What are the early signs of osteoporosis?

Bone health may not be something most people think about on a regular basis, but it's a daily concern for the nearly 200 million people worldwide who are affected by osteoporosis, a disease that causes weak and brittle bones. Since the disease is irreversible, recognizing the early signs of osteoporosis is crucial for getting treatment to reduce further damage.

What is osteoporosis?

Osteoporosis is a disease that occurs when bone mineral density and mass decrease, making it easier for bones to fracture or break. The word means "porous bone" and is often characterized by bones that look "holey" under a microscope. Since we can't see our bones, people who are affected by osteoporosis are often unaware that this deterioration is happening until they break a bone.

"Osteoporosis is more like a silent disease," says Dr. Cynthia Kelly, an orthopedic surgeon at Colorado Limb Consultants/OrthoONE. The signs and symptoms can take years to develop, or they may be mistaken for other conditions such as osteoarthritis.

"Something that comes up early that people don't recognize is the development of kyphosis, so they're bent over in their back and spine and appear hunched over," Dr. Kelly says. Kyphosis usually results from vertebral compression fractures caused by osteoporosis. Compression fractures are breaks or cracks in the bones known as the vertebrae, which make up the spine. Although kyphosis can occur at any age, it is most common in older women.

Other early signs of osteoporosis include balance or mobility issues, previous fractures that were undetected, and sarcopenia, Dr. Kelly says. Sarcopenia is a progressive loss of muscle mass and strength that can affect people in their 30s and older, increasing the risk of falls and fractures.

"Most times there isn't a big 'aha' moment as far as symptoms go," Dr. Kelly says. Some people might experience back pain, but it can be hard to pinpoint whether it's related to aging, osteoporosis or something else.

Who is affected by osteoporosis?

Anyone can develop osteoporosis, but it is more common in women. Roughly a third of women and a fifth of men over the age of 50 will experience osteoporosis-related fractures in their lifetime, Dr. Kelly says, and the condition is usually diagnosed in a person's mid-to-late 60s. Caucasian and Asian people are generally at higher risk for osteoporosis than African American and Hispanic people.

What are the risk factors for osteoporosis?

There are nonmodifiable and modifiable risk factors for osteoporosis, according to Dr. Kelly. Nonmodifiable risk factors refer to things that are out of your control, but you may be able to influence modifiable factors.

Nonmodifiable risk factors include:

• Being assigned female at birth
• Being Caucasian
• Genetic and family history
• Increasing age

Modifiable risk factors include:

• Smoking nicotine products
• Low body mass index (BMI) or a BMI below 20, which is considered underweight
• Rapid weight loss associated with low BMI
• Limited exercise
• Alcoholism
• Estrogen deficiency
• Low calcium and vitamin D intake

Although it is important to be aware of both your modifiable and nonmodifiable risk factors, having one or several risk factors doesn't necessarily mean you will develop osteoporosis. A DEXA scan, a noninvasive imaging test that measures bone density, can help assess your risk for osteoporosis and fractures. It can also provide insights about your body composition, including muscle mass and body fat.

How is osteoporosis treated?

Although osteoporosis cannot be cured or reversed, it can be treated or prevented, Dr. Kelly says. "If you suspect somebody is in a category of being at risk to develop osteoporosis, you can encourage increased activity with resistance and weight-bearing exercises," she says. "Running is better than walking, is better than biking, is better than swimming. You want people to actually be putting stress on their bony skeleton by walking around doing something and lifting weight." Between 120 and 300 minutes per week of moderate to high intensity physical activity, in addition to balance exercises, can help keep people from falling, notes Dr. Kelly.

There are also several treatment options available, including medication. For example, antiresorptive drugs can stop osteoclast cells from absorbing bone. There are also anabolic drugs that increase bone density as well as combination drugs that do both.

If you suspect that you or a loved one might be at risk for osteoporosis, there are certain things you can do to lower the risk. "As a preventive measure, start your exercise regimen, and increase your calcium and vitamin D intake," Dr. Kelly says. "If somebody is a smoker, smoking cessation is recommended, and people who abuse alcohol should be encouraged to decrease their intake or stop."

Many people with osteoporosis are able to live full and healthy lives by taking precautions to prevent breaks and fractures. If you are at risk or have osteoporosis, talk to your doctor about your management and treatment options.