Osteoporosis is a condition in which bones lose mass and strength and break under a load that would not destroy a healthy bone. It develops over years and causes no pain until a fracture occurs. Below: the mechanics of the process, risk factors, examinations, and what affects bone strength.
What Exactly Breaks Down in the Bone
Bone is both a load-bearing structure and a store of minerals. When minerals from food are insufficient, the body takes them from the bone; constant borrowing makes the tissue porous and less dense. Osteoporosis is a systemic disease of the skeleton: bone mass decreases and the microarchitecture is disrupted, so fragility increases along with the risk of fracture. Bone loss with age is a normal process, but in some people it proceeds much faster. In women, loss begins at about 35–40 years of age and amounts to 0.5–1% per year; with the onset of menopause and in the first 3–5 years after it, the rate rises to 3–7% per year. During this period, up to 9–35% of bone mass can be lost.
Why There Are No Symptoms
Osteoporosis does not hurt as long as the bone is intact. Changes occur over years without sensation — which is why osteoporosis is called the "silent killer." The first sign is often a fracture from a fall or a sudden movement, sometimes from coughing or sneezing that causes a rib fracture or partial destruction of a vertebra. Vertebral fractures are a common cause of prolonged back pain. In some older people, a characteristic stooped posture develops: destroyed vertebrae cannot support the body's weight.
Who Is at Risk
Women have a higher risk than men, especially if menopause began early — before age 45 — or if the ovaries were removed. In postmenopause, osteoporosis affects from one-third to half of women. In Ukraine, it is detected in 13% of women aged 50–59, in 25% aged 60–69, in 50% aged 70–79, and in 53% aged 80–89.
Risk is also increased by:
- long-term use of glucocorticoids (steroid hormones);
- family history, especially a hip fracture in one of the parents;
- inflammatory and hormone-dependent diseases, malabsorption;
- low body mass index and lack of regular physical activity;
- smoking, alcohol, eating disorders.
In men, bone mass is reduced by declining testosterone levels in older age, and mortality after a hip fracture is higher in men than in women.
Fracture as the First Sign
The most common injuries in osteoporosis are fractures of the wrist, femoral neck, and vertebrae; fractures of other bones also occur, including the arm or pelvis. A femoral neck fracture is the most severe in its consequences: first-year mortality reaches 14 to 58%, about half of patients cannot move without assistance, and one-third lose the ability to care for themselves. The total risk of an osteoporotic fracture at age 50 is 39.7% for women and 13.1% for men.
Densitometry and the T-score
If a doctor suspects osteoporosis, they assess the future fracture risk using online tools such as FRAX or Q-Fracture and refer the patient for densitometry — a scan of bone tissue density. The procedure is short and painless, lasting 10–20 minutes depending on the area. The result is compared with that of a healthy young person, and the difference is expressed in standard deviations — this is the T-score. Above -1 is normal, from -1 to -2.5 is osteopenia, below -2.5 is osteoporosis. Osteopenia does not always progress to osteoporosis.
The examination is ordered by a doctor. The decision on treatment is made based on age, sex, and the scan result; it concerns medications that strengthen bones, and the specific regimen is selected by the doctor.
What Affects Bone Strength at Different Ages
Peak bone mass acquired in childhood and adolescence largely determines the risk for life. Its buildup is influenced by heredity, sex, ethnic origin, sufficient calcium and vitamin D in the diet, growth patterns, and physical activity. In adulthood, bone strength is associated with dietary calcium deficiency, physical inactivity, smoking, and excessive alcohol consumption — these are risk factors, not a reason for self-treatment. When a diagnosis already exists, the doctor can discuss prevention and fall-risk reduction with the patient.
See a doctor immediately. A serious injury after a fall or blow with suspected hip fracture and life-threatening conditions — call 103 or 112. Do not travel on your own.
This is reference text, not a diagnosis: examination and treatment are determined by a doctor after an evaluation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer