Osteoporosis: Your GoodRx Guide

Osteoporosis is a disorder in which bones lose their strength. This greatly increases the risk of fracture — which is when a bone breaks. It happens gradually with age and is more common in women. 

More than 10 million Americans aged 50 and older are estimated to have osteoporosis.

There are two types of osteoporosis: 

• Primary: This kind of osteoporosis occurs as we age and our sex hormones (estrogen and testosterone) decline.

• Secondary: This kind is due to other medical conditions (such as thyroid disease) or medications (such as long-term use of corticosteroids).

Osteopenia is an in-between condition: Bone strength is not healthy, but it is not low enough to be osteoporosis. But it means that, without treatment, you are at risk of developing osteoporosis.

Osteoporosis is a “silent disease,” meaning it has no symptoms. Osteoporosis is most commonly found after a fracture. When you have osteoporosis, fractures can happen from a simple trip and fall, and sometimes even without a fall.

Causes

To understand what causes osteoporosis, it helps to know how our bones stay healthy. 

Throughout life, our bones are always remodeling themselves. Old bone is removed in a process called resorption, and new bone is made in its place. This keeps our bones healthy and allows for repair when needed. 

Osteoporosis happens when this process is out of balance. In other words, when there is more resorption of bone than replacement, bone loss occurs. This tends to happen with age, but it happens earlier and faster for women. Hormones also play a part: Estrogen and testosterone normally help slow resorption. When levels of these hormones decrease in our bodies, bone loss speeds up.

Women over age 45 spend more days in the hospital for osteoporosis-related fractures than for breast cancer.

Many things can increase the risk of osteoporosis. Some examples include:

Gender, genetics, and age

• Female sex

• Increasing age

• Asian or non-Hispanic white race

• Family history of osteoporosis or hip fracture

Medical conditions

• Conditions that cause immobility

• Impaired absorption of vitamins and minerals

• HIV/AIDS

• Inflammatory bowel disease

• Kidney disease

Medications

• Antiseizure medications

• Proton pump inhibitors (for ulcers or reflux disease)

• Selective serotonin reuptake inhibitors or SSRIs (for depression and anxiety)

• Corticosteroids

• Thiazolidinediones or glitazones (for type 2 diabetes)

Behaviors

• Heavy alcohol use

• Insufficient physical activity

• Not getting enough calcium or vitamin D 

• Smoking

Diagnosis

Because low bone density and osteoporosis often don’t have symptoms, screening plays a big part in getting a diagnosis. Testing is the only way to know whether you have osteoporosis, and you need to be tested before you can get medication for it.

Clinical guidelines recommend BMD testing for all women over age 65, as well as women who have gone through menopause and have osteoporosis risk factors. Because osteoporosis is less common in men, there is less evidence to guide recommendations for screening in this group. 

Osteoporosis is more common with age: 1 in 4 women and 1 in 20 men over age 65 have osteoporosis in the U.S.

Osteoporosis is usually diagnosed with a special test called a bone mineral density (BMD) test. This test is done with a special scan called dual-energy X-ray absorptiometry (DEXA), which measures how dense your bones are. It is noninvasive and painless.

DEXA scans give a T-score, which measures your bone density compared with healthy bone density. A negative score means that your bones are thinner than average.

• Healthy bone: –1.0 or above

• Osteopenia: between –1.0 and –2.5

• Osteoporosis: –2.5 or lower

Some people can be diagnosed with osteoporosis when they get a fracture, even if their T-score does not meet the criteria above.  

The Fracture Risk Assessment Tool, called FRAX, can be used to estimate your risk of fracture. This is a calculation tool that estimates the likelihood of an osteoporosis-related fracture in the next 10 years. According to experts, if a person has osteopenia and a high risk of fracture by FRAX, then they have osteoporosis. 

Medications

The American Association of Clinical Endocrinologists, the National Osteoporosis Foundation (NOF), and the Endocrine Society all have guidelines for treatment. In a nutshell, postmenopausal women and men over age 50 should be treated with medication if they have any of these:

• Fracture of the hip or spine

• T-score worse than –2.5

• T-score between –1.0 and –2.5 and high FRAX 10-year probability of osteoporosis-related fracture 

Several types of osteoporosis medications are available. Many work by slowing bone resorption. They can be taken by mouth, as an injection, or through an IV. Examples include:

• Alendronate (Fosamax)

• Alendronate plus D

• Ibandronate (Boniva)

• Risedronate (Actonel, Atelvia)

• Zoledronic acid (Reclast)

• Calcitonin (Miacalcin, Fortical)

• Raloxifene (Evista)

• Denosumab (Prolia)

Other osteoporosis medications work by building new bone. These injectable medications include:

• Teriparatide (Forteo)

• Abaloparatide (Tymlos)

• Romosozumab (Evenity)

Treatments

The goal of osteoporosis treatment is to reduce the risk of fracture. The three most commonly affected areas are the spine, the hip, and the wrist. Most people think of pain when they think about fractures, but there’s more to it. Fractures can lead to disability, making it hard or impossible to do certain activities. They can also lead to dependence on others for daily living and mobility.

In addition to medications, it’s also important to mention fall prevention when thinking about how to treat and live with osteoporosis. In people with osteoporosis, falls are the leading cause of fractures. So it’s good to know what your risk of falls is, and what you can do to help prevent them — even if you think you’re not someone who falls. 

Here are some of the commonest risk of falls:

• Conditions at home, such as poor lighting and clutter on the floors

• Poor balance

• Drinking alcohol

• Muscle weakness

• Vision problems

• Medications that make you feel dizzy or less alert

You can use this tool to assess your own risk of falling and then share it with your healthcare provider. 

Here are some tips to help prevent falls at home:

• Always wear your glasses and hearing aids (if prescribed).

• Pick up or secure any loose wires, rugs, or pet items on the floor.

• Keep floors and stairs free of clutter.

• Make sure rooms, stairs, and hallways are well lit.

• Ask for help reaching for things instead of using step stools.

• Install handrails in bathrooms and stairways.

It’s common to feel sad or frustrated if you need help doing things that you previously didn’t need help with. If you are struggling with your feelings, or if you have a fear of falling, be sure to reach out to your healthcare provider for help. 

Prevention

It’s important to build bone strength early in life to help your chance of avoiding bone injuries later. According to the NOF, lifestyle behaviors can really have an impact on bone mass. Here are some steps you can take to keep your bones as healthy as possible and help prevent further bone loss if you already have osteoporosis:

• Getting enough calcium and vitamin D: Calcium and other minerals are the building blocks of healthy bone, and vitamin D helps the body absorb calcium. It’s better to get what you need through diet, but vitamins and minerals are available as supplements, too. For adults 50 years of age and older, experts recommend getting at least 1,000 IU of vitamin D daily (no more than 4,000 IU) and 1,200 mg calcium daily (no more than 1,500 mg). 

• Cut back on smoking and drinking, or stop completely: Excessive alcohol consumption (three or more drinks per day) and smoking have both been linked to an increased risk of fractures.

• Make exercise a regular habit, if you don’t already: Exercise strengthens muscles and improves balance, both of which can reduce the risk of falls. Also, strength training in postmenopausal women has been shown to slow the rate of bone loss. To keep your bones healthy, you need to challenge them with weight-bearing activities (like walking and dancing) as well as resistance activities (such as free weights or yoga). 

Be sure to speak with your healthcare provider before starting a new exercise program. This is especially true if you have osteoporosis and/or you have experienced a fracture, because certain movements might be harmful. A referral to physical therapy for balance and strength training is often a good option.