An Overview of the Stages of Osteoporosis

Osteoporosis is a condition that develops over time as your bones get weaker with age. You may not have symptoms early on, but as the disease progresses, your bones will get frailer. This means that breaks and fractures can happen more easily.

This article will explain the stages of osteoporosis, as well as the causes, symptoms, and possible treatments for the condition.

What Is Osteoporosis?

Osteoporosis is the most common bone disease. A diagnosis of osteoporosis means that your bones have become weakened and frail. This happens with age, but a number of other factors can make the condition worse or speed the disease's progression.

Your bone mass is a measurement of how strong your bones are. According to the Centers for Disease Control and Prevention (CDC), low bone mass can be found in almost half of all Americans over the age of 50. Osteoporosis, the advanced stages of low bone mass, develops in nearly 13% of Americans after age 50.

Osteoporosis affects women more often than men: Almost 20% of people over age 50 with osteoporosis are women, while men account for less than 5%.

Causes of Osteoporosis

Bone loss is a natural process. Bone tissue is constantly lost and replaced, but bones become weakened when bone tissue is not replaced as fast as it's lost. Bone mass peaks in the teenage years, and declines throughout adulthood.

The process of bone loss is called resorption. There are a number of things that can increase your rate of resorption without increasing your rate of replacement. Factors that can affect your bone mass and rates of resorption include:

• Sex
• Genetics
• Overall health
• Nutrition
• Hormone balance
• Physical strength and activity
  
• Medications such as steroids
• Using substances such as caffeine, nicotine (smoking), and opiates
• Vitamin deficiencies

As bone mass is reduced, the entire structure of your bones becomes weaker. In addition to your overall health, there are also conditions or lifestyle choices that can cause bone loss and lead to osteoporosis.

Types of Osteoporosis

There are several types and stages of bone loss. Osteoporosis is usually classified based on how much bone mass you have lost and what caused the bone loss to happen.

Osteopenia

Osteopenia, or a diagnosis of low bone mass, is like "pre-osteoporosis." With this type of bone loss, your bones are weakening, but you are not classified as having osteoporosis. With osteopenia, you have a T score between -1 and -2.5.

Primary Osteoporosis

Primary osteoporosis describes bone loss that occurs as part of the natural aging process. It is broken up into two subgroups:

• Involutional osteoporosis type I or postmenopausal osteoporosis is caused by a lack of the hormone estrogen. This type of primary osteoporosis mainly affects women who have reached menopause.
• Involutional osteoporosis type II or senile osteoporosis is strictly related to normal aging.

Secondary Osteoporosis

Secondary osteoporosis refers to bone loss that happens outside of the normal aging process, most often from nutritional deficiencies or other underlying health conditions. The table below highlights some lifestyle factors and diseases that can contribute to or cause bone loss.

Roughly a third of postmenopausal women who have primary osteoporosis also have a secondary cause. Between 50% and 80% of men with osteoporosis have secondary contributing factors.

Signs and Symptoms of Each Stage of Osteoporosis

Osteoporosis develops gradually, often with no symptoms at all. Most people do not even know that they have the condition until they experience a break or fracture.

Stage 1

When you're young, your bones grow faster than they break down. At some point in your 20s and 30s, bone resorption and new bone formation reach an equilibrium—meaning that you lose and form bone at the same rate. This can be considered the first stage of osteoporosis because the formation of bone is no longer outpacing bone loss.

You will have no symptoms at this stage. Your bone density scores (T-score) will be normal and range from +1 to -1.

Stage 2

At this stage, you still have no symptoms, but your bone loss is now happening faster than your bone growth. If you experience an injury or have bone mass testing done for another reason, you might be diagnosed with osteopenia. T-scores during this stage range from -1 to -2.5.

Stage 3

When you have reached this stage, you officially have osteoporosis. Again, you may not notice any symptoms, but you are at a higher risk of breaks and fractures even from simple injuries like hitting your leg against a door. In this stage, your T-score is -2.5 or lower.

Stage 4

This is a more severe form of osteoporosis. Outside of breaks and fractures, this is the only stage where you may actually notice the bone loss. The softening and weakening of your bones can cause deformities (such as a bent-over appearance called kyphosis that results from weak bones in your spine) and pain with everyday activities.

In this stage, your T-score is well below -2.5 and you have had one or more breaks or fractures.

Diagnosis of Osteoporosis

While bone density testing is the most exact way to determine your level of bone loss, your doctor will usually start by taking your personal and family medical history, get a list of your health conditions and any medications you are taking, and do a physical exam.

Bone density measurements are taken with a dual energy X-ray absorptiometry (DEXA) scan. This test is similar to an X-ray, but it gives your doctor an actual reading of the mineral density in each square centimeter of bone.

The measurement is given with a T-score, which requires several measurements and takes many factors into account. Your scores are then compared with those of other people in your sex and age group.

All women who are age 65 and older should be screened for osteoporosis with a bone density test, according to the U.S. Preventive Services Task Force (USPSTF). People with certain risk factors, or some women who have been through menopause but are under age 65, should be tested early or more frequently.

If you have been diagnosed with osteoporosis and are taking medications to treat the condition, your bone density scan should be repeated every one to two years.

Treatment

Treating osteoporosis usually involves taking nutritional supplements to boost your bone health, strengthening the muscles that help support your bones, and taking medications that can reduce bone loss or increase bone density.

Supplements

Vitamin D and calcium supplements are often used to treat or prevent bone loss. Below are the usage recommendations for these supplements:

• Adults age 50 and under: 1,000 milligrams (mg) of calcium and 400 to 800 international units (IU) of vitamin D daily
• Women ages 51 to 70: 1,200 mg of calcium and 400 to 800 IU of vitamin D daily
• Men ages 51 to 70: 1,000 mg of calcium and 400 to 800 IU of vitamin D daily
• Adults over age 70: 1,200 mg of calcium and 800 IU of vitamin D daily

If you can, it's best to obtain these nutrients directly from your diet. Try to include foods that are rich in calcium and vitamin D and use supplements only to make up for shortages. Your doctor may also recommend other dosages of these supplements for you based on your health and risk factors.

Exercise

You cannot directly exercise your bones, but you can strengthen the muscles that are around them. While staying active overall is most important, there are particular activities that can help preserve your bone density.

Types of exercise that support your bones include:

• Weight-bearing exercises
• Free weights
• Balancing exercises
• Rowing

These exercises should be done for at least 30 minutes three times a week. However, you should avoid exercises that could increase your risk of injury or falls.

Medications

Medications are sometimes used to help slow or stop bone loss, or to help improve overall bone health. You may not need to take these medications forever. In some cases, you may need to take the medication for only a few years, depending on your risk.

Examples of medications that may be used to treat osteoporosis and bone loss include:

• Bisphosphonates
• Denosumab
• Teriparatide or abaloparatide
• Romosozumab
• Estrogen receptor modulators
• Calcitonin

Ways to Prevent the Condition

You cannot prevent all forms of osteoporosis—especially those that are caused by underlying diseases or the aging process. However, you can try to slow the process.

Your age, your sex, and your genetics are not factors that you can control, but there are several risk factors that contribute to osteoporosis that you can have an effect on by making lifestyle changes.

You can help prevent bone loss and osteoporosis by:

• Quitting smoking
• Exercising regularly
• Eating a well-balanced diet
• Limiting alcohol use
• Reducing caffeine
• Preventing falls
  

Summary

Osteoporosis is a condition in which your bones get weaker over time until you start to have breaks and fractures. You cannot always prevent osteoporosis, but you can slow its progress. If you are in the early stages of bone loss, your doctor can help you identify ways to promote bone growth and slow or stop bone loss.

Everyone loses bone density over time, but for some, these losses can lead to pain and fractures. Women are at a higher risk of developing the condition than men. There are certain activities—like smoking—that can increase your risk.

Talk to your doctor about preventing and screening for osteoporosis. Identifying and modifying risk factors in the early stages of the disease can help slow or stop its progression.