Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 29, 2016

Millions of people worldwide suffer from osteoporosis, and even more are at risk for developing the condition soon. This metabolic bone disease can make the senior years for more difficult for an elderly person, because it tends to worsen with age. Since more people are living past the age of 75, due to advances in modern healthcare, the epidemic of osteoporosis is becoming extremely problematic.


Definition & Facts

Osteoporosis belongs in the category of metabolic bone diseases, and it causes the bones of the body to become brittle and weakened. This greatly increases the risk of bones breaking during minor falls or even just daily movement. Hip fracture or spinal fractures are most common, but osteoporosis can cause fractures in any of the bones.

Every year, about 1.5 million fractures occur due to osteoporosis. Roughly 80 percent of all people who have osteoporosis are women, and it primarily occurs among people who are Hispanic, Asian American, Caucasian, or Native American. Asian American postmenopausal women are the demographic that is most likely to develop osteoporosis.

Symptoms & Complaints

Part of the reason that osteoporosis is so harmful is because there are often no symptoms during the early stages of the condition. At most, patients in the early stages of osteoporosis may feel a small amount of back pain. Many people do not even get diagnosed with osteoporosis until they end up fracturing a bone in an unusual way, such as taking a step down a stair or coughing.

Osteoporosis often affects the spine, and small vertebral compression fractures can occur along vertebrae. These fractured vertebrae may go essentially unnoticed, because sometimes they only result in a very minor amount of soreness.

Over time, a person with osteoporosis will often start to gradually lose height due to these tiny fractures. Compressed vertebrae may also result in stooped posture, as the upper back curves slightly. This stooped posture may result in more complaints of back or neck pain, and breathing can be affected.


Osteoporosis is caused by the bones losing density, and this can be due to a variety of issues. The bones of the body are a living tissue that is constantly being broken down and built up again. A special form of bone cell, osteoclasts break down bone cells that are damaged, and osteoblasts, a different type of cell, build up new bone tissue.

Bones are never solid, but as osteoporosis sets in, the bones develop larger spaces between clusters of tissue. In secondary osteoporosis, this loss of density is due to a diagnosed medical condition, including bone marrow disease, inflammatory disorders, endocrine diseases, or taking certain corticosteroids.

In primary osteoporosis, the relationship between osteoclasts and osteoblasts gradually gets off balance as people age, and they lose bone density without a medical condition. Certain levels of hormones and nutrients tend to contribute to primary osteoporosis. If a person does not have enough calcium for essential bodily functions, the body will leach calcium from the teeth and bones, causing osteoporosis.

Since vitamin D is necessary for calcium absorption, vitamin D deficiency can also cause osteoporosis. Women are far more likely to develop osteoporosis than men because hormones have a massive impact on bone growth. When estrogen decreases, more osteoclasts are produced, causing bone to break down more rapidly. Therefore, postmenopausal women particularly have issues with osteoporosis.

Diagnosis & Tests

To diagnose osteoporosis, a doctor will often take a complete medical history to see if the patient’s family has a history of osteoporosis, if the patient has risk factors for osteoporosis, or if the patient is presenting any symptoms of osteoporosis. The first step to diagnosing osteoporosis is often taking height measurements to see if a person is gradually getting shorter.

Blood tests may also indicate heightened metabolic activity that may be due to the body breaking down bone. If the doctor determines that their patient is at risk of possibly having osteoporosis, then they will often schedule a DXA bone mineral density test. In this test, a DXA scan uses very low levels of X-rays to measure the density of the hips and spine.

The results are then compiled into two different scores. The T score compares the patient’s bone density to a young adult’s density, and it can range from more than -1, indicating normal bone mass, to less than -2.5, indicating osteoporosis. The Z score compares the patient’s bone density to the density of someone who is the same age and gender as the patient. A Z score of below -2 indicates that there may be an underlying cause, which is not just old age, for the lower bone density.

Treatment & Therapy

Most osteoporosis treatments involve trying to slow or halt the rate of bone density loss. If a person is not likely to break a bone due to osteoporosis in the next ten years, doctors may just recommend lifestyle changes, such as taking vitamin supplements and avoiding risk factors.

If the bone density loss is more severe, bisphosphonates are often prescribed. Effective prescription drugs include risedronate, ibandronate, alendronate, and zoledronic acid. For postmenopausal women, hormone therapy to replace lost estrogen can help to halt osteoporosis.

Prevention & Prophylaxis

Starting osteoporosis prevention at an early age is the best way to avoid issues later in life. People between the age of 18 and 50 need at least 1,000 milligrams of calcium each day, and women over the age of 50 or men over the age of 70 need 1,200 milligrams per day. In addition to calcium, a vitamin D supplement of 800 IU a day is also helpful.

There is research to suggest that regular exercise, particularly weight training exercises, can also prevent bone density loss. In addition to taking these measures, people should also avoid smoking or drinking excessive alcohol, because both of these habits can negatively affect bone formation.