What is Osteoporosis and What Causes It?

By Dr. Kiran Seth in Rheumatology

Oct 20, 2017

World Osteoporosis Day: Understanding Osteoporosis, Its Causes, Symptoms and Prevention

Every year, 20 October is observed as World Osteoporosis Day to raise awareness about osteoporosis, bone health, fracture prevention, early diagnosis, and appropriate treatment.

“Osteoporosis may remain undetected as bone strength gradually decreases, with a fracture sometimes revealing the condition. A person may not realise that their bones have become weaker until they experience a fracture after a relatively minor fall or injury.

The good news is that osteoporosis can often be prevented, diagnosed, and managed effectively with healthy lifestyle habits, appropriate screening, and medical treatment when required.

What Is Osteoporosis?

Osteoporosis causes a gradual loss of bone strength and density, making bones more fragile and susceptible to fractures.

Healthy bones continuously undergo a natural process of breakdown and rebuilding. With osteoporosis, bone loss can occur faster than new bone formation, resulting in reduced bone strength.

Osteoporosis can affect any bone, but fractures commonly occur in the:

• Hip
• Spine
• Wrist
• Upper arm

A spinal fracture may cause back pain, loss of height, or a stooped posture. A hip fracture, particularly in older adults, can significantly affect mobility and independence.

Why Is Osteoporosis a Serious Health Concern?

Bone loss can develop gradually and may remain unnoticed for years. A fracture can sometimes be the first indication that a person has osteoporosis.

Osteoporotic fractures may lead to:

• Persistent pain
• Reduced mobility
• Difficulty performing daily activities
• Loss of independence
• Reduced quality of life
• Longer recovery periods
• Complications, particularly after hip fractures in older adults

Early identification of people at increased risk can help reduce the likelihood of preventable fractures.

What Causes Osteoporosis?

Several factors can contribute to reduced bone strength. Some are related to natural aging, while others are associated with lifestyle, medical conditions, or medications.

Important risk factors include:

1. Increasing Age

Bone mass generally changes with age, and bone loss may accelerate in later life. The risk of osteoporosis therefore increases as people get older.

2. Hormonal Changes

Reduced oestrogen levels after menopause can accelerate bone loss in women.

Low testosterone levels can also contribute to reduced bone density in some men.

3. Family History

A family history of osteoporosis or certain types of fractures may increase an individual’s risk.

4. Inadequate Calcium and Vitamin D

Calcium and vitamin D are essential nutrients that support bone strength and overall skeletal health. Insufficient intake or poor absorption may contribute to reduced bone health.

5. Lack of Physical Activity

Regular weight-bearing and muscle-strengthening activity helps support bone and muscle health. Prolonged inactivity may increase the risk of bone loss.

6. Smoking and Excessive Alcohol Consumption

Smoking can negatively affect bone health, while excessive alcohol consumption may also increase fracture risk.

7. Certain Medical Conditions

Conditions affecting hormonal balance, nutrient absorption, kidney function, or other aspects of metabolism may contribute to secondary osteoporosis.

8. Long-Term Use of Certain Medicines

Some medications, particularly long-term corticosteroid treatment, can increase the risk of bone loss. People taking such medicines should discuss bone-health monitoring with their doctor.

What Are the Symptoms of Osteoporosis?

Osteoporosis may develop silently, with few noticeable signs during the early stages.

When significant bone loss has occurred, possible signs may include:

• A bone fracture that occurs after a minor fall or relatively mild injury.
• Persistent or sudden back pain
• Loss of height over time
• Development of a stooped or curved posture
• Recurrent fractures
• Reduced mobility following a fracture

A sudden change in back pain, particularly in an older adult or someone with known osteoporosis, should be medically evaluated.

Who Is at Higher Risk of Osteoporosis?

Osteoporosis can affect both women and men. Various health and lifestyle factors may raise the risk of developing osteoporosis.

Are older

• Have gone through menopause
• Have a close family history of osteoporosis or hip fractures.
• Have previously experienced a fragility fracture
• Have low body weight
• Smoke
• Consume excessive alcohol
• Have low physical activity
• Do not obtain adequate amounts of calcium and vitamin D from their regular diet
• Have certain chronic medical conditions
• Take long-term corticosteroids or other medicines that affect bone health

If you have one or more risk factors, speak with a healthcare professional about whether bone-health assessment is appropriate.

How Is Osteoporosis Diagnosed?

Because osteoporosis can develop without symptoms, bone-density testing plays an important role in diagnosis and fracture-risk assessment.

A commonly used test is Dual-Energy X-ray Absorptiometry (DEXA or DXA). It measures bone mineral density, usually at sites such as the hip and spine.

Depending on the patient’s age, medical history, symptoms, and risk factors, a doctor may also recommend:

• Blood tests
• Vitamin D assessment
• Calcium-related investigations
• Hormonal evaluation
• Kidney or liver function tests
• Additional imaging when required
• Assessment of overall fracture risk

Your doctor will determine which investigations are appropriate for you.

How Can You Help Prevent Osteoporosis?

Healthy lifestyle habits can play an important role in maintaining bone strength.

1. Stay Physically Active

Regular exercise supports both bone and muscle health.

Activities that may benefit bone health include:

• Walking
• Strength training
• Weight-bearing exercise
• Balance exercises
• Appropriate resistance training

Exercise should be selected according to age, fitness level, existing medical conditions, and fracture risk.

2. Maintain Adequate Calcium Intake

Calcium is essential for normal bone health. Good dietary sources include:

• Milk and dairy products
• Curd and yoghurt
• Cheese
• Green leafy vegetables
• Calcium-fortified foods
• Certain nuts and seeds

The amount of calcium required varies according to age and individual circumstances. Supplements should be taken only when recommended by a healthcare professional.

3. Ensure Adequate Vitamin D

Vitamin D supports calcium absorption and contributes to maintaining strong, healthy bones.

Safe sunlight exposure, dietary sources, and supplements when medically indicated can help maintain adequate vitamin D levels.

People with vitamin D deficiency or specific health conditions may require medical evaluation and supplementation.

4. Avoid Smoking

Smoking can weaken bone health over time and may increase the likelihood of fractures.

Quitting smoking is beneficial not only for your bones but also for your heart, lungs, and overall health.

5. Limit Alcohol Consumption

Excessive alcohol intake can negatively affect bone health and increase the risk of falls and fractures.

Limiting alcohol consumption can therefore support both bone health and overall well-being.

6. Prevent Falls

For older adults, preventing falls is an important part of fracture prevention.

Simple measures include:

• Keeping floors and walking areas free of obstacles
• Using adequate lighting
• Wearing appropriate footwear
• Improving balance and muscle strength
• Using walking aids when medically advised
• Reviewing medicines that may increase dizziness or fall risk

Can Osteoporosis Be Treated?

Yes. Osteoporosis can be managed with a combination of lifestyle measures, fall prevention, and medication when clinically indicated.

Treatment depends on factors such as:

• Bone-density results
• Age
• Previous fractures
• Overall fracture risk
• Other medical conditions
• Current medications

Depending on the individual’s needs, a doctor may prescribe medicines that help slow bone loss or reduce the risk of fractures.

Treatment should always be personalised and monitored by a qualified healthcare professional.

Osteoporosis and Menopause

Women may experience accelerated bone loss around and after menopause because of declining oestrogen levels.

Women approaching or going through menopause should discuss their individual osteoporosis risk with their doctor, particularly if they have additional risk factors such as family history, low body weight, smoking, previous fractures, or long-term corticosteroid use.

When Should You Consult a Doctor?

Consider speaking with a healthcare professional if you:

• Have had a fracture after a minor fall or injury
• Have persistent or unexplained back pain
• Notice a reduction in height
• Develop a stooped posture
• Have reached an age or life stage associated with increased osteoporosis risk
• Have a family history of osteoporosis or hip fracture
• Take long-term corticosteroids
• Have a medical condition that may affect bone health

Early assessment can help identify bone loss and determine whether treatment or preventive measures are needed.

Frequently Asked Questions About Osteoporosis

1. What is osteoporosis?

Osteoporosis is a condition in which bones become weaker and more fragile, increasing the risk of fractures.

2. Can osteoporosis occur without symptoms?

Yes. Osteoporosis often progresses without noticeable symptoms. A fracture may be the first sign of significant bone loss.

3. What is the best test for osteoporosis?

DXA/DEXA bone-density testing is commonly used to assess bone mineral density. Your doctor may recommend it based on your age, risk factors, and medical history.

4. Does osteoporosis affect only women?

No. Osteoporosis can affect both women and men. The risk generally increases with age, and certain hormonal, medical, lifestyle, and medication-related factors can increase risk.

5. Can osteoporosis be prevented?

The risk can often be reduced through regular physical activity, adequate calcium and vitamin D, avoiding smoking, limiting excessive alcohol, maintaining a healthy weight, and addressing medical risk factors.

6. Is osteoporosis treatable?

Yes. Depending on fracture risk and bone health, treatment may include lifestyle measures, fall prevention, and prescription medicines designed to reduce fracture risk.

7. Is calcium alone enough to prevent osteoporosis?

No. Bone health depends on several factors, including physical activity, vitamin D, nutrition, hormonal health, lifestyle, medical conditions, and age. Calcium is important but is only one part of overall bone-health management.

Takeaway

Osteoporosis can develop silently, but its consequences do not have to be ignored. Maintaining strong bones requires attention throughout life—not only after a fracture occurs.

A balanced diet, regular exercise, adequate calcium and vitamin D, avoidance of smoking, moderation of alcohol, fall prevention, and timely medical assessment can all contribute to better bone health.

If you have osteoporosis risk factors or have experienced a fracture after a minor injury, consult a Rheumatologist or qualified healthcare professional for an appropriate evaluation and personalised management plan.