Osteoporosis and NIH Women's Health Research

Signs, Symptoms, and Risk Factors

Osteoporosis is characterized by a decrease in bone mass and bone mineral density, which increases the risk of fractures in people with osteoporosis. These fractures can occur during situations that would not normally cause them, such as falling from a standing height, lifting objects, or bending over.¹ Fractures occur most often in the vertebrae, hip, and wrist, although any bone has the potential to break.² Osteoporosis can significantly impair a person's quality of life and is associated with higher risks of morbidity and mortality.³ Some of the risk factors for this condition include a family history of osteoporosis or hip fractures, a diet that is low in vitamin D and calcium, smoking, and the long-term use of certain medications.^{1 , 4 , 5}

Impact on Women's Health

Although osteoporosis can occur in anyone, women have a higher risk of developing this condition than men.² Women tend to have lower peak bone mass than men, making them more susceptible to bone loss. Low levels of certain hormones, such as estrogen or testosterone, can also contribute to the development of osteoporosis. Because estrogen levels decline after menopause osteoporosis is a known risk in older women.

Diagnosis and Treatment

Currently, the U.S. Preventive Services Task Force recommends screening for osteoporosis to prevent osteoporotic fractures in women aged 65 years or older and in postmenopausal women who are younger than 65 years but who have a high risk of these types of fractures.⁶ Despite these recommendations, osteoporosis is often not diagnosed until after multiple fractures have occurred, and there is a need to improve risk assessments, preventive screening, and public education about this disease.⁷

Diagnosis generally involves taking a comprehensive history, paying special attention to the person's age, history of prior fractures, family history of osteoporosis, and current medications. A physical exam can reveal changes in gait, balance, mobility, or strength that may lead to future falls. Bone mineral density, a predictor of fracture risk, is measured using dual-energy x-ray absorptiometry (DEXA), with a T-score of -2.5 or lower indicating osteoporosis.^{3 , 5 , 8} Individuals who have T-scores between -1.0 and -2.5 are considered to have osteopenia.^{4 , 5}

Reducing the risk of fractures and slowing the decline of bone mineral density are the primary goals of treatment. Treatment may include the use of pharmacological therapies, such as bisphosphonates (e.g., alendronate, ibandronate) or the fully human IgG2 monoclonal antibody denosumab.^{3 , 9 , 10} Engaging in moderate exercise, limiting alcohol intake, quitting smoking, and meeting the recommended intakes of calcium and vitamin D can also improve bone mineral density and prevent falls and fractures.^{3 , 8}

Ongoing Research

The rates of screening and treatment for osteoporosis among Black, Hispanic, and Native American women are disproportionately lower than the rates among White women,⁷ and more research is needed to effectively address potential barriers to care for these populations. Other active areas of research include developing new bone-building and maintenance interventions for perimenopausal and postmenopausal women and identifying key indicators for progressive bone loss.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) supports key research areas related to osteoporosis, including methods for preventing and treating osteoporosis and the genetic and environmental factors that contribute to the development of this condition. NIAMS teamed up with the National Institute on Aging (NIA) to support the Study of Osteoporotic Fractures, which originally began in 1986. This study enrolled over 10,000 women aged 65 and older and has given researchers insights into key risk factors for osteoporosis and fractures.¹¹