Let me ask you a question.
How do your bones feel today?
Pretty good?
No pain? No problems? Unfortunately, that tells me almost nothing about how strong your bones actually are.
You can have high blood pressure and feel perfectly fine. You can have high cholesterol and feel perfectly fine. And you can lose a significant amount of bone without feeling a thing.
That’s why osteoporosis is often called the silent disease.
For some people, the first warning sign isn’t pain. It’s a broken bone.
Yesterday you were walking through the kitchen. Today you’re sitting in the emergency room with a fractured wrist—or worse, a fractured hip.
So let’s talk about osteoporosis, how you can have it without knowing it, who’s at risk, and most importantly, how we can find it before a fracture finds you.
What Exactly Is Osteoporosis?
Your bones may look solid, but they’re actually living tissue. Throughout your life, your body is constantly removing older bone and replacing it with new bone. Think of it as a remodeling project that never ends.
When you’re younger, the construction crew usually keeps up pretty well with the demolition crew. As you get older, that balance can change.
Your body may begin removing bone faster than it replaces it. Over time, bones can become less dense and their internal structure can deteriorate.
Eventually, they may become fragile enough that a relatively minor fall—or sometimes even normal everyday stress—can cause a fracture.
That’s osteoporosis.
And here’s the problem:
You usually don’t feel it happening.
Why Is Osteoporosis Called a Silent Disease?
If you tear a muscle, it hurts. If you sprain an ankle, it hurts. If you have arthritis, your joints may remind you about it every morning when you get out of bed.
Osteoporosis usually doesn’t work that way.
You can’t feel your bone density decreasing. There isn’t a particular ache that tells you your hip has lost 15% of its bone density.
You don’t wake up one morning and say: “You know, my femur feels a little thin today.”
Bone loss can progress quietly for years.
That’s why some people don’t discover they have osteoporosis until something breaks.
And by then, we’ve missed an opportunity to intervene earlier.
Osteopenia Usually Comes First
You may also have heard the word osteopenia.
Osteopenia means your bone density is lower than normal but hasn’t reached the level classified as osteoporosis.
Think of bone strength as a continuum rather than an on-off switch. Normal bone doesn’t suddenly become osteoporotic overnight. Bone loss usually happens gradually.
Normal bone density can become osteopenia. Osteopenia can progress to osteoporosis.
But—and this is important—having osteopenia doesn’t automatically mean you’re destined to develop osteoporosis or have a fracture.
Your overall fracture risk depends on much more than one number.
Age, previous fractures, medications, smoking, alcohol use, family history, fall risk, and other health conditions can all matter.
That’s why we look at the whole person, not simply a test result.
Who Is Most at Risk?
Anyone can develop osteoporosis, but some people are much more likely to develop it than others.
Women are at particularly high risk because estrogen levels drop rapidly around menopause. Estrogen helps protect bone, so this change can accelerate bone loss.
But men shouldn’t stop reading here.
Men get osteoporosis too.
Bone loss in men tends to occur somewhat later and more gradually, which may be one reason it receives less attention.
Risk also tends to increase as we get older.
Other factors that may increase your risk include:
- A parent who had a hip fracture
- A previous fracture after relatively minor trauma
- Low body weight
- Smoking
- Heavy alcohol use
- Physical inactivity
- Low calcium or vitamin D intake
- Certain medical conditions
- Long-term use of certain medications
One particularly important medication is corticosteroids such as prednisone.
These medications can be extremely useful when they’re needed, but prolonged use can significantly affect bone health.
If you’ve taken steroids for an extended period, that’s something your healthcare professional should know when evaluating your fracture risk.
What Does an Osteoporotic Fracture Look Like?
When young people break bones, there’s usually a pretty good story.
They fell off a bicycle. They crashed skiing. They got tackled playing football.
With osteoporosis, sometimes the story sounds very different.
“I tripped on the rug.”
“I fell while getting out of the shower.”
“I missed the last step.”
A fall from standing height that results in a fracture may be a warning that the bone was already weaker than it should have been.
The most common osteoporosis-related fractures occur in the hip, spine, and wrist.
And some spinal fractures can occur without a dramatic fall at all.
Are You Getting Shorter?
Here’s something people sometimes dismiss as simply part of aging.
“Doc, I used to be 5-foot-8. Now I’m 5-foot-6.”
A small change in height can occur for several reasons as we age.
But significant height loss deserves attention.
Osteoporosis can cause the vertebrae—the bones in your spine—to compress or fracture.
Sometimes this causes sudden back pain.
Sometimes the fracture isn’t nearly as obvious.
Multiple compression fractures can eventually lead to loss of height and a more rounded or stooped posture.
So if you’ve lost noticeable height, particularly several inches, don’t automatically shrug and say:
“I guess I’m just getting old.”
Mention it to your healthcare professional.
Why I’m Particularly Concerned About Hip Fractures
All fractures matter. But hip fractures concern me the most. A hip fracture in an older adult can begin a chain of events that dramatically changes someone’s life.
There may be surgery. Then hospitalization. Then rehabilitation. Then weeks or months of reduced mobility.
During that period, muscle strength can decline remarkably quickly.
Someone who was living independently before the fracture may suddenly need a walker, home assistance, or help with everyday activities.
Some people never return to their previous level of independence.
That’s why osteoporosis isn’t simply a disease of the bones.
It can become a disease of independence.
And preventing that first fracture is much better than trying to recover from it.
How Do You Know If You Have Osteoporosis?
We measure bone mineral density with a test called a DEXA scan, sometimes written DXA.
It’s painless.
There’s no tunnel.
There’s no needle.
You simply lie on a table while the machine measures bone density, usually at your hip and spine.
The radiation exposure is very low.
The test produces something called a T-score, which compares your bone density with that of a healthy young adult.
In general:
Normal: T-score of -1.0 or higher
Osteopenia: between -1.0 and -2.5
Osteoporosis: -2.5 or lower
But remember what I said earlier.
That number isn’t the entire story.
Doctors may also use your age, medical history and other risk factors to estimate your chance of having a fracture over the coming years.
Dr. Mike’s Prescription
Don’t wait for a fracture to discover that your bones are weak.
Ask your healthcare professional whether you should have a bone-density test based on your age and risk factors.
Who Should Be Screened?
Current recommendations generally support routine osteoporosis screening for women age 65 and older.
Postmenopausal women younger than 65 may also benefit from screening when their fracture risk is increased.
Screening recommendations for men are less uniform. Rather than assuming osteoporosis is only a women’s disease, men should discuss screening with their healthcare professional based on age and individual risk factors.
And regardless of your age or sex, certain situations may justify earlier evaluation—including a fragility fracture, long-term steroid treatment, or medical conditions associated with bone loss.
This is one of those situations where an individualized conversation makes sense.
Did You Know?
A fracture after a relatively minor fall may be more than bad luck.
It can be the first clue that osteoporosis is already present.
If you’ve had a fracture after age 50, particularly from a fall from standing height, ask whether your bone health should be evaluated.
What Happens If Osteoporosis Is Found?
This is where I want to reassure you.
Finding osteoporosis doesn’t mean a fracture is inevitable.
It means we have information we can act on.
Treatment may involve improving nutrition, making sure you’re getting adequate calcium and vitamin D, strength and weight-bearing exercise, reducing fall risks, stopping smoking, limiting excessive alcohol, and addressing medications or medical conditions contributing to bone loss.
For people at sufficiently high fracture risk, medications can also substantially reduce the chance of future fractures.
We’ll talk more about how osteoporosis is treated and what you can do to build and protect stronger bones later this week.
Because today’s message is simpler.
First, you have to know whether you’re at risk.
Research Snapshot
Osteoporosis screening isn’t simply about finding a low number on a scan.
The real goal is to identify people at increased risk for fractures before those fractures occur.
That’s preventive medicine at its best.
Find the problem while we still have an opportunity to change the outcome.
The Bottom Line
Osteoporosis doesn’t usually announce itself.
You probably won’t feel your bones becoming weaker.
You may not have pain.
You may continue doing everything you’ve always done.
Until one day you fall.
And something breaks.
That’s why I want you to think about bone health before that happens.
Know your risk factors.
Pay attention to unexplained height loss.
Don’t ignore a fracture after a minor fall.
And ask your healthcare professional whether a bone-density test is appropriate for you.
Because the best time to discover osteoporosis isn’t in the emergency room after a broken hip.
It’s years earlier—when we still have time to do something about it.