What Are the First Signs of Osteoporosis?

The main cause of osteoporosis is a loss of estrogen in women, which often occurs during menopause and is why about 80% of all cases of osteoporosis occur in women. 

Other causes of osteoporosis include: 

• Certain diseases that hinder bone growth
  • Hyperthyroidism
  • Adrenal gland disorders (Cushing's syndrome)
  • Pituitary gland disorders
  • Diabetes
  • Eating disorders
  • Autoimmune disorders 
  • Digestive and gastrointestinal disorders
  • Some cancers (breast, prostate, leukemia and lymphoma)
  • Blood disorders such as sickle cell disease
  • Spinal cord injuries 
  • Premature menopause
  • Low levels of testosterone and estrogen in men
• Medical procedures
  • Weight loss surgery
  • Gastrectomy
• Certain medications that diminish the bones' ability to rebuild themselves
  • Steroids
  • Excess thyroid hormone replacement
  • The blood thinners heparin
  • Some anticonvulsants
  • Aromatase inhibitors used to treat breast cancer
• Inadequate calcium early in life which results in insufficient bone growth during youth
• Poor diet, including malnutrition
• Genetic factors
  • Higher risk if family members had osteoporosis
  • Small, thin body types may be predisposed to developing osteoporosis

Screening for osteoporosis is recommended for women 65 years and older and for women under 65 who have gone through menopause and have risk factors for osteoporosis, such as past bone fractures, certain medical conditions, use of certain medications, smoking, or alcohol use. 

The FRAX tool is an osteoporosis risk assessment test that uses information about a patient’s bone density and other risk factors for breaking a bone to estimate their 10-year fracture risk. 

Screening for osteoporosis involves physical examination, patient history, and bone density tests. 

Tests used to diagnose osteoporosis include: 

• Bone mineral density (BMD) test
• Dual energy X-ray absorptiometry (DXA), a type of bone scan
• Biochemical marker tests
• X-rays
• Vertebral fracture assessments (VFAs)

Treatment for osteoporosis usually includes medication or hormonal therapy. 

Medications used to treat osteoporosis include: 

• Bisphosphonates
  • Used to slow the breakdown and removal of bone (resorption)
    • Alendronate (Binosto, Fosamax) 
    • Risedronate (Actonel, Atelvia) 
    • Ibandronate (Boniva) 
    • Zoledronic acid (Reclast) 
• Selective estrogen receptor modulators (SERMs)
  • Produces some estrogen-like effects in the bone and provides protection against postmenopausal bone loss
    • Raloxifene (Evista) 
    • Tamoxifen (Nolvadex)
• Hormone therapy with estrogen or estrogen-progestin 
  • Estrogen is not recommended to treat or prevent osteoporosis in postmenopausal women but it may be used to prevent osteoporosis in young women whose ovaries do not make estrogen
• Denosumab (Prolia) 
  • An antibody that works to improve bone mineral density and reduce fractures in postmenopausal women with osteoporosis
• Calcitonin 
  • No longer used to treat osteoporosis, but due to its pain-relieving effects it may be used for short-term therapy for acute pain due to vertebral fractures
• Anabolic agents 
  • Only recommended for severe osteoporosis
• Parathyroid hormone/parathyroid hormone-related protein 
  • Teriparatide (Forteo) 
  • Abaloparatide (Tymlos) 
  • Romosozumab (Evenity) 

Complications of osteoporosis include: 

• Bone fractures
  • Most likely to occur in the hip, spine, or wrist, but may occur in other bones 
  • 20% of seniors who break a hip die within one year from complications related to the broken bone itself or the surgery to repair it
• Permanent pain
• Loss of height
• Stooped or hunched posture
• Limited mobility, which can lead to feelings of isolation or depression
• Need for long-term nursing care