In its early stages, osteoporosis lacks symptoms. Some people may experience back pain or a loss of height or stooped posture over time. Sometimes loss of height is the first presenting symptom in the physician’s office.

As bone loss progresses, fractures may occur. They are most likely to occur in bones that support a person’s weight, such as the spine or hips, or are injured in a fall, such as the wrist.

Vertebral fractures are the most common fractures associated with osteoporosis. In many cases, these fractures will occur without symptoms and will not be detected unless an x-ray is performed. However, in other cases, fractures manifest as sudden back pain, particularly when bending and lifting. Such pain often recedes for several weeks before returning as a chronic, dull ache. This pain usually subsides gradually but may persist for months.

In some cases, fractures occur in vertebrae that deteriorate to the point where they begin to compress. These compression fractures can cause severe pain and require an extended period of recovery. An accumulation of such fractures may cause a person to lose several inches of height as posture becomes stooped. This abnormal curvature of the spine (thoracic kyphosis) creates a rounding of the back known as dowager’s hump. The abdomen may become compressed, causing it to protrude. 

Multiple vertebral fractures may lead to hip discomfort due to a decrease in the space between the bottom of the rib cage and the top of the pelvis. Other symptoms include difficult or labored breathing and digestive abnormalities, such as constipation and early feelings of fullness while eating.

Hip fractures often occur after a person falls. They almost always require hospitalization and surgery such as joint replacement (arthroplasty). They can result in disability or even death from postoperative complications such as pneumonia or blood clots. In fact, 24 percent of hip fracture patients aged 50 or older die in the first year after the fracture, according to the National Osteoporosis Foundation (NOF).

Although women are two to three times more likely to suffer hip fractures than men, they are less likely to die from the fracture than males, according to the NOF. White women age 65 or older have twice the incidence of fractures as African-American women. In 2004, the U.S. surgeon general issued a report predicting that because of the aging population, the number of hip fractures may double or triple by 2020.

Hip fractures are usually marked by severe pain in the hip or groin, an inability to put weight on the injured leg, and stiffness, bruising and swelling around the hip area.

Wrist fractures usually occur in the lower end of the radius, the bone on the thumb side of the forearm. This causes backward displacement of the wrist and hand and is often known as a Colles’ fracture. These fractures may occur when a person uses an outstretched hand to try to break a fall. Symptoms include wrist pain, swelling just above the wrist, deformity of the arm just above the wrist and inability to hold or lift an object of significant weight.

Patients who experience pain should discuss pain management strategies with their physician. Left untreated, this pain can become chronic and lead to even more severe pain.