Osteoporosis is a condition that causes bones to become porous, weak, and prone to fractures. It often develops silently over time, showing no symptoms until a bone break occurs. In the United States, nearly 10 million people are affected, with women making up about 80% of those cases. About one in four women aged 65 and older has osteoporosis.

The main driver of bone loss is reduced estrogen production during and after menopause. Estrogen plays a key role in maintaining bone density, and lower levels cause bone mass to decrease, making fractures more likely.

Osteoporosis Types

There are three main types of osteoporosis, depending on what causes bone loss: primary, secondary, and idiopathic.

Primary osteoporosis
This is the most common form and results from aging. As estrogen levels decline in both men and women, bone breakdown accelerates faster than bone rebuilding, leading to weaker bones.

Secondary osteoporosis
This type occurs due to an underlying medical condition or long-term medication use. Common causes include:

  • Autoimmune disorders (e.g., rheumatoid arthritis, multiple sclerosis)

  • Diabetes

  • Gastrointestinal conditions (e.g., celiac disease, inflammatory bowel disease)

  • Hormonal or metabolic disorders

  • Blood-related diseases (e.g., multiple myeloma, HIV)

Certain medications, such as corticosteroids, SSRIs, and antiretroviral drugs, can also contribute to bone loss.

Idiopathic osteoporosis
A rare form that affects premenopausal women, men under 50, and children. The exact cause is unknown, but genetic and hormonal factors are suspected.

Osteoporosis Symptoms

Osteoporosis is often called a “silent disease” because bone loss occurs without noticeable symptoms. Many people don’t realize they have it until a minor fall leads to a fracture.

As the condition progresses, you may notice:

  • Gradual loss of height

  • Stooped or hunched posture

  • Sudden back pain

  • Fragility fractures (from minor injuries)

  • Bones that break easily or heal slowly

Fractures most often occur in the spine, hip, wrist, and upper arm.

Causes

Bone tissue constantly renews itself through a balance of bone breakdown and formation. When this process slows or becomes unbalanced, bone density declines.

Common causes include:

  • Estrogen loss: Reduced hormone levels during menopause weaken bones.

  • Nutritional deficiencies: Low intake of calcium, vitamin D, or protein.

  • Sedentary lifestyle: Lack of weight-bearing exercise.

  • Eating disorders: Poor nutrition limits bone development.

  • Medical conditions: Certain diseases accelerate bone loss.

Approximately 90% of peak bone mass in women develops before age 18, meaning early deficiencies can increase future osteoporosis risk.

Risk Factors

Certain factors can increase your risk of developing osteoporosis, including:

  • Aging and menopause (especially before age 45)

  • Family history of fractures

  • Low body weight

  • Tobacco or alcohol use

  • Long-term corticosteroid use

  • Autoimmune or metabolic conditions

  • Air pollution exposure

  • High stress levels

  • Poor diet or limited physical activity

Diagnosis

Early diagnosis is key to preventing fractures.

Bone Density Test (DXA):
Women aged 65 and older—or younger postmenopausal women with risk factors—should undergo a dual-energy X-ray absorptiometry (DXA) scan. This test measures bone mineral density (BMD) and helps determine fracture risk.

Additional evaluations may include:

  • Standard X-rays: To detect existing fractures.

  • CT scans: To assess spine bone structure.

  • Blood tests: To check calcium, vitamin D, and hormone levels.

Osteoporosis Treatments

While osteoporosis cannot be completely cured, treatments can slow bone loss, strengthen existing bone, and prevent fractures.

Medications commonly used include:

  • Bisphosphonates: Slow bone breakdown and preserve density.

  • Calcitonin: Helps regulate calcium and reduce bone resorption.

  • Denosumab: Prevents bone loss in postmenopausal women (injection).

  • Estrogen therapy: May protect bones but carries risks of clots and cancer.

  • SERMs (Selective Estrogen Receptor Modulators): Mimic estrogen’s bone-protective effects.

  • Teriparatide: A synthetic parathyroid hormone that stimulates new bone formation.

Lifestyle recommendations:

  • Increase calcium and vitamin D intake.

  • Engage in weight-bearing and resistance exercises to strengthen bone and muscle.

Prevention

Preventing osteoporosis begins decades before it develops. Building strong bones in early adulthood is crucial.

Practical prevention tips:

  • Quit smoking: Nicotine accelerates bone loss.

  • Eat calcium-rich foods: Dairy, leafy greens, soy, and fortified cereals.

  • Get enough vitamin D: Found in fatty fish (salmon, tuna, mackerel) and sunlight.

  • Maintain a healthy weight: Both underweight and obesity raise fracture risk.

  • Exercise regularly: Include resistance and weight-bearing activities like walking, stair climbing, or dancing.

  • Limit alcohol and caffeine: Excessive intake can interfere with calcium absorption.

Related Conditions

Osteoporosis often appears alongside other chronic diseases:

  • Breast cancer: Certain therapies reduce estrogen levels, increasing bone loss.

  • Celiac disease: Nutrient malabsorption weakens bones.

  • Eating disorders: Restrictive diets lead to hormonal imbalance and bone fragility.

  • Inflammatory bowel disease (IBD): Impaired nutrient absorption and corticosteroid use accelerate bone loss.

  • Rheumatoid arthritis: Chronic inflammation and glucocorticoid use increase fracture risk.

  • Type 1 diabetes: High blood sugar and metabolic dysfunction weaken bone tissue.

Living With Osteoporosis

Osteoporosis can cause anxiety about movement or falls, but staying active and maintaining a positive mindset is vital for long-term well-being.

Coping strategies:

  • Pain management: Use heat/cold therapy, massage, or acupuncture.

  • Positive affirmations: Remind yourself of your progress and self-care efforts.

  • Social connection: Engage with supportive friends and family.

  • Safe physical activity: Choose low-impact exercises to maintain flexibility and balance.

With the right care and awareness, many people with osteoporosis live full, active, and independent lives.