Osteoporosis is a silent, usually painless, saboteur. For many people, the first sign of trouble is a fracture. However, subtle signs may have been present for some time—a gradual loss of height over the years, for instance, the rounding of the upper back (known as kyphosis, or dowager’s hump), or even tooth loss.

The most common sites of osteoporosis-related fractures are the spine and hip, but the wrist and other bones may be affected as well.

Both the type and location of the trauma usually determine the kind of fracture that is involved. For example, falling on an outstretched hand can lead to a type of injury known as a Colles’ fracture (a break at the end of one of the bones in the forearm). The wrist, toes, and ribs are among the most common sites of osteoporotic fractures.

For a person with severe osteoporosis, simply sneezing or coughing may be enough to cause painful fractures of the ribs and spine. Such fractures can sometimes lead to deformities as well as pain.

Osteoporosis is responsible for more than two million fractures a year, including approximately 550,000 spinal (vertebral) fractures, more than 300,000 hip fractures, 400,000 wrist fractures, and 800,000 other fractures.

An expert panel convened by the National Osteoporosis Foundation estimated that at least 90% of all hip and spine fractures in older women are caused by osteoporosis. Anyone who has had one osteoporosis-related fracture is at very high risk for a second.

Fractures in Men

Some people think that men can’t get osteoporosis. That is simply not true. Before age 60, fractures are more common in men than in women, likely because of injuries related to sports and accidents. Although the prevalence of fractures increases in men after age 60, their rate is still less than half that of women of the same age. This is because men enter adulthood with greater bone mass than women—and women rapidly lose bone mass during the first three to five years after a natural or surgical menopause (or any other cause of estrogen deficiency). Nevertheless, one in five men will experience an osteoporosis-related fracture in his lifetime.

The most commonly identified risk factors for osteoporosis in men are excessive alcohol intake, use of corticosteroid drugs (such as prednisone), and hypogonadism (testosterone deficiency).

If a man develops osteoporosis, a thorough medical evaluation should be performed to determine the underlying cause. Similarly, a premenopausal woman or any woman who is not responding to treatment should also undergo an evaluation for secondary causes of the disease.

Publication Review By: Lee H. Riley III, M.D., and Suzanne M. Jan de Beur, M.D.

Published: 10 Aug 2011

Last Modified: 14 Dec 2011