Osteoporosis guide: Symptoms, screening, diet, treatment

TL;DR:

• Osteoporosis weakens bones and raises fracture risk.
  
• DXA scans diagnose osteoporosis using T scores.
  
• USPSTF, as of January 14, 2025, advises screening all women 65+, and younger postmenopausal women with risk factors.
  
• Use FRAX with or without BMD to gauge 10-year fracture risk.
  
• Calcium, vitamin D, strength work, fall prevention, and medicines all cut risk.
  

What is osteoporosis

Osteoporosis makes bones thin and fragile. Fractures can happen from a minor fall. The World Health Organization calls these low energy injuries fragility fractures and notes a rising global burden as populations age. Hip and spine fractures are the most serious. Many vertebral fractures go undiagnosed. (WHO, fact sheet dated September 25, 2024)

Who is at higher risk

Risk climbs with age, menopause, low body weight, prior fracture, parental hip fracture, smoking, high alcohol intake, long term steroid use, poor diet, low activity, and frequent falls. Medical conditions like diabetes and kidney disease add risk. Some risks you cannot change, but many you can. (WHO)

Signs and symptoms

Osteoporosis is quiet until a fracture. Clues can include loss of height, a stooped posture, sudden back pain, or a wrist or hip fracture after a simple fall. Treat any adult fracture from standing height as a red flag for bone loss.

How osteoporosis is diagnosed

Doctors use bone mineral density testing with dual energy X-ray absorptiometry, called DXA. DXA of the hip and spine is the most reliable test to diagnose osteoporosis, predict risk, and track treatment. Results are reported as a T score.

• Normal: T score above −1.0
  
• Low bone mass, often called osteopenia: between −1.0 and −2.5
  
• Osteoporosis: at or below −2.5
  

NIAMS explains that DXA is quick, painless, and uses low radiation. Peripheral tests of heel or wrist can screen, but central DXA guides treatment. (NIAMS)

Who should be screened

The U.S. Preventive Services Task Force updated guidance on January 14, 2025:

• Screen all women 65 years and older.
  
• Screen younger postmenopausal women who have risk factors, then use a risk tool to decide on DXA.
  
• Evidence is not yet enough to recommend for or against routine screening in men. Decisions for men are individualized.
  (USPSTF 2025)
  

FRAX and other risk tools

FRAX estimates a 10 year probability of a major osteoporotic fracture and of hip fracture. Clinicians can run FRAX with clinical risks alone, or add femoral neck BMD for better accuracy. Country specific versions exist. The USPSTF notes FRAX is the most studied tool and is often used with DXA to decide on therapy. (USPSTF 2025)

Prevention you can start today

Food and supplements

NIAMS advises a balanced pattern with enough calcium, vitamin D, and protein. If diet falls short, a clinician may suggest supplements.

Daily calcium and vitamin D targets

Sources of calcium include low fat dairy, leafy greens, and canned fish with bones. Vitamin D comes from fortified foods and fatty fish, and the sun also helps. Targets above from NIAMS, based on NIH Office of Dietary Supplements.

Exercise

Do strength training 2 to 3 days a week and regular weight bearing activity, such as brisk walking. For those with established osteoporosis, avoid high impact moves and deep forward bends. A physical therapist can tailor a safe plan. Exercise will not rebuild large amounts of bone in older adults, but it improves balance, muscle, and confidence, which lowers fall risk. (NIAMS)

Fall proof your day

Most hip fractures result from falls. Simple home fixes go a long way.

• Remove loose rugs and clutter.
  
• Add grab bars in bathroom and railings on stairs.
  
• Improve lighting, use nightlights.
  
• Wear shoes with thin, non slip soles.
  
• Review medicines that affect balance or blood pressure.
  (NIAMS and WHO)
  

Treatment options

The goals are to reduce fractures and maintain quality of life. Your plan may include lifestyle steps, fall prevention, and medicines. Choices depend on age, sex, DXA results, FRAX risk, prior fractures, kidney function, other illnesses, and personal preference.

Common medicines

• Bisphosphonates such as alendronate or zoledronic acid slow bone breakdown and lower fracture risk. Often first choice.
  
• Denosumab is a RANKL inhibitor given by injection every six months.
  
• Anabolic agents build bone. Options include teriparatide, abaloparatide, and romosozumab for severe osteoporosis or after multiple fractures.
  
• Hormone therapy or SERMs can help select postmenopausal women when other options do not fit, considering risks and benefits.
  (NIAMS)
  

Treatment usually runs for years. After 3 to 5 years on some drugs, your clinician may recheck risk to decide on a pause or switch. Never stop denosumab without a plan, since bone loss can rebound. Keep calcium, vitamin D, exercise, and fall prevention in place during any drug holiday.

Screening and follow up plan

• Women 65+, schedule a DXA. Younger postmenopausal women, check risk factors, then use FRAX to decide on testing. For men, discuss personal risks.
  
• Recheck DXA in about 2 to 5 years based on initial results and risks. Longer intervals may be fine after a normal scan. Shorter if you start therapy or have a new fracture. The USPSTF summarizes evidence that very frequent DXA adds little benefit.
  
• If you fracture a hip, spine, wrist, or shoulder from a minor fall, ask for evaluation and treatment. Secondary prevention prevents the next fracture.
  (USPSTF and WHO)
  

Quick checklist

• Know your risk factors and height history.
  
• Review medicines, smoking, and alcohol with your clinician.
  
• Get enough calcium, vitamin D, and protein each day.
  
• Do strength work and weight bearing activity most days.
  
• Make the home fall safe and check vision and footwear.
  
• Ask about DXA and FRAX based on your age and risks.
  
• If on therapy, stick with it and keep follow ups.
  

Common mistakes to avoid

• Waiting for pain before testing. Osteoporosis is silent.
  
• Taking calcium without checking total daily intake first.
  
• Doing only cardio and skipping strength work.
  
• Stopping or skipping doses of bone medicine without a plan.
  
• Ignoring a new height loss or back pain. It could be a vertebral fracture.
  

Why it matters

Fragility fractures lead to loss of independence and reduced mobility. WHO reports a steady rise in fracture numbers worldwide. Screening the right people, fixing fall risks, and using proven therapies prevent fractures and save lives. Clear steps today protect your future. (WHO, USPSTF)

Sources:

• World Health Organization, Fragility fractures fact sheet, https://www.who.int/news-room/fact-sheets/detail/fragility-fractures, published 2024-09-25, accessed 2025-10-13.
  
• U.S. Preventive Services Task Force, Screening for Osteoporosis to Prevent Fractures, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening, published 2025-01-14, accessed 2025-10-13.
  
• National Institute of Arthritis and Musculoskeletal and Skin Diseases, Osteoporosis: Diagnosis, Treatment, and Steps to Take, https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take, reviewed 2022-12-01, accessed 2025-10-13.