Osteoporosis is often called a “silent disease.” But its consequences are anything but quiet. The condition weakens bones, making them thinner, more fragile, and more likely to break, and a hip or wrist fracture after a minor fall is often the first warning sign. Understanding your risk and treatment options could prevent a life-altering injury.
Who Should Be Screened?
Screening for osteoporosis remains a major gap in care. Bone density testing is generally recommended for all women age 65 and older and for younger postmenopausal women with risk factors, such as family history of hip fractures. However, several high-risk groups are frequently overlooked:
- Men over 70, particularly those with risk factors such as low testosterone levels. This includes men receiving androgen-deprivation or other hormone-lowering therapies for prostate cancer, which accelerate bone loss.
- Women taking aromatase inhibitors for breast cancer, which significantly increase the rate of bone loss.
- Individuals who are underweight (BMI ≤19) or women who are under 127 pounds, consume more than three alcoholic drinks per day, or smoke.
- People taking chronic steroids.
- Individuals with rheumatologic disease, including but not limited to rheumatoid arthritis, lupus, alkalizing spondylitis psoriatic arthritis.
- Individuals with endocrine disease, including: type 1 diabetes, hyperthyroidism, parathyroid disease.
- Women who experienced menopause before age 45.
- Adults over 50 with a personal or family history of fragility fractures, particularly fractures of the spine, hip, forearm, humerus, or pelvis.
Recognizing these often-overlooked risk factors can mean the difference between preventing a fracture and responding to one.
The Treatment Gap
Even after a fracture occurs, treatment rates remain surprisingly low. Many patients who experience a hip or wrist fracture never receive osteoporosis medication, despite clear evidence that they are at high risk for another fracture.
This treatment gap has serious consequences. Beyond mortality, fractures often lead to:
- Loss of independence
- Chronic pain
- Long-term disability
Putting Medication Risks into Perspective
One of the main reasons patients decline treatment is fear of side effects. Media coverage and online discussions often highlight rare complications such as atypical femur fractures and osteonecrosis of the jaw. While these risks are real, they are extremely uncommon.
In contrast, the benefits of osteoporosis medications are substantial. Many approved therapies reduce the risk of spine fractures by up to 50–70% and hip fractures by approximately 35-40%. For patients at high risk, the reduction in fracture risk far outweighs the rare possibility of serious side effects.
The Good News
Osteoporosis is both detectable and treatable. Bone density scans are simple, noninvasive tests that provide valuable information about fracture risk. Medications are effective, and lifestyle measures, including weight-bearing exercise, adequate calcium and vitamin D intake, smoking cessation, and fall prevention strategies, further support bone health.
While osteoporosis may be silent, its consequences are not. If you or a loved one has experienced a fracture, has risk factors, or is receiving cancer therapies that affect bone health, it’s important to speak with a physician about screening.
With appropriate screening, informed discussions about medication risks and benefits, and proactive treatment when indicated, we can significantly reduce the burden of this common and often underestimated disease.
Dr. Eric Rudin is an endocrinologist at Scarsdale Medical Group/White Plains Hospital Physician Associates. To make an appointment, visit call 914-723-8100.