Osteoporosis: Key Q&A

Reviewed By:
Vikas Garg, M.D., MSA

What is osteoporosis?

Osteoporosis is a disorder that causes bones to become porous, weak and brittle. It usually affects older adults and occurs when low levels of calcium, phosphorus and other minerals cause bones to lose mass, making them susceptible to fractures. Most fractures occur in the spine, hip or wrist.

What is the difference between osteoporosis and osteopenia?

Osteopenia is a precursor to osteoporosis and may be diagnosed when bone density is below normal but not low enough for a diagnosis of osteoporosis.

What causes osteoporosis?

Osteoporosis occurs when bones lose mass and density, which is partly a result of a decrease in minerals. When this occurs, bone strength decreases and the bone's internal supporting structure declines.

Loss of bone mass occurs naturally with age to some extent because the body starts to lose more bone than it makes. However, many factors can accelerate the process. These include declining levels of sex hormones such as estrogen and testosterone, a diet poor in calcium and vitamin D, a history of physical inactivity, alcoholism, smoking, and long-time use of corticosteroids or other immunosuppressive drugs. People may also be at risk if they have certain medical conditions including rheumatoid arthritis, hyperparathyroidism (overactive parathyroid glands), eating disorders, diabetes, polycystic ovarian disease, cancer, cardiovascular conditions, cystic fibrosis, digestive or kidney diseases, lung disease or certain bone disorders.

What are the signs and symptoms of osteoporosis?

In its early stages, osteoporosis lacks symptoms. Over time, people with this condition may experience a loss of height due to compression of vertebrae and hunched-forward posture (known as "dowager's hump") and sometimes have back pain. In many people who don't have screening tests for osteoporosis, the condition is not discovered until they suffer a fracture.

How is osteoporosis diagnosed?

Early detection of osteoporosis is important because it can help people slow the progress of the disease. The best method for at-risk people is to have regular bone density tests, such as a type of x-ray called a DEXA scan.

Is hormone replacement therapy used to treat osteoporosis?

It can be, but this is typically not a first-line treatment. Hormone replacement therapy (HRT) was formerly recommended as the primary treatment for osteoporosis for women. By taking estrogen or combined estrogen and progesterone replacements, women have been able to slow down or halt the loss of bone mass associated with menopause. However, research projects such as the Women's Health Initiative indicated that the risks of this therapy may be greater than the benefits. Because of this, most doctors no longer recommend hormone replacement therapy solely to treat osteoporosis. Other drugs are available that help women increase their bone density.

For men, testosterone replacement therapy may be recommended in treating osteoporosis, but it too has side effects.

How can osteoporosis and related fractures be prevented?

People can take several steps to reduce their risk of osteoporosis and of suffering fractures related to osteoporosis. The most effective preventive measure is to build bone mass through adequate exercise, a good diet and not smoking. These measures are most effective when performed in youth and early adulthood but can benefit people of any age.