Osteoporosis Quiz
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Back pain triggered by movement
Low back pain when standing straight
Back pain appears with movement
Standing upright causes my lower back to hurt
Back pain induced by exercise
Can't stand straight because lower back will hurt
Back ache from standing straight all the time
Not seeing your symptoms? No worries!
What is Osteoporosis?
Osteoporosis is a disease that makes your bones weak and brittle. As result, the bones become more prone to break even with minor trauma or stress that would normally not result in a break. It may be caused due to long-term low calcium intake, estrogen deficiencies in women, and an inactive lifestyle.
Typical Symptoms of Osteoporosis
- Taking steroids
- Previously diagnosed with a bone fracture
- Back pain worse with exercise
- I am taking or have taken oral diabetes medication
- Diagnosed with hypogonadism (low sex hormone production)
- Aware I am thinner than peers
- No periods for one year
- History of connective tissue, autoimmune or rheumatic disease
Diagnostic Questions for Osteoporosis
Your doctor may ask these questions to check for this disease:
- Are you currently taking steroids?
- Have you ever had a broken fracture?
- Does your back pain worsen after exercising?
- Have you taken oral medication for diabetes?
- Have you been diagnosed with low sex hormone production (hypogonadism)?
Treatment of Osteoporosis
Treatment includes bone-preserving medications, calcium and vitamin D supplementation, a healthy diet, and weight training to prevent bone loss, strengthen weak bones and maintain mobility.
Reviewed By:
Kenji Taylor, MD, MSc (Family Medicine, Primary Care)
Dr. Taylor is a Japanese-African American physician who grew up and was educated in the United States but spent a considerable amount of time in Japan as a college student, working professional and now father of three. After graduating from Brown, he worked in finance first before attending medical school at Penn. He then completed a fellowship with the Centers for Disease Control before going on to specialize in Family and Community Medicine at the University of California, San Francisco (UCSF) where he was also a chief resident. After a faculty position at Stanford, he moved with his family to Japan where he continues to see families on a military base outside of Tokyo, teach Japanese residents and serve remotely as a medical director for Roots Community Health Center. He also enjoys editing and writing podcast summaries for Hippo Education.
Tomohiro Hamahata, MD (Orthopedics)
Dr. Hamahata graduated from the Jikei University of Medical Science. After working at Asanokawa General Hospital and Kosei Chuo Hospital, he joined the Department of Orthopedics at Asakusa Hospital in April 2021, specializing in general orthopedics and joint replacement surgery.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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Symptoms Related to Osteoporosis
Diseases Related to Osteoporosis
FAQs
Q.
Preventing Muscle Loss After 50: A Sarcopenia Recovery & Strength Plan
A.
Muscle loss after 50 is common but not inevitable: a focused program of resistance training 2 to 3 days weekly, about 1.0 to 1.2 g/kg daily protein, vitamin D optimization, daily movement, balance work, and quality sleep can prevent and even reverse sarcopenia, which is especially important for women after menopause. There are several factors to consider. See below to understand more, including step by step exercise options, how to set protein goals, when to test vitamin D or bone density, whether hormones may help, red flags that warrant medical care, and what timeline to expect.
References:
* Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019 Jul 27;394(10199):498-507. doi: 10.1016/S0140-6736(19)31138-9. PMID: 31354109.
* McLeod JC, et al. Resistance exercise training for sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2019 Feb;10(1):16-29. doi: 10.1002/jcsm.12356. PMID: 30141203.
* Cederholm T, et al. ESPEN guidelines on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019 Feb;38(1):10-47. doi: 10.1016/j.clnu.2018.05.024. PMID: 29903338.
* Bauer E, et al. Sarcopenia: Current concepts and future directions. Eur J Nutr. 2020 Feb;59(1):1-18. doi: 10.1007/s00394-019-02107-1. PMID: 31758227.
* Beaudart C, et al. Management of sarcopenia: A critical review of the current evidence. J Cachexia Sarcopenia Muscle. 2017 Aug;8(4):531-542. doi: 10.1002/jcsm.12209. PMID: 28247545.
Q.
Frequent Fractures? Why Your Bones Are Breaking: Medically Approved Next Steps for OI
A.
Frequent fractures from minor bumps can signal osteogenesis imperfecta, a genetic collagen disorder. Medically approved next steps include prompt evaluation with X-rays, bone density and genetic testing, followed by coordinated care using bisphosphonates, tailored physical therapy, possible surgical rods, targeted nutrition, and fall prevention. There are several factors to consider, including severity, age, dental and hearing involvement, and red flags that require urgent care. See the complete guidance below for details that can shape your next steps.
References:
* Struijs B, ten Kate J, van Dijk F, et al. The Dutch national guidelines on diagnosis and management of osteogenesis imperfecta: Summary and key recommendations. Orphanet J Rare Dis. 2021 Jul 26;16(1):335. doi: 10.1186/s13023-021-01968-3. PMID: 34311892; PMCID: PMC8313413.
* Forlino A, van Dijk FS, Marini JC. Osteogenesis imperfecta: current and emerging treatments. Curr Osteoporos Rep. 2022 Feb;20(1):15-28. doi: 10.1007/s11914-021-00705-4. Epub 2021 Dec 7. PMID: 34874402; PMCID: PMC8806282.
* Semler O, Zillikens MC, Rauch F, et al. Clinical Practice Guideline for the Management of Osteogenesis Imperfecta: Best Practice for Fracture Prevention, Rehabilitation, and Surgery. J Bone Miner Res. 2024 Jan;39(1):15-37. doi: 10.1002/jbmr.4947. Epub 2023 Dec 30. PMID: 38166548.
* van Dijk F, Cobben JM, Bierau K, et al. Osteogenesis imperfecta: a review of the disease and its medical management. J Bone Miner Metab. 2018 Mar;36(2):125-136. doi: 10.1007/s00774-017-0845-8. Epub 2017 Jun 16. PMID: 28616781; PMCID: PMC5824967.
* Marini JC, Forlino A, Bachrach LK, et al. Osteogenesis imperfecta. Nat Rev Dis Primers. 2017 Aug 10;3:17052. doi: 10.1038/nrdp.2017.52. PMID: 28796220; PMCID: PMC5840049.
Q.
Persistent Bone Pain? Why Your Bones Are Reshaping and Medically Approved Next Steps
A.
Persistent, deep bone pain with changes in shape can signal abnormal remodeling such as Paget’s disease, where overactive breakdown and disorganized rebuilding make bones enlarged yet weaker. There are several factors to consider, and medically approved next steps often include seeing a doctor for alkaline phosphatase blood tests and imaging, plus proven treatments like bisphosphonates to reduce pain and complications. See below for important details on symptoms, risks, when to seek urgent care, and how to prepare for your appointment.
References:
* Suda T, Ishida T, Iida H, Naito H, Shigenobu Y, Kanaya M, Hishiya A, Ozaki T, Hatta T, Nakai T. Advances in the Understanding of Pathological Bone Remodeling and Associated Pain. Int J Mol Sci. 2022 Nov 19;23(22):14371. doi: 10.3390/ijms232214371. PMID: 36430930; PMCID: PMC9690186.
* Suda T, Ishida T, Naito H, Hatta T, Nakai T. Pathophysiology of Chronic Bone Pain: From Cancer to Osteoporosis. Int J Mol Sci. 2022 Jan 10;23(2):684. doi: 10.3390/ijms23020684. PMID: 35054779; PMCID: PMC8775460.
* Al-Jarrah S, Al-Qudimat AR. Metabolic bone diseases: A practical approach to diagnosis and treatment. World J Clin Cases. 2021 Dec 26;9(36):11153-11166. doi: 10.12998/wjcc.v9.i36.11153. PMID: 35071195; PMCID: PMC8759325.
* Zhang J, Wang J, Hou Y, Hu H, Liang J, Li P, Xu X, Zhang Q, Zhao M, Zhang H, Wu D, Wang P, Zeng Z, Pan J, Li Y, Peng J, Li M, Zhang D, Zhang M, Lu S. Osteoporotic pain: an update. Bone Res. 2023 Jan 24;11(1):5. doi: 10.1038/s41413-022-00244-z. PMID: 36690772; PMCID: PMC9870141.
* Khan K, Iqbal M, Saadi AM. Clinical approach to skeletal manifestations of systemic diseases. J Fam Med Prim Care. 2022 Sep;11(9):4959-4965. doi: 10.4103/jfmpc.jfmpc_612_22. PMID: 36569165; PMCID: PMC9777995.
Q.
Deep Bone Aches? Why Your Human Skeleton is Signaling Trouble and Medically Approved Next Steps
A.
Deep bone aches can be your human skeleton signaling issues like osteoporosis, vitamin D or calcium deficiency, stress fractures, or arthritis, and less commonly infections or cancers, especially if pain is persistent, worse at night, or paired with fever, weight loss, or inability to bear weight. Medically approved next steps include not ignoring pain that lasts more than 1 to 2 weeks, improving calcium and vitamin D, doing weight-bearing exercise, and seeing a clinician for an exam, labs, imaging, and possible bone density testing. There are several factors to consider. See below to understand more, including red flags and details that could change your next steps.
References:
* Mercadante S, Fulfaro F. Bone pain: aetiology and management. Drugs. 2019 Jan;79(1):15-22. doi: 10.1007/s40265-018-1033-9. PMID: 30617639.
* Khan MH, Khan HM. Diagnosis and Management of Bone Pain in Primary Care. J Clin Med. 2023 Aug 21;12(16):5445. doi: 10.3390/jcm12165445. PMID: 37622823; PMCID: PMC10454379.
* Elson D. The differential diagnosis of bone pain: A review. J Musculoskelet Surg Res. 2020 Apr-Jun;4(2):160-165. doi: 10.4103/JMSR.JMSR_58_19. PMID: 32470719; PMCID: PMC7235061.
* Kancso Z, Kancso M, Csupor D, Molnar V, Kovacs K, Hajdu Z, Zsuga J, Szabo I. Chronic bone pain: aetiology and pathophysiology. Orv Hetil. 2021 Jun 27;162(26):1038-1044. doi: 10.1556/650.2021.32049. PMID: 34198947.
* Ali A, Ali G, Ali Z, Ali Q, Ali M, Ali S. Investigation and management of bone pain in adults: A review. Int J Health Sci (Qassim). 2023 Jul 24;17(4):46-51. doi: 10.53730/ijhs.v17n4.19502. PMID: 37622699; PMCID: PMC10442387.
Q.
Is It Normal Aging? Why Your Geriatric Body Changes & Medically Approved Next Steps
A.
There are several factors to consider. Normal aging after 65 can include gradual muscle and bone loss, slower metabolism with weight changes, drier skin that heals slower, and mild memory lapses, but red flags like frequent falls, sudden weight loss, daily exhaustion, depression or withdrawal, or disruptive incontinence are not just age. Evidence based steps include strength, balance and aerobic exercise, bone protection with calcium, vitamin D and density testing, regular medication reviews, hearing and brain health support, a protein rich diet, and home fall prevention, and seek urgent care for chest pain, stroke signs, severe shortness of breath, sudden confusion, or black or bloody stools. Important nuances and condition specific next steps, including when to see a doctor and helpful tools, are detailed below.
References:
* Kirkwood, T. B. (2017). Physiological and Molecular Mechanisms of Aging. *Cell*, *168*(1-2), 11–19. doi:10.1016/j.cell.2016.12.023. PMID:28084009.
* López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013). The Hallmarks of Aging. *Cell*, *153*(6), 1194–1217. doi:10.1016/j.cell.2013.05.039. PMID:23746838.
* Sierra, F., Auwerx, J., Barzilai, N., et al. (2018). Interventions to Slow Aging in Humans: The Case for a Clinical Trial. *The Journals of Gerontology Series A, Biological Sciences and Medical Sciences*, *73*(3), 360–368. doi:10.1093/gerona/glx186. PMID:29095945.
* Vilar-Compte, M., Téllez-Rojo, M. M., Hernández-Ávila, M., et al. (2019). Principles of healthy aging: a review. *Salud Publica de Mexico*, *61*(5), 660–669. doi:10.21149/10543. PMID:31758652.
* Ellis, G., & Marshall, T. (2018). Comprehensive Geriatric Assessment: a primer for 21st century clinicians. *Journal of the Royal College of Physicians of Edinburgh*, *48*(2), 162–167. doi:10.4997/JRCP.2018.218. PMID:29994998.
Q.
Chronic Bone Pain? Why Your Skeletal System Aches & Medically Approved Next Steps
A.
Deep, constant bone pain that may worsen at night can stem from osteoporosis or stress fractures, vitamin D deficiency, autoimmune inflammation, infection, or less commonly cancer, and lasting symptoms should be assessed with a physical exam, imaging, and blood tests. Medically approved steps include optimizing calcium and vitamin D, weight-bearing and balance exercise, and targeted treatments such as bisphosphonates, anti-inflammatory medicines, antibiotics, pain management, and physical therapy, with urgent care for fever, sudden severe pain, swelling, or unexplained weight loss. There are several factors to consider; see the complete guidance below to understand what to do next for your specific situation.
References:
* Borromeo MV, Abell J, Umpir S, Khan M, Perisetti A, Goyal H. Bone pain: an updated review for the clinician. J Clin Orthop Trauma. 2023 Feb;37:102073. doi: 10.1016/j.jcot.2022.102073. PMID: 36777647.
* Krayer RW, Chen CCM. Diagnosis and Treatment of Chronic Bone Pain. Curr Pain Headache Rep. 2019 Jun 28;23(7):52. doi: 10.1007/s11916-019-0797-0. PMID: 31254132.
* Hanley CJ, Brown LC, Chapman K, Cowie RM, Kelly S. Bone pain: Pathophysiology and current management. Eur J Pain. 2021 Jul;25(6):1199-1215. doi: 10.1002/ejp.1741. PMID: 33606709.
* Smith PJW, Hanley CJ, Brown LC, Chapman K, Cowie RM, Kelly S. Emerging concepts in the pathophysiology of bone pain. Bone. 2023 Feb;167:116634. doi: 10.1016/j.bone.2022.116634. PMID: 36473550.
* Santos RBN, Hanania AN, Awan H, Ghilardi FF, De Carvalho E Silva B, De Campos GC, da Costa LT, Binda S, Telles JB. Pathophysiology and therapeutic strategies for bone pain. Pain. 2021 Oct 1;162(10):2613-2624. doi: 10.1097/j.pain.0000000000002241. PMID: 33883447.
Q.
What are the seven worst foods for osteoporosis?
A.
Certain foods can negatively impact bone health and contribute to the risk of osteoporosis. The seven worst foods for osteoporosis include excessive salt, caffeine, soft drinks, alcohol, high-protein diets, processed foods, and foods high in oxalates. Limiting these foods can help support bone health and reduce the risk of osteoporosis.
References:
Tucker KL. Osteoporosis prevention and nutrition. Curr Osteoporos Rep. 2009 Dec;7(4):111-7. doi: 10.1007/s11914-009-0020-5. PMID: 19968914.
Biver E, Herrou J, Larid G, Legrand MA, Gonnelli S, Annweiler C, Chapurlat R, Coxam V, Fardellone P, Thomas T, Lecerf JM, Cortet B, Paccou J. Dietary recommendations in the prevention and treatment of osteoporosis. Joint Bone Spine. 2023 May;90(3):105521. doi: 10.1016/j.jbspin.2022.105521. Epub 2022 Dec 22. PMID: 36566976.
Ratajczak AE, Zawada A, Rychter AM, Dobrowolska A, Krela-Kaźmierczak I. Milk and Dairy Products: Good or Bad for Human Bone? Practical Dietary Recommendations for the Prevention and Management of Osteoporosis. Nutrients. 2021 Apr 17;13(4):1329. doi: 10.3390/nu13041329. PMID: 33920532; PMCID: PMC8072827.
Q.
How is osteoporosis diagnosed?
A.
Diagnosis of osteoporosis is done by a bone mineral density scan (DEXA scan). Other tests that may be done include x-rays, blood and urine testing to look for an underlying cause of the osteoporosis.
References:
Ralston SH, Fraser J. Diagnosis and management of osteoporosis. Practitioner. 2015 Dec;259(1788):15-9, 2. PMID: 26882774.
Peacock-Johnson AM, Keresztes P. Osteoporosis: Diagnosis and management updates. Nursing. 2023 Dec 1;53(12):28-35. doi: 10.1097/01.NURSE.0000991592.29755.37. PMID: 37973009.
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Srivastava M, Deal C. Osteoporosis in elderly: prevention and treatment. Clin Geriatr Med. 2002 Aug;18(3):529-55. doi: 10.1016/s0749-0690(02)00022-8. PMID: 12424871.
https://geriatric.theclinics.com/retrieve/pii/S0749069002000228Miller PD. Management of severe osteoporosis. Expert Opin Pharmacother. 2016;17(4):473-88. doi: 10.1517/14656566.2016.1124856. Epub 2015 Dec 23. PMID: 26605922.
https://www.tandfonline.com/doi/full/10.1517/14656566.2016.1124856Armas LA, Recker RR. Pathophysiology of osteoporosis: new mechanistic insights. Endocrinol Metab Clin North Am. 2012 Sep;41(3):475-86. doi: 10.1016/j.ecl.2012.04.006. Epub 2012 Jun 9. PMID: 22877425.
https://www.sciencedirect.com/science/article/abs/pii/S088985291200028X?via%3DihubYong EL, Logan S. Menopausal osteoporosis: screening, prevention and treatment. Singapore Med J. 2021 Apr;62(4):159-166. doi: 10.11622/smedj.2021036. PMID: 33948669; PMCID: PMC8801823.
http://www.smj.org.sg/article/menopausal-osteoporosis-screening-prevention-and-treatment