Osteoporosis is a condition that weakens bones, causing them to become less dense and more fragile, which increases the risk of fractures. It most commonly affects the hips and spine.

Often referred to as a “silent disease,” osteoporosis can develop without noticeable symptoms as bone strength gradually decreases. Many people are unaware they have the condition until they experience a fracture.

Taking osteoporosis seriously is essential. Early detection, proper management, and appropriate treatment can help protect bone health, reduce the risk of fractures, and maintain overall quality of life.

How Is Osteoporosis Diagnosed?

Osteoporosis can be diagnosed following a fracture or through a bone mineral density (BMD) test.

A bone mineral density test is a specialized, low-dose X-ray that measures the density of your bones. It helps determine how strong your bones are and assess your risk of fracture. Generally, the lower your bone density, the greater your risk of breaking a bone.

Bone density testing is recommended for women aged 65 and older, as well as adults between the ages of 50 and 65 who have additional risk factors for osteoporosis. Your doctor can help determine whether testing is appropriate based on your individual risk.

Diagnosis Following a Fragility Fracture

Osteoporosis may also be diagnosed after a fragility fracture. This is a fracture that occurs from a fall from standing height or less, or from minimal trauma that would not normally cause a healthy bone to break.

The most common locations for fragility fractures include:

• Wrist
• Hip
• Spine (vertebrae)

Sometimes, an X-ray may reveal bones that appear thinner or less dense than normal. This can be an early indication of osteoporosis and may lead to further investigation and bone density testing.

What to Expect During an Osteoporosis Assessment

If you are at risk of osteoporosis, your doctor will take a detailed medical history and perform a thorough physical examination. Depending on your individual circumstances, this may be followed by blood tests, X-rays, a bone mineral density test, and other investigations.

Blood Tests for Secondary Causes of Osteoporosis

Blood tests may also be performed to identify underlying medical conditions that can contribute to bone loss. These are known as secondary causes of osteoporosis.

Depending on your medical history, testing may include:

• Serum calcium and phosphate: Measures mineral levels in the blood that are important for healthy bones.
• Parathyroid hormone (PTH): Evaluates parathyroid function, which helps regulate calcium levels in the body.
• Creatinine: Assesses kidney function, which plays an important role in maintaining calcium and vitamin D balance.
• Liver enzymes: Helps identify liver conditions that may affect bone health and vitamin D metabolism.
• Thyroid-stimulating hormone (TSH): Evaluates thyroid function, as an overactive thyroid can contribute to bone loss.
• Testosterone: May be measured in men with suspected low testosterone, as reduced levels can contribute to decreased bone density.

Identifying osteoporosis early is important. A proper assessment can help determine the cause of bone loss, evaluate your risk of fractures, and guide an appropriate treatment plan.

If you are diagnosed with osteoporosis, one of the first steps in managing the condition is ensuring you get enough calcium and vitamin D. Both nutrients play an essential role in maintaining bone health and helping to reduce the risk of fractures.

Calcium is an important mineral that helps maintain bone strength and density. Adults with osteoporosis are generally advised to aim for approximately 1,000–1,200 mg of elemental calcium per day, depending on their age, sex and individual needs.

Good dietary sources of calcium include:

• Milk, cheese and yogurt
• Calcium-fortified plant-based beverages
• Canned salmon with bones
• Other calcium-rich foods

Whenever possible, calcium should come from dietary sources. If you are unable to meet your daily requirements through food, your doctor may recommend a calcium supplement.

Vitamin D is equally important because it helps the body absorb calcium and maintain healthy bones. A daily intake of approximately 1,000–2,000 IU may be recommended for people with osteoporosis, depending on individual needs and vitamin D levels.

Vitamin D can be obtained from:

• Vitamin D-fortified milk and plant-based beverages
• Fortified foods and cereals
• Fatty fish, such as salmon
• Vitamin D supplements

Your doctor may recommend a daily vitamin D supplement to help ensure you are getting enough.

Getting adequate calcium and vitamin D is an important foundation of osteoporosis management. However, these nutrients alone may not be sufficient to prevent fractures. Your doctor can help determine whether additional osteoporosis treatments are needed based on your bone density and overall fracture risk.

Medications for Osteoporosis

There are several medications available to treat osteoporosis and help reduce the risk of fractures. Before recommending treatment, your doctor will assess your overall bone health and estimate your risk of experiencing a fracture. This assessment helps determine whether medication is needed and which treatment is most appropriate for you.

One commonly used tool is the FRAX (Fracture Risk Assessment) tool. It estimates your risk of experiencing a major osteoporotic fracture or hip fracture over the next 10 years. The assessment considers several factors, including age, sex, medical history, lifestyle factors and bone mineral density (when available).

Based on your overall fracture risk, your doctor will determine the most appropriate management plan. Treatment decisions generally consider whether your fracture risk is low, moderate or high.

Calcium and Vitamin D Are Important

Regardless of your fracture risk, getting adequate amounts of calcium and vitamin D is an important part of osteoporosis management. These nutrients help maintain bone health and support the effectiveness of osteoporosis treatments.

If you cannot obtain enough through your diet, your doctor may recommend supplements to meet your daily requirements.

When Is Medication Necessary?

If you have already experienced a fragility fracture, particularly a hip or vertebral fracture, medication will often be recommended to reduce the risk of future fractures.

Your doctor will consider your medical history, bone density results and overall fracture risk when deciding on the most appropriate medication.

Early treatment and ongoing management can help slow bone loss, preserve bone strength and reduce the likelihood of future fractures.

If your risk of fracture is low, osteoporosis medication may not be necessary. Instead, the focus is on maintaining healthy bones and preventing further bone loss through lifestyle changes.

Important steps include:

• Quit smoking: Smoking can accelerate bone loss and increase the risk of fractures. If you smoke, quitting is an important step toward protecting your bone health.
• Stay physically active: Regular exercise, particularly weight-bearing and resistance exercises, helps maintain bone strength and reduce bone loss.
• Improve balance and strength: Balance and muscle-strengthening exercises can improve stability, reduce the risk of falls and help prevent fractures.

Even when medication is not required, maintaining a healthy lifestyle and following up with your doctor are important for protecting your bones and monitoring your fracture risk over time.

Quitting smoking and increasing exercise is also key component in this risk category. Prescription medication may be recommended and you should discuss this with your doctor.

Management of Moderate to High Fracture Risk

Lifestyle changes remain an important part of osteoporosis management, regardless of whether medication is prescribed. Quitting smoking and increasing physical activity are key steps in maintaining bone health, slowing bone loss and reducing the risk of falls and fractures.

Medications Used to Treat Osteoporosis

There are several medications available to treat osteoporosis and reduce the risk of fractures. The choice of medication depends on several factors, including fracture risk, cost, convenience, availability, medical history and individual treatment needs.

Common medications include:

1. Oral Bisphosphonates

Oral bisphosphonates are commonly used to treat osteoporosis. They help slow bone breakdown and prevent further loss of bone density.

Examples include:

• Alendronate (Fosamax, Fosavance)
• Risedronate (Actonel)

These medications are taken by mouth, usually once weekly, depending on the specific prescription.

2. Intravenous Bisphosphonates

Zoledronic acid (Aclasta) is another type of bisphosphonate. Unlike oral medications, it is administered through an intravenous (IV) infusion, generally once a year.

It works by slowing the breakdown of bone and helping maintain bone density.

3. Denosumab (Prolia)

Denosumab (Prolia) is a biologic medication that helps prevent bone loss by reducing the activity of cells responsible for breaking down bone.

It is administered as an injection under the skin every six months.

It is important not to delay or discontinue denosumab without discussing an alternative treatment plan with your doctor, as stopping it can lead to rapid bone loss and an increased risk of vertebral fractures.

4. Hormone Therapy

For some women experiencing menopausal symptoms alongside osteoporosis, hormone therapy may be considered.

Estrogen plays an important role in maintaining bone density. Following menopause, estrogen levels decline, which can accelerate bone loss and increase the risk of osteoporosis.

Hormone therapy, which may include estrogen alone or estrogen combined with progesterone, can help reduce bone loss and manage menopausal symptoms. However, it is not appropriate for everyone, and the potential benefits and risks should be discussed with your doctor.

For more information about the specific medications used to treat osteoporosis, please refer to the Medications section of this website.

Osteoporosis is often referred to as a “silent disease” because it can develop without noticeable symptoms. In many cases, it is not diagnosed until a person experiences a fragility fracture, often involving the vertebrae (bones of the spine).

Vertebral fractures can cause back pain, but some people may have no obvious symptoms. Over time, these fractures can lead to a loss of height and a forward-curving posture, sometimes resulting in a hunched-back appearance.

Changes in posture can also affect the shape of the abdomen, causing it to protrude forward and making some people feel as though they are gaining weight. As the spine curves forward, the ribs may move closer to the pelvis, sometimes rubbing against it and causing discomfort or pain.

Recognizing these changes and seeking medical assessment is important for early diagnosis and appropriate treatment of osteoporosis.

Early diagnosis and treatment of ankylosing spondylitis (AS) are essential to help manage the condition and slow its progression.

Appropriate treatment can reduce inflammation, relieve pain and stiffness, maintain mobility, and help prevent long-term complications, including damage to the spine. Effective management may also help reduce the risk of complications associated with chronic inflammation, such as cardiovascular disease, and support overall health and well-being.

There is no specific diet proven to stop Osteoarthritis Education or reverse spinal changes. A Mediterranean-style pattern—vegetables and fruit, whole grains, legumes, nuts, fish, and unsaturated fats—is a reasonable approach for overall health. Foods such as tomatoes and bell peppers can be included, but they shouldn’t be considered treatments for Osteoarthritis Education.

Tomatoes and Osteoporosis Education

Tomatoes can be a nutritious addition to an Osteoarthritis -friendly diet, although they do not cure Osteoporosis Education or directly reverse joint damage.

• Lycopene: Tomatoes are particularly rich in lycopene, an antioxidant that helps protect cells from oxidative stress. Cooked tomatoes and tomato products can provide especially well-absorbed lycopene.

• Vitamin C: Supports collagen formation and normal connective-tissue function.

• Antioxidants: Tomatoes contain vitamin C, carotenoids, and other plant compounds that contribute to overall antioxidant intake.

• Potential anti-inflammatory effects: Laboratory and observational research suggests that compounds in tomatoes may influence inflammatory pathways, but evidence that eating tomatoes significantly reduces arthritis pain or inflammation in people is still limited.

• Heart health: Tomatoes can contribute to a heart-healthy diet, which is particularly relevant for people with Osteoporosis Education because RA is associated with increased cardiovascular risk.

Some people with arthritis report that tomatoes or other nightshade vegetables worsen their symptoms. There isn’t strong scientific evidence that tomatoes generally cause arthritis inflammation or should routinely be avoided. If you consistently notice symptoms after eating a particular food, discussing this pattern with a healthcare professional or dietitian can be more useful than eliminating foods unnecessarily.

For osteoarthritis, tomatoes are best viewed as part of an overall nutritious eating pattern. For rheumatoid arthritis, diet can complement medical treatment but shouldn’t replace disease-modifying medication when it is prescribed.