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Osteoporosis
What is osteoporosis?
Osteoporosis is a very common condition that affects the metabolism of bones. Its main feature is fragile bones, due to reduced bone density. Today, it is estimated that 1 in 3 women and 1 in 5 men over the age of 50 have osteoporosis.
It is often called a “silent disease” because in 2 out of 3 patients there are no symptoms. Over time, however, osteoporosis can cause loss of height, kyphosis (hunched back), and chronic pain. Because the bones are weaker, fractures can occur more easily after a fall—especially in the spine, hip, and wrist.
What causes osteoporosis?
Bone density decreases naturally with age and can be worsened by lack of calcium, vitamin D, magnesium, and other nutrients.
Other important risk factors include:
- Gender: Women are at higher risk, especially after menopause due to hormonal changes. Men can also develop osteoporosis, usually 10–20 years later than women.
- Ethnicity: People of Caucasian or Asian descent are more prone.
- Family history: If osteoporosis runs in the family, the risk is higher.
- Lifestyle: Poor diet, smoking, lack of exercise, and excessive alcohol increase risk.
- Medical conditions and medications: Disorders like Cushing’s syndrome, hyperthyroidism, and digestive problems (e.g., lactose intolerance) can contribute.
How is osteoporosis diagnosed?
The main test is a bone density scan called DEXA (Dual Energy X-Ray Absorptiometry). It is quick, painless, and very accurate. Another test, QCT (Quantitative CT), can also measure bone density but is less commonly used.
Can osteoporosis be prevented?
Yes. Prevention is the best treatment. Key steps include:
- A diet rich in calcium and vitamin D
- Regular exercise
- Avoiding smoking and excess alcohol
What treatments are available?
For people with established osteoporosis, medications can strengthen bones and increase bone density. The most common options are:
- Bisphosphonates
- Estrogen therapy (used less often now due to side effects)
- Parathyroid hormone (Forsteo®)
- Denosumab (Prolia®), a monoclonal antibody
Osteoporosis and spinal fractures
Osteoporosis is often underdiagnosed and undertreated. Many patients first discover it after suffering a fracture.
- In the U.S., about 24 million people have osteoporosis (10% of the population).
- Every year, 700,000 patients develop spinal fractures.
- Only 1 in 3 spinal fractures cause noticeable pain, but even painless ones can lead to loss of height, spinal deformity, mobility problems, and reduced quality of life.
Patients with one spinal fracture are 5 times more likely to suffer another.
Symptoms and complications
- Kyphosis (hunched back): Caused by multiple spinal fractures, leading to posture changes, breathing problems, digestive issues, and increased risk of more fractures.
- Chronic back pain: From repeated micro-fractures or spinal collapse.
- Height loss: Both real (shortened vertebrae) and compensatory (bending of hips/knees).
- In severe cases, bone fragments may press on the spinal cord, causing neurological problems.
Treatment of spinal fractures
Conservative treatment includes:
- Pain management
- Braces
- Limited bed rest (prolonged immobility worsens osteoporosis)
If pain persists, minimally invasive surgeries such as vertebroplasty or kyphoplasty may be performed. In these procedures, bone cement is injected into the fractured vertebra, stabilizing it and relieving pain.
Important note
Treatment for osteoporosis is lifelong—similar to treatment for high blood pressure. Unfortunately, some dentists stop osteoporosis medications before dental implants, which can dangerously increase the risk of spinal fractures. Any treatment interruption should only be short-term and carefully considered.
In summary
Osteoporosis is common but preventable. With early diagnosis, proper medication, healthy lifestyle changes, and modern surgical options when needed, patients can maintain mobility, reduce fracture risk, and live healthier lives.
Frequently Asked Questions about Osteoporosis
Can osteoporosis be cured?
For established osteoporosis, there are several medications that can strengthen the bones and increase bone density. However, osteoporosis treatment is lifelong, just like the treatment of high blood pressure, and any break in treatment should be short and carefully considered.
Is there a treatment for osteoporosis without medication?
The best way to deal with osteoporosis is prevention. A change in lifestyle, a diet rich in calcium and vitamin D, exercise and avoiding smoking and alcohol are key for bone density, while physical exercise also helps improve posture and prevent falls. When osteoporosis is established, medical treatment includes calcium with vitamin D and medications that strengthen the bones.
What are the symptoms of osteoporosis?
Osteoporosis is considered a silent disease, as two out of three patients have no symptoms. It often shows up with an osteoporotic fracture, followed by pain in the upper or lower back, loss of height and kyphosis. Because of the reduced bone density, fractures of the spine, hip and wrist happen more easily after falls.
Which test shows if I have osteoporosis?
The diagnosis is made by measuring bone density with DEXA (Dual-Energy X-ray Absorptiometry), an easy, quick and painless test, like a simple X-ray, that can detect as little as 1% loss of bone mass. It is recommended after a low-energy fracture, for all women over 65 who are not taking osteoporosis medication and for postmenopausal women aged 50–65 with one risk factor for osteoporosis.
How is an osteoporotic fracture of the spine treated?
The standard treatment is pain relief until the fracture heals, together with treatment of the osteoporosis itself. If the pain persists despite treatment, surgery with the minimally invasive methods of vertebroplasty or kyphoplasty may be considered: bone cement is injected through a needle, which immediately stabilizes the fracture and relieves the pain. You can find more on the Spinal Fracture page.
Do men get osteoporosis too?
Yes. It is estimated that one in five men over 50 has osteoporosis, compared with one in three women. Women are at higher risk because of their lower bone mass and the hormonal changes of menopause, while in men osteoporosis appears one to two decades later.