promote lifelong bone
health, help improve the lives of those affected by osteoporosis and related
fractures, and find a cure.
The NIH Osteoporosis and Related Bone Diseases—National
Resource Center is a government resource center that helps health
professionals, patients, and the public learn about and locate current
information on metabolic bone diseases such as osteoporosis, Paget's disease,
osteogenesis imperfecta, and hyperparathyroidism.
The North American Menopause Society (NAMS) is a nonprofit
organization that promotes the understanding of menopause and thereby improves
the health of women as they approach menopause and beyond. NAMS members include
experts from medicine, nursing, sociology, psychology, nutrition, anthropology,
epidemiology, pharmacy, and education. The NAMS website has information on
perimenopause, early menopause, menopause symptoms and long-term health effects
of estrogen loss, and a variety of therapies.
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).
U.S. Preventive Services Task Force (2011). Screening for Osteoporosis: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.
Gillespie LD, et al. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (2).
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
American Association of Clinical Endocrinologists (2003). Medical guidelines for clinical practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocrine Practice, 16(Suppl 3): 1–37.
Becker C (2011). Diseases of calcium metabolism and metabolic bone disease. In EG Nabel, ed., ACP Medicine, section 5, chap. 4. Hamilton, ON: BC Decker.
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).
Liu H, et al. (2008). Screening for osteoporosis in men: A systematic review for an American College of Physicians guideline. Annals of Internal Medicine, 148(9): 685–701.
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:
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.
Vondracek SF, Hansen LB (2004). Current approaches to the management of osteoporosis in men. American Journal of Health-System Pharmacists, 61(17): 1801–1811.
November 6, 2012
Kathleen Romito, MD - Family Medicine
& Carla J. Herman, MD, MPH - Geriatric Medicine
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