What Is Primary Osteoporosis?

Primary osteoporosis is a bone disease characterized by the progressive loss of bone mass and bone density due to the normal aging process. Because the condition causes bones to become fragile and weak, people with primary osteoporosis are at an increased risk of fractures—even after minor bumps and falls.

Primary osteoporosis does not usually cause symptoms; many people are unaware they have it until they’ve broken a bone.

This article discusses types of primary osteoporosis, symptoms, causes, diagnosis, and treatment.

Types of Primary Osteoporosis 

There are two types of primary osteoporosis: postmenopausal osteoporosis (type 1) and senile osteoporosis (type 2):

Postmenopausal Osteoporosis (Type 1)

Hormonal changes that occur after menopause can affect bone health. Estrogen is a sex hormone that plays many roles in the female body, including protecting bones from getting weaker and slowing the natural breakdown of bone. Its reduction after menopause speeds up bone loss. An estimated 50% of all postmenopausal people have osteoporosis.

Senile Osteoporosis (Type 2)

Senile osteoporosis is caused by aging and can affect both women and men. This form of osteoporosis develops slowly over time as the formation of new bone tissues (bone remodeling) also slows. Additionally, aging is associated with impaired calcium absorption and low vitamin D levels in the body, making senile osteoporosis most common in people over 70 years old. 

Primary Osteoporosis Symptoms

Primary osteoporosis is often called a silent disease because it usually doesn’t cause symptoms. Many people don’t know they have the condition until they experience a fracture. Fractures are most common in the hips, wrist, and spine but can occur in other bones, too.

When symptoms do occur, they can include: 

• Severe back pain (caused by a spinal fracture) 
• Loss of height
• Postural problems, such as a hunched or stooped-over posture (kyphosis) 

Spinal fractures, called compression fractures, can occur anywhere in the spine, even without a fall or bump. The pain can come on suddenly or develop over time.

Causes

Primary osteoporosis is caused by regular age-related bone density and mass changes. It is most common in postmenopausal people but can affect anyone as they age. Certain factors can increase the risk of developing osteoporosis, including:

• Sex: Women are more likely to develop osteoporosis than men, but the risk for men still exists—especially after age 70. 
• Age: Primary osteoporosis is associated with the body’s natural aging process. As you age, new bone formation slows, and your risk increases. 
• Race: Caucasian and Asian people have a higher prevalence of osteoporosis. 
• Body type: People with slender frames and small, thin bones are at a greater risk of the disease because they have less bone to lose compared to people with larger bones. 
• Family history: If you have a family member with osteoporosis or a history of hip fracture, your odds of developing the disease are higher. 
• Menopause: People who have gone through menopause are more likely to develop osteoporosis due to a change in hormone levels (e.g., estrogen in women and testosterone in men). 
• Smoking: Tobacco use is linked to decreased bone density.
• Poor diet: A diet lacking calcium, protein, and vitamin D is associated with an increased risk of osteoporosis and fractures. 
• Sedentary lifestyle: Low levels of physical activity and prolonged periods of inactivity can increase the rate of bone loss and increase the risk of falls and fractures. 

Not everyone with risk factors will develop osteoporosis, and some people with no or few risk factors can develop the disease. 

Diagnosis

If you have risk factors for osteoporosis or your healthcare provider suspects you have the condition, they will ask about your medical history and use a fracture risk assessment tool (FRAX) to estimate your future risk of fractures.

They may also perform a physical examination to check for:

• Loss of height and weight 
• Posture changes 
• Muscle strength (e.g., your ability to stand up from sitting without using your arms) 
• Balance and gait (walking pattern) problems 

If the results of the FRAX assessment indicate you are at a high risk of osteoporosis—or you are 65 or older—your healthcare provider may recommend a bone mineral density (BMD) test. 

There are different bone density tests, but the most commonly used test is the dual-energy X-ray absorptiometry (DEXA) test. This particular type of X-ray determines the density of the bone and can detect small percentages of bone loss. A DEXA scan is a painless, non-invasive test.

Your healthcare provider will use your results to diagnose osteoporosis, determine whether you need treatment, and assess your risk of future fractures. 

Treatment

Bone loss can’t be reversed, but treating primary osteoporosis can help slow or stop bone loss to prevent fractures. Medications used to treat osteoporosis include:

• Hormone replacement therapy 
• Bisphosphonates
• Calcitonin
• Estrogen receptor modulators
• Prolia (denosumab)
• Anabolic steroids

The type of medications your healthcare provider recommends will depend on your specific needs and overall health. 

Lifestyle Choices

In addition to medical treatments, lifestyle modifications can help prevent bone loss and reduce the risk of fractures. Making healthy lifestyle choices not only helps improve your bone health but benefits your overall health and well-being as well. 

• Get regular exercise, including walking, swimming, and resistance training.
• Quit smoking.
• Eat a healthy diet rich in calcium, vitamin D, and lean proteins. 
• Take supplemental vitamin D and calcium if you do not get adequate amounts through diet alone. 

Coping 

Living with osteoporosis can impact your physical and emotional well-being. You may be worried about breaking a bone, experience adverse side effects of medications you’re taking, or wonder if you can safely participate in activities you once enjoyed. These are normal concerns that many people with osteoporosis have. Fortunately, there are things you can do to cope and live well with the disease.

Prevent Falls

Making simple changes at home and work can help reduce the risk of falls and fractures. Look for hazards in your home that may cause a fall, such as unsecured rugs. Consider putting rubber mats in the shower and by the kitchen sink to avoid slipping and falling. 

Get Support

You may find it helpful to talk with a therapist or someone who has experience working with osteoporosis and understands its implications on a person’s life. Some people find it beneficial to speak with others with the condition, so consider joining a local or online support group for people with osteoporosis. Your healthcare provider may have information about counseling options and support groups near you. 

Pain Management

If you have a broken bone, are recovering, or live with chronic pain, there are ways to help manage pain to reduce its impact on your quality of life. Heat treatment, such as heating pads or warm baths, can help soothe some pain. Relaxation techniques, such as stretching, meditation, or yoga, can help relax your body and mind.

Talk to your healthcare provider about pain medications if your pain is limiting your ability to carry out your daily tasks. 

Summary 

Primary osteoporosis is a common bone disease associated with losing bone mass and density, which increases the risk of falls. This type of osteoporosis is most common in postmenopausal women but can occur in older adults of any age.

Primary osteoporosis rarely causes symptoms, and many people do not know they have it until they break a bone. Bone mass density tests can diagnose osteoporosis, and treatments include different types of medications and lifestyle modifications.

The most important thing for people with osteoporosis to do is prevent falls and fractures. Living well with osteoporosis is possible with the right treatments and support and by adopting healthy lifestyle habits.