Osteoporosis is the most common reason older adults break a bone after a minor fall. It develops quietly over years, gives no warning signs, and is often found only after a hip, spine or wrist fracture. The good news is that it can be detected with a quick scan, and there are effective ways to lower the chance of a first or repeat fracture. This guide explains what osteoporosis is, who is at risk, how it is diagnosed and what treatment involves.
What osteoporosis is
Bone is living tissue. Throughout life, your body breaks down small amounts of old bone and lays down new bone in its place. In early adulthood, building outpaces loss and bone mass peaks. Later, especially after menopause in women and with older age in both sexes, loss starts to outpace building.
Osteoporosis is the point at which that imbalance has gone far enough to make bones fragile. Two things happen together: the amount of mineral in the bone falls, and the inner honeycomb structure thins out, with fewer and weaker connecting struts. The result is bone that looks normal from the outside but breaks under forces a healthy skeleton would easily absorb.
A break caused by a fall from standing height or less, or by everyday stresses such as bending, lifting or even coughing, is called a fragility fracture. It is the hallmark of the condition.
Symptoms: why it is called a silent disease
Thinning bone does not hurt. Most people have no symptoms at all until a bone breaks, which is why the condition is often described as silent. When symptoms do show up, they usually come from fractures:
- Hip fractures nearly always follow a fall and usually need surgery. They are the most serious osteoporotic fracture and often lead to a long recovery and loss of independence.
- Spine (vertebral) fractures happen when a vertebra collapses. Some cause sudden, severe back pain; many cause little pain and go unnoticed. Several of them over time can cause height loss and a forward-curved upper back, called kyphosis.
- Wrist fractures often happen when someone puts out a hand to break a fall. In midlife, a wrist break can be the first clue that bones are weakening.
The shoulder (upper arm), pelvis and ribs are other common sites. If you have lost more than an inch or two of height, or your posture has changed, mention it at your next checkup.
The global picture
The International Osteoporosis Foundation (IOF) estimates that, worldwide, about 1 in 3 women and 1 in 5 men over age 50 will have an osteoporotic fracture. An earlier IOF estimate put the rate at roughly one fracture every 3 seconds. Its more recent figures are higher still: up to 37 million fragility fractures a year in people over 55, or about 70 every minute. In the United States, the Bone Health & Osteoporosis Foundation estimates about 10 million people have osteoporosis, roughly 80% of them women.
Risk factors you can and cannot change
Osteoporosis rarely has a single cause. Risk builds from a mix of factors, some fixed and some within your control.
| Factors you cannot change | Factors you can influence |
|---|---|
| Older age | Smoking |
| Female sex, especially after menopause | Drinking more than moderate amounts of alcohol |
| Parent with osteoporosis or a hip fracture | Low calcium or vitamin D intake, or too little protein |
| A previous fragility fracture | Physical inactivity |
| Small, thin body frame | Very low body weight or restrictive dieting |
| White or Asian background (higher average risk in women) | Falls hazards at home and untreated vision or balance problems |
A previous fragility fracture deserves special attention. According to the IOF, it raises the risk of another fracture to almost twice that of someone without one, and the risk is highest in the following five to ten years.
Medical conditions and medicines
Some health problems and treatments speed up bone loss. NIAMS lists examples such as rheumatoid arthritis, some digestive diseases that limit absorption, low sex hormones, anorexia nervosa and HIV. Long-term use of glucocorticoid (steroid) medicines is a well-known cause, and certain anti-seizure drugs, some cancer treatments, proton pump inhibitors and a few other drug classes have also been linked to bone loss. Never stop a prescribed medicine on your own; ask your prescriber whether bone protection makes sense.
Who should be screened
Because osteoporosis has no symptoms, screening is the main way to catch it before a fracture. In its January 2025 recommendation, the U.S. Preventive Services Task Force (USPSTF) advises:
- Women 65 and older: screening is recommended.
- Postmenopausal women younger than 65: screening is recommended for those at increased risk of fracture, as estimated by a clinical risk assessment (often a tool such as FRAX) that takes their risk factors into account.
- Men: the Task Force found the evidence insufficient to recommend for or against routine screening.
Other organizations go further. The Bone Health & Osteoporosis Foundation, for example, suggests testing men aged 70 and older, younger adults with risk factors, and anyone who breaks a bone after age 50. Your clinician can help you decide what fits your situation.
Where do your bones stand?
Take the two-minute bone health risk check. It's private, needs no sign-up, and ends with questions to bring to your next appointment.
How osteoporosis is diagnosed
DXA bone density scan
The standard test is a dual-energy X-ray absorptiometry scan, usually called DXA or DEXA. It uses a very low dose of X-rays to measure bone mineral density at the hip and lower spine, the sites that best predict fracture risk. It takes minutes and is painless. Our bone density test guide walks through the scan and how to read the report step by step.
Results for postmenopausal women and men aged 50 and older are reported as a T-score, which compares your bone density with that of a healthy young adult:
| T-score | Category |
|---|---|
| -1.0 or higher | Normal bone density |
| Between -1.0 and -2.5 | Low bone mass (osteopenia) |
| -2.5 or lower | Osteoporosis |
| -2.5 or lower plus a fragility fracture | Severe (established) osteoporosis |
A clinician may also diagnose osteoporosis after a low-trauma hip or spine fracture, even if the T-score is above -2.5.
FRAX fracture risk
Bone density is only part of the story. FRAX is a widely used calculator that combines age, sex, body size, prior fractures, parental hip fracture, smoking, alcohol, steroid use, rheumatoid arthritis and other factors, with or without the hip bone density result. It estimates your 10-year probability of a hip fracture and of a major osteoporotic fracture (hip, spine, forearm or shoulder). Clinicians often use it to decide whether someone with osteopenia would benefit from medicine.
Other tests
Blood and urine tests may look for conditions that cause bone loss, such as vitamin D deficiency, thyroid or parathyroid problems, or kidney disease. A spine X-ray or a vertebral fracture assessment during the DXA can reveal fractures you did not know about.
Treatment options in general terms
Treatment aims to prevent fractures. Which option is right depends on your fracture risk, other health conditions, kidney function, dental health, preferences and cost. The main medicine groups are:
- Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid). These slow bone breakdown and are the most commonly prescribed first choice. Some are tablets; others are given by infusion.
- Denosumab. An injection given every few months that also slows bone breakdown. Stopping it without switching to another treatment can lead to rapid bone loss and a higher risk of spine fractures, so changes should always be planned with your clinician.
- Bone-building (anabolic) medicines. Teriparatide and abaloparatide, which act like parathyroid hormone, and romosozumab, which blocks a protein called sclerostin. They are typically reserved for people at very high risk or who have fractured despite other treatment, are given for a limited period, and are usually followed by a medicine that preserves the new bone.
- Hormone-related options. Menopausal hormone therapy may be considered when menopause symptoms also need treatment. Raloxifene, a selective estrogen receptor modulator, acts like estrogen on bone. Men with low testosterone may have that addressed alongside osteoporosis treatment.
All medicines carry possible side effects. Bisphosphonates and denosumab have been linked to two rare complications: osteonecrosis of the jaw (poor healing of the jawbone, often after a tooth extraction) and an unusual break in the thighbone. For most people at high fracture risk, the benefit of preventing fractures far outweighs these rare risks, but it is worth discussing, and worth having a dental checkup before starting. Some people on long-term bisphosphonates may be offered a planned break; this is a decision for your clinician.
Lifestyle steps that protect bone
Calcium and vitamin D
Your bones need enough calcium and vitamin D whether or not you take medicine. The NIH Office of Dietary Supplements gives these daily recommendations:
| Group | Calcium | Vitamin D |
|---|---|---|
| Adults 19–50 | 1,000 mg | 600 IU (15 mcg) |
| Men 51–70 | 1,000 mg | 600 IU (15 mcg) |
| Women 51–70 | 1,200 mg | 600 IU (15 mcg) |
| Adults 71 and older | 1,200 mg | 800 IU (20 mcg) |
Food first is the usual advice, with supplements to fill any gap. Our calcium calculator estimates how much you get from your diet, and the calcium and vitamin D guide covers food sources and supplement safety.
Exercise
Weight-bearing activity such as walking, plus muscle-strengthening and balance exercises, helps maintain bone and lowers fall risk. If you already have osteoporosis or spine fractures, a physical therapist can show you which movements to favor and which deep bends or twists to avoid. See exercises for strong bones or build a plan with the bone exercise planner.
Falls prevention
Most hip fractures follow a fall, so preventing falls is as important as strengthening bone. Clear clutter and loose cords, secure rugs, add grab bars and good lighting, wear supportive shoes, have your vision checked, and ask whether any of your medicines cause dizziness or drowsiness.
Smoking and alcohol
Smoking speeds bone loss, and quitting at any age helps. NIAMS suggests limiting alcohol to no more than one drink a day for women and two for men.
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Men get osteoporosis too
Osteoporosis is often thought of as a women's condition, but men are far from immune. Men start with larger, denser bones and do not go through a sudden hormonal drop like menopause, so their bone loss tends to show up later, often after 70.
Bone loss in men is often linked to another factor, such as low testosterone, long-term steroid use, heavy drinking or a digestive condition, so a clinician will usually check for these. A man who breaks a bone in a minor fall should ask about a bone density test.
Questions to ask your doctor
- Based on my age and risk factors, should I have a bone density test now?
- What is my T-score at each site, and what is my FRAX 10-year fracture risk?
- Could a medical condition or one of my medicines be contributing to bone loss?
- Do I need medicine? What are the benefits and possible side effects of each option?
- How long should I take it, and what happens when I stop?
- Should I have a dental checkup first?
- How much calcium and vitamin D should I aim for, and do I need a supplement?
- Which exercises are safe for me, and could a physical therapist help?
- When should I be retested?
To find out where you stand, start with the bone health risk check, then take the results to your clinician. If you need a specialist or a bone density scan, our find care page can help.