Yourself, a family member, or a patient is affected by osteoporosis which is often referred to as the ‘silent disease’, which progresses quietly and is frequently undetected until you have a fracture.
The purpose of this article is to address the common frequently asked questions from those affected with osteoporosis disease and to highlight earlier signs so that you can act before it is too late.
I relied on:
1️⃣The most frequent question
2️⃣ My radiography knowledge about bone diseases and fractures.
3️⃣ In-depth research in medical literature, all references at the end of the article.
I hope this article will answer some of your questions, feel free to ask questions.
Happy reading!😃
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Jan 2025. Written by Juliet Semakula, a diagnostic.
Disclaimer: no affiliate links.
▶️What do we understand by the term osteoporosis?
Osteoporosis is a skeletal system health condition that weakens bones, making them fragile and more likely to break. It can develop slowly over the years.
It is a major clinical problem in older women and men, at this age almost any bone can fracture because of the increased bone fragility.it is irreversible, when you have it ,you have it for life.
It is important to note that the most serious complication of osteoporosis is fractures.
Image from: nia.nuh.gov/health /osteoporosis
▶️The different types of osteoporosis in adults
It’s always helpful to understand the different terms doctors use for osteoporosis based on when it starts or what causes it because treatment will depend on the type you have.
Here are the 4 types of osteoporosis:
1️⃣Primary stage or type I
This is when your bones become thinner but not enough to be considered osteoporosis. It’s characterised by excess osteoclast genesis leading to net bone loss and brittle fractures
2️⃣Secondary stage or type II
This occurs when you have certain medical conditions, such as diabetic, hyperparathyroidism, hyperthyroidism, or leukaemia.
It may also occur because of taking medicines known to cause bone breakdown, such as oral or high-dose inhaled corticosteroids
Is a rare form of osteoporosis that is present at birth. Osteogenesis imperfecta causes bones to break for no apparent reason.
4️⃣Idiopathic juveniles is rare.
It occurs in children between the ages of 8 and 14 or during times of rapid growth.
There is no known cause for this type of osteoporosis, in which there is too little bone formation or excessive bone loss. This condition increases the risk of fractures.
▶️What really causes osteoporosis?
1️⃣Hormonal imbalances.
Many hormones in our body affect bone turnover. If you have a disorder of the hormone-producing glands, you may have a higher risk of developing osteoporosis.
Hormone-related disorders that can trigger osteoporosis include:
🟣Overactive thyroid gland
🟣Reduced amounts of sex hormones (oestrogen and testosterone)
🟣Disorders of the pituitary gland
🟣Overactivity of the parathyroid glands (hyperparathyroidism)
2️⃣Nutritional deficiencies
🟣Having an eating disorder, such as anorexia or bulimia
🟣Heavy drinking and smoking
3️⃣Sedentary lifestyle choices for example:
🟣Long periods of inactivity, such as long-term bed rest
🟣A body mass index (BMI) of 19 or less
4️⃣Genetics and some medical conditions
🟣Having a family history of osteoporosis
🟣A parental history of hip fracture
🟣Rheumatoid arthritis
🟣Being on long-term use of high-dose steroid tablets (these are widely used for health conditions such as arthritis and asthma)
🟣Some medicines used to treat breast cancer and prostate cancer that affect hormone levels
▶️What are stages of osteoporosis
Osteoporosis usually progresses in four stages however the first two stages can be forerunners to the condition.
Stage 1️⃣: In this stage the bone will develop and lose bone formation at the same rate. This means the bone no longer makes more bone material than it should.
Usually at this stage you will have no symptoms.
Stage 2️⃣: At this stage you may have a lower bone mass or bone density than usual for your age. This stage is usually called osteopenia because the bone loss occurs faster than bone formation.
Despite this you may still not experience any symptoms, and your bones are less likely to fracture yet.
Stage 3️⃣: here your bone loss is likely exceeding your bone growth and putting them at a high risk of fractures.
At this stage a doctor may be able to diagnose you with osteoporosis and a minor fall at his stage can lead to a fracture.
You may still have no symptoms at this stage.
Stage 4️⃣: this is the most severe stage of osteoporosis, the risk of you having a bone fracture is very high and you may start having symptoms.
Image of stages of osteoporosis.
▶️How is osteoporosis treated and prevented?
There’s no cure for osteoporosis but there are steps you can take to slow or prevent its progress.
Several factors determine the treatment approach for osteoporosis, including the extent of the deformity, age at onset, personal preference and the treatment practices of the healthcare providers involved.
The medical advisory council of the British Menopause Society (Stevenson,2023) recently investigated prevention and treatment of osteoporosis especially in women.
They provided the following number of studies based on the prevention and treatment of osteoporosis.
Here are some of the treatment pharmacological interventions options.
Some of the interventions for the treatments and prevention of osteoporosis: source (Stevenson 2023)
These are all pharmacological interventions which I will not go into detail.
Caution! Treatment choice should be based on up-to-date evidence-based information and targeted to individual needs.
▶️What are 5 symptoms of osteoporosis you can start noticing in the early stages.
Early warning signs of osteoporosis can be very faint and progress quietly and they are frequently undetected until you probably broke a bone.
🟢You may start feeling pain from your spine, hips and wrists. Pain caused by spinal osteoporosis can affect many activities of your daily living.
The pain can range from a sudden, sharp, and severe pain from walking or simply standing and difficulty when you twist, turn, or bend.
🟢Loss of height and a curved (kyphosis) or stopped spine.
🟢You may have multiple bone fractures even from minor incidents. In some severe osteoporosis cases, fractures can even be triggered by a strong sneeze or cough.
🟢Disappearing gums and loss of bone density in the jawbones which makes it easy for bacteria to penetrate and affect the bone.
🟢You may start noticing brittle and weak fingernails which often break after a hand wash or any other manual work. This can be signs that you have low bone mineral density.
While osteoporosis itself does not cause fatigue, the pain and stress from managing fractures can lead to feelings of tiredness if left untreated.
▶️How to manage osteoporosis Pain?
People experience pain differently. Therefore, the way you choose to address the problem will vary.
The following options are available:
♦Relaxation techniques
♦Meditation sessions can help take your mind away from pain.
♦Gentle massage with a help of a physiotherapist if you can afford the cost
♦Light stretching/strengthening exercises if pain allows.
♦You can apply heat and ice to help relieve swelling and pain.
♦Acupuncture treatments if your doctor allows
♦Transcutaneous Electrical Nerve Stimulation (TENS)
♦Ultrasound
♦Use pain medication prescribed by your doctor.
♦You can wear a brace or support (only as a temporary measure)
♦Physical activity is good for your bones though it is understandable that often when you are in pain, you may not feel like moving.
But sitting still is not good for your bones or your pain. Find ways to move that accommodate your condition.
Walking, even if inside your home or apartment, is a desirable exercise because it forces your major bones to bear the weight of your body
As you feel stronger, you can begin a formal exercise program that incorporates other weight-bearing exercises.
▶️How do they diagnose osteoporosis?
Osteoporosis being a silent disease it is important to have a routine check especially if you are 50 years and above.
In the United States, the prevalence of osteoporosis increases from 15% in 50- to 59-year-old women to 70% in women aged 80 years (Srivastava 2002)
Both osteopenia and osteoporosis are diagnosed using a test that measures bone mineral density.
The most common test is called dual-energy X-ray absorptiometry (DEXA) and quantitative ultrasound.
A DEXA scan provides results such as bone mineral density and T-score, which compares your bone density to the highest possible value.
Thresholds for T-scores are defined as:
♦ Minus 1 or above – Normal
♦Lower than minus 1 and greater than minus 2.5 – Osteopenia
♦Minus 2.5 or lower – Osteoporosis
Woolf, 2003
If you have osteopenia, you’re at significant risk of developing osteoporosis.
▶️What do studies say about the life Expectancy in Patients Treated for Osteoporosis
We currently have several hundred studies devoted to the subject in the international medical literature. And several publications that summarise these studies
Studies on the mortality after being diagnosed with osteoporosis indexed in one of the largest databases of medical publications.
In one of the observational Cohort Study Using National Danish Prescription Data (Abrahamsen,2015)
The residual life expectancy of a 50-year-old man beginning osteoporosis treatment was estimated to be 18.2 years and that of a 75-year-old man was 7.5 years. Estimates in women were 26.4 years and 13.5 years, respectively.
According to the study the average life expectancy of osteoporosis patients is more than 15 years in women younger than 75 years and in men younger than 60 years.
Another research from other different countries explored from 1990 to 2019 show the highest disease burden disability adjusted life- years because of fractures but not mortality was accounted for in these percentages.
♦United states: 18.75 %
♦China: 25.59%
♦Japan: 8.35%
♦Germany:3.29%
♦India:3.04%
This means that because the higher percentages of fractures when you have osteoporosis is 1 in 5 people die because of the burden of these disabilities.
Keeping in mind that death also occurs in the following years in people of the same age who have not got osteoporosis.
Even though functional status slightly decreases with age it is possible to maintain a good quality of life for a long time if you develop tools for long-term management of the disease.
▶️How do we limit this mortality and the fracture rate?
Non-pharmacological interventions
🟠It’s important to maintain a balanced diet rich in calcium and vitamin D.
The effects of calcium and vitamin D supplements alone or in combination on fracture, however, are contradictory and may depend on the study population (Stevenson, 2023)
🟠Also to engage in regular weight-bearing exercises
The benefits are mainly related to increased wellbeing, muscle strength, postural stability and a reduction of chronic pain rather than an increase of skeletal mass.
Exercise must be structured carefully because of concerns about falls and fractures.
🟠Try to avoid smoking and excessive alcohol consumption.
🟠It is also vital to undergo regular bone density tests, especially after menopause to monitor bone health.
🟠Menopausal hormone therapy (MHT) effectively prevents osteoporosis and fractures, and it’s encouraged in those aged < 50 years
Yong, 2021
▶️What some people with osteoporosis had to say about their feelings and thoughts.
Feelings and thoughts about osteoporosis differ depending on how the condition affects your everyday life.
According to the health talk done by one of the osteoporosis clinics, people with osteoporosis had this to say.
🟠Several people who had been recently diagnosed felt ‘lucky’ to have had a diagnosis before developing serious osteoporosis-related health problems.
🟠Some people were afraid of falling and fracturing their bones. This forced some to stop doing sports, like skiing or jogging, because they did not want to take unnecessary risks.
🟠Some had low Self-esteem after being diagnosed with osteoporosis. They felt like they were losing control and realisation that they need to be dependent on others
🟠Some people were concerned about the future: the fear of becoming disabled and dependent on others
What do we learn from this?
Although osteoporosis fractures can be associated with physical disability, impaired quality of life, and increased mortality to certain individuals
It does not mean that you will not be able to live a normal life.
If you have just been diagnosed it is very normal to have questions and feel uncertain. But it’s also important to remember that many people with osteoporosis live full, rewarding lives.
▶️Some Reasons to Still Smile in Adulthood if you have osteoporosis
🟠You must be optimistic about the future and base your positive thoughts on the advances in osteoporosis treatments.
🟠Try to have regular appointments to monitor your condition and follow your doctor’s treatment plan
🟠Try to look after yourself and remember self-care is very important.
🟠Joining a support group is one of the best ways to realize you’re not alone. I think it helps when you are experiencing something like this to learn that others have been there too.
We have come to the end of this article; hope I have answered some of your questions on the subject.
I wish you a quick recovery,🙋 look after yourself and find the support you need.
📚Source:
Srivastava M, Deal C. Osteoporosis in elderly: prevention and treatment. Clin Geriatr Med. 2002 Aug;18(3):529-55. doi: 10.1016/s0749-0690(02)00022-8. PMID: 12424871.
Yong EL, Logan S. Menopausal osteoporosis: screening, prevention and treatment. Singapore Med J. 2021 Apr;62(4):159-166. doi: 10.11622/smedj.2021036. PMID: 33948669; PMCID: PMC8801823.
Zhang W, Gao R, Rong X, Zhu S, Cui Y, Liu H, Li M. Immunoporosis: Role of immune system in the pathophysiology of different types of osteoporosis. Front Endocrinol (Lausanne). 2022 Sep 6;13:965258. doi: 10.3389/fendo.2022.965258. PMID: 36147571; PMCID: PMC9487180.
Abrahamsen B, Osmond C, Cooper C. Life Expectancy in Patients Treated for Osteoporosis: Observational Cohort Study Using National Danish Prescription Data. J Bone Miner Res. 2015 Sep;30(9):1553-9. doi: 10.1002/jbmr.2478. Epub 2015 May 21. PMID: 25663501.
Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56. Epub 2003 Nov 14. PMID: 14710506; PMCID: PMC2572542.
Shen Y, Huang X, Wu J, Lin X, Zhou X, Zhu Z, Pan X, Xu J, Qiao J, Zhang T, Ye L, Jiang H, Ren Y, Shan PF. The Global Burden of Osteoporosis, Low Bone Mass, and Its Related Fracture in 204 Countries and Territories, 1990-2019. Front Endocrinol (Lausanne). 2022 May 20;13:882241. doi: 10.3389/fendo.2022.882241. PMID: 35669691; PMCID: PMC9165055.