“If You’ve Been Told You Have Osteoporosis, Start Here”
Part 1: What Osteoporosis Is, Why It Happens, and Who Is at Risk
If you’ve been told you have osteoporosis—or are worried you might—you’re not alone. Osteoporosis (OP) is extremely common yet often misunderstood. As a rheumatologist, I often meet patients who are alarmed by the diagnosis or confused because they “feel fine.” This blog post will explain osteoporosis clearly and calmly, starting with the basics to help you before, after, or during your visit with your physician.
What Is Osteoporosis?
Osteoporosis literally means “porous bone.”
Healthy bone looks solid under a microscope, like a honeycomb with small holes. In osteoporosis, those holes become larger and weaker, making bones fragile and more likely to break.
Importantly:
Osteoporosis does not cause pain by itself; I repeat Osteoporosis does not cause pain
Many people don’t know they have OP it until a fracture occurs
It progresses silently over time, like high blood pressure can be silent, OP can be silent as well, until it is too late.
However, Osteoporosis can lead to fractures or bone breaks. Common fracture sites include:
Spine/Vertebrae known as Compression Fractures
Hip
Wrist
Shoulder
How Bones Normally Stay Strong
Bone is living tissue. Your body is constantly:
Breaking down old bone
Building new bone
When you’re young, you build bone faster than you lose it. Peak bone mass is usually reached by your late 20s to early 30s. After that, bone breakdown slowly begins to exceed bone formation.
Osteoporosis develops when bone loss happens faster than bone replacement.
Why Does Osteoporosis Happen?
Several factors can tip the balance toward bone loss:
Aging
Bone density naturally decreases with age, especially after:
Menopause in women (due to estrogen loss)
Age 70+ in men
Hormones
Estrogen and testosterone protect bone. Low levels—whether from menopause, medical conditions, or certain treatments—accelerate bone loss.
Medications
Some common medications can weaken bones, including:
Long-term corticosteroids (prednisone)
Certain cancer treatments
Some anti-seizure medications
Smoking and Bone Health: An Often-Overlooked Risk Factor
· One important risk factor for osteoporosis that deserves special attention is smoking.
· Many patients are surprised to learn that smoking affects bones—not just lungs and heart. As a rheumatologist, this is something I routinely discuss with patients concerned about bone loss and fractures.
· Smoking weakens bones in several ways
Inflammatory Diseases
Conditions rheumatologists treat—such as rheumatoid arthritis or lupus—can raise fracture risk due to:
Chronic inflammation
Steroid use
Reduced mobility
Who Is Most at Risk?
You may have a higher risk if you:
Are postmenopausal
Have a family history of osteoporosis or hip fracture
Are thin or have a small frame
Smoke or drink excessive alcohol
Have low calcium or vitamin D intake
Have had a previous fracture from a minor fall
Osteoporosis is not just a “women’s disease.” Men account for up to 25% of hip fractures and often experience worse outcomes.
Key Takeaway from Part 1
Osteoporosis is common, silent, and treatable. Understanding how it develops is the first step toward protecting your bones. In Part 2, we’ll discuss how osteoporosis is diagnosed—and what your test results mean.