Symptom Guide: Osteoporosis

Apr 15, 2022
Medically reviewed by: 
Dr. Leah Millheiser, MD, FACOG, NCMP

Osteoporosis is sometimes known as a “silent disease,” endangering women as they age. It is silent because women often don’t experience symptoms until they have suffered a fracture. With osteoporosis, women may endure broken bones, poor posture, back pain, and collapsed vertebrae. Menopause can heighten the risk for osteoporosis, but treatments are available.

What is Osteoporosis?

Osteoporosis is the weakening of skeletal bones to the point that they break easily from a mild trauma. Healthy bones are composed of a spongy interior with small holes; the smaller the holes, the higher the bone density and the stronger the bones. Women reach peak bone density in their late 20s. As women age, however, the holes in their bones widen, sometimes leading to severely weakened bones that break easily. The decline in estrogen during menopause contributes to the decrease in bone density, and this factor combined with others may lead to osteoporosis for some menopausal women. 

What Causes It?

Doctors have identified contributing factors to osteoporosis, one of which is the decline in estrogen in a woman’s body. Contributing factors include: 

Sex. In general, peak bone density in women is lower than what is seen in men, which means that women are more likely to develop osteoporosis than men are.

Race. Asian and white women tend to have lower bone density than women from other racial and ethnic backgrounds.

Hormones. Women who start their periods earlier and use estrogen-based contraceptives reach higher bone density compared to those who start periods later or do not use estrogen-based contraceptives. 

Calcium Intake. Deficiencies in calcium intake, especially in adolescence, can lead to lower peak bone density.

Weight-bearing exercise. Those who lift weights or regularly perform weight-bearing exercises, such as walking, aerobics, and gardening, develop higher bone density and preserve it for longer as they age.

Smoking. Smoking among adolescents has been linked to low peak bone density—and the problem compounds as they age.

What Does the Research Say?

Estrogen deficiency is the primary cause of postmenopausal osteoporosis, according to The North American Menopause Society and bone loss accelerates in late perimenopause and continues at a steadier pace in early menopause, according to a longitudinal study on almost 2000 multiethnic women

However, Postmenopausal women who exercise are less likely to develop osteoporosis, according to one long-term study. Research also shows that body weight has an impact on bone mass, and underweight women tend to have lower bone mass than women who maintain a healthy weight.

How is Osteoporosis Diagnosed?

Doctors measure bone mineral density as the primary indicator of osteoporosis. A dual-energy x-ray absorptiometry (DXA) images your body to measure bone density at various points in the skeleton, but especially at the hip and spine. Your bone density is reported as 2 scores: a T-score and a Z-score. The T-score tells you whether your bone density is higher or lower than that of a healthy, young adult. Your Z-score compares your bone density to the average bone density of a person of the same age and sex assigned at birth.

What are Effective Treatments?

Bisphosphonates: This type of medication slows down bone loss to prevent fractures. Drug names include alendronate (Binosto, Fosamax), risedronate (Actonel, Atelvia), ibandronate (Boniva) and zoledronic acid (Reclast, Zometa).

Raloxifene (Evista): This type of drug mimics the hormone estrogen in certain areas of the body like bone, helping to prevent further bone loss and fractures..

Hormone Replacement Therapy: Estrogen therapy can help prevent further bone loss and fractures. 

Teriparatide and Abaloparatide: These injectable drugs are a type of hormone which increases bone density. Drug names include Forteo and Tymlos.

Denosumab: This is a type of antibody drug that inhibits the body’s process of breaking down bones, reducing the risk of bone fractures. Drug names include Prolia and Xgeva.

What are Some Non-Medical Treatments?

Your lifestyle can support good bone health in menopause and beyond.

Exercise. Weight-bearing and resistance exercises are the best options to keep your bones as strong as possible. Lifting weights is one possibility, but even exercises such as walking, dancing, gardening, and aerobics can maintain bone density for longer.

Calcium. Eating calcium throughout life builds and maintains strong bones. Dairy products, dark, leafy green vegetables, white beans, and canned salmon and sardines are rich sources of calcium. Talk with your PCP first before taking calcium supplements. 

Vitamin D. This vitamin is critical in allowing your body to absorb calcium. Twenty minutes outside per day is enough for most people to make the vitamin D they need, but you can also ingest vitamin D through dairy products, fatty fish, eggs, or nutritional supplements.

Smoking. Stop or cut back on smoking. Cigarette smoke can cause your body to produce less estrogen.

What to Do Next?

Make an appointment with a trusted PCP or a clinician who specializes in menopause to discuss your bone health and determine the best preventative or, if needed, treatment options for you.

Reviewed by Leah Millheiser, MD, Evernow Chief Medical Officer, March 2022