Osteoporosis is a condition where your bones become thinner and more fragile over time

Osteoporosis means your bones have lost density — they contain less mineral and are more porous, like a sponge with larger holes. This makes them break more easily from a fall or even a bump that wouldn't normally cause injury. The condition develops slowly and usually without symptoms, so many people don't know they have it until a bone fractures.

Your bones are living tissue that constantly breaks down and rebuilds. In osteoporosis, new bone is added more slowly than old bone is removed, creating a net loss of bone mass. This happens to everyone as they age, but some people lose bone density much faster than others.

Key Takeaways

  • Osteoporosis causes bones to become less dense and more fragile, but it usually has no symptoms until a fracture occurs.
  • Bone loss accelerates after age 50, especially for women after menopause when estrogen levels drop sharply.
  • A bone density test (DEXA scan) is the only way to know if you have osteoporosis before a break happens.
  • Risk factors include age, family history, low body weight, certain medications, and low physical activity.
  • Weight-bearing exercise, adequate calcium and vitamin D, and sometimes medication can slow bone loss or build bone back.

How bone loss happens and who is at higher risk

Bone density peaks around age 30, then gradually declines. After age 50, bone loss speeds up — particularly for women after menopause, when the hormone estrogen drops. Estrogen helps bones hold onto calcium, so when it falls, bones weaken faster. Men lose bone more slowly but still lose it, especially after age 70.

Your risk is higher if you have a family history of osteoporosis, a small or thin frame, low physical activity, or a diet low in calcium and vitamin D. Certain medications — including some steroids and blood thinners — increase bone loss. Smoking and heavy alcohol use also weaken bones. Some medical conditions, like rheumatoid arthritis and thyroid disease, raise your risk too.

The difference between osteoporosis and osteopenia

Osteopenia is an earlier stage of bone loss. Your bones are thinner than normal but not yet thin enough to be called osteoporosis. Think of it as a warning sign. Many people with osteopenia never develop osteoporosis, but some do over time.

Both are measured by a bone density test that compares your bone density to that of a healthy young adult. The results are given as a T-score. A T-score between -1 and -2.5 is osteopenia; below -2.5 is osteoporosis. The lower your score, the weaker your bones.

Why fractures happen more easily with osteoporosis

When bones are less dense, they cannot absorb impact as well. A fall from standing height that a person with normal bone density might walk away from can break a hip, wrist, or spine in someone with osteoporosis. Hip fractures often require surgery and can lead to long-term disability. Spine fractures can happen even without a fall — sometimes just from a cough or sneeze — and can cause height loss and stooped posture.

Wrist fractures are often the first sign of osteoporosis, especially in women. They happen when someone falls and puts out their hand to catch themselves. After a wrist fracture, the risk of other fractures rises sharply over the next few years.

How osteoporosis is detected

A DEXA scan (dual-energy X-ray absorptiometry) is the standard test for bone density. It is painless, takes about 10 to 30 minutes, and uses very low radiation — less than a chest X-ray. The scan measures bone density in your hip, spine, and sometimes forearm.

The U.S. Preventive Services Task Force recommends bone density screening for all women age 65 and older, and for postmenopausal women under 65 who have risk factors. Men age 70 and older should also be screened. Your doctor may recommend screening earlier if you have risk factors like a family history, use of steroids, or a previous fracture.

What you can do to slow bone loss or build bone

Weight-bearing exercise — walking, jogging, dancing, or strength training — signals your bones to maintain or build density. Aim for at least 150 minutes of moderate activity per week, plus two days of strength training. Even light activity is better than none.

Calcium and vitamin D are the building blocks bones need. Calcium-rich foods include dairy products, leafy greens, and fortified plant-based milks. Vitamin D comes from fatty fish, egg yolks, fortified milk, and sunlight exposure. Many people over 50 need a supplement to reach recommended levels — talk to your doctor about whether you need one.

Avoid smoking and limit alcohol to no more than one drink per day for women and two for men. If you take medications that affect bone, ask your doctor whether the benefit outweighs the risk or whether alternatives exist.

When medication is used to treat osteoporosis

If your bone density is very low or you have already had a fracture, your doctor may recommend medication. Bisphosphonates (such as alendronate, taken weekly or monthly) are the most common first choice. They slow bone loss and can reduce fracture risk. Other medications work differently — some help your body absorb calcium better, others stimulate bone-building cells.

Medications work best when combined with exercise and good nutrition. They are not a substitute for staying active and eating well. Your doctor will discuss which medication fits your situation, how long you might take it, and what side effects to watch for.

Frequently Asked Questions

Can osteoporosis be reversed?

Osteoporosis cannot be fully reversed, but bone loss can be slowed or stopped with exercise, nutrition, and sometimes medication. In some cases, bone density can improve slightly. The goal is to prevent fractures and maintain the bone you have.

Is osteoporosis painful?

Osteoporosis itself causes no pain. Pain usually comes only after a fracture occurs. Some people with spine fractures experience chronic back pain or height loss, but many have no symptoms until a break happens.

How often do I need a bone density test?

If your first test is normal, you may not need another for 10 years. If you have osteopenia, testing every one to two years helps track changes. If you have osteoporosis or are taking bone-building medication, your doctor will recommend how often to retest — usually every one to two years.

Can men get osteoporosis?

Yes. About one in four men over age 50 will break a bone due to osteoporosis. Men are screened later than women because bone loss happens more slowly, but screening is still important, especially after age 70 or if you have risk factors.

Does osteoporosis run in families?

Family history is a risk factor, but it is not destiny. If your parent had osteoporosis, your risk is higher, but exercise, good nutrition, and screening can help prevent or delay it. Talk to your doctor about your family history so they can recommend screening at the right time.