You know when your back hurts.

You notice when your muscles become weaker.

But your bones can slowly become less dense and more fragile without giving you much warning at all.

That is one of the difficult things about osteoporosis. You can feel perfectly fine while it is developing.

For many people, the first sign isn’t pain.

It’s a broken bone.

Your Bones Are Alive

We tend to think of our skeleton as the permanent framework holding everything together.

But bone is living tissue.

Throughout your life, your body continually removes older bone and replaces it with new bone. When we’re young, we generally build bone faster than we lose it. As we age, that balance begins to change.

Eventually, the body may remove more bone than it replaces.

Slowly, bones can become less dense and their internal structure can weaken.

That’s osteoporosis.

And you don’t feel it happening.

A Quiet Disease With a Very Real Impact

About 10 million Americans are estimated to have osteoporosis, with millions more having low bone density that puts them at increased risk.

Those numbers matter.

But from a nurse’s perspective, the number that matters most is one.

The one patient who was independent last week and is now lying in a hospital bed with a fractured hip.

The person who bent over, felt sudden back pain and later learned that a vertebra had fractured.

The patient who says:

“I had no idea there was anything wrong with my bones.”

That is the part of osteoporosis statistics don’t really capture.

Osteoporosis Doesn’t Mean Your Bones Are Crumbling

The word itself can sound frightening.

Osteoporosis does not mean your bones are suddenly going to break.

It means their strength has decreased enough that the risk of fracture has increased.

And risk is not destiny.

Knowing that your bones are becoming weaker gives you an opportunity to do something about it.

That might mean looking at nutrition, exercise and fall prevention. It may mean checking medications or medical conditions that affect bone health. For some people, it may mean medication specifically intended to reduce fracture risk.

But first you have to know there is a problem.

Why Does Bone Loss Happen?

Some bone loss is part of aging.

Women can experience more rapid bone loss around and after menopause as estrogen levels fall. Men lose bone too, although it often happens later and more gradually.

But age isn’t the whole story.

Family history can matter. Smoking and heavy alcohol use can affect bone health. Low body weight can increase risk. Certain medical conditions can contribute.

And medications matter too.

Long-term use of some medications—particularly glucocorticoid steroids such as prednisone—can increase osteoporosis risk.

This is why osteoporosis isn’t simply an “old woman’s disease.”

Men get it.

Younger people can develop it.

And sometimes people who don’t seem to fit the stereotype discover they have low bone density.

We’ll look much more closely at those risks later in this series.

The Fracture May Be the First Clue

Osteoporosis-related fractures commonly occur in the hip, spine and wrist.

Sometimes the injury seems surprisingly small compared with the damage it causes.

A fall from standing height.

A relatively ordinary stumble.

In severely weakened bones, even normal stresses such as bending or lifting can sometimes result in a vertebral fracture.

That’s when an important question needs to be asked:

Why did this bone break?

Of course falls cause fractures.

But particularly as we get older, treating the broken bone may only be part of the story.

The strength of the bone itself deserves attention too.

What About Losing Height?

This is another change people sometimes dismiss.

“I’m just getting shorter because I’m getting older.”

Some loss of height can occur with aging, but significant height loss, new back pain or developing a stooped posture can sometimes be associated with compression fractures in the spine.

Those fractures aren’t always dramatic.

A person may not remember an injury at all.

That’s why changes in height and posture are worth mentioning to your healthcare provider rather than automatically assuming they’re simply part of getting older.

You Can’t Tell How Strong Your Bones Are by Looking at Yourself

This may be the most important point.

You can be active and have osteoporosis.

You can look healthy and have osteoporosis.

You can have no pain and have osteoporosis.

And you can have osteoporosis without ever having broken a bone.

There is a test that measures bone mineral density, commonly called a DXA or DEXA scan.

It’s quick, noninvasive and uses a small amount of radiation.

But then comes another confusing part.

The result may arrive with numbers called T-scores and Z-scores, along with words such as normal, osteopenia or osteoporosis.

And suddenly you’re staring at something like –2.3 wondering:

Is that bad? How bad? And what am I supposed to do with it?

That’s exactly where we’re going next.

Because knowing you have bone loss is one thing.

Understanding what those numbers actually mean is another.

References

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: Overview, Symptoms & Causes.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. What Is Bone?

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: Diagnosis, Treatment, and Steps to Take.

Bone Health & Osteoporosis Foundation. Osteoporosis and Bone Health Statistics.