Bone Health Basics

What is osteoporosis?

A plain-language guide to a disease that develops silently for years — what it is, what causes it, and how it's found before a bone breaks.

A disease of weak, brittle bones

Osteoporosis is a disease where bones become weak and brittle, which increases your risk of broken bones — fractures. The most common areas of fracture are the spine, hip, and wrist.

According to World Health Organization criteria, osteoporosis is defined as a bone mineral density with a T-score of -2.5 or below. Your T-score can be measured by either a DEXA or a REMS scan. A T-score between -1.0 and -2.5 is classified as osteopenia — lower than normal bone density, but not yet osteoporosis.

What makes osteoporosis dangerous is that it has no symptoms until something breaks. You cannot feel your bones getting thinner. For most people, the first sign of the disease is the fracture itself.

1 in 2

Women aged 50 and older will break a bone due to osteoporosis — equal to the risk of breast, ovarian and uterine cancer combined.

1 in 4

Men aged 50 and older will break a bone due to osteoporosis — a risk greater than prostate cancer.

This is why screening matters. REMS testing provides the opportunity for early detection of bone density loss. Detecting and managing osteoporosis or osteopenia early has been shown to lower the risk of fractures.

Primary vs. secondary osteoporosis

Not all osteoporosis has the same cause. The distinction matters, because it determines what you and your physician can actually do about it.

Primary osteoporosis

Primary osteoporosis occurs when the body is no longer producing the building blocks for effective bone growth at a rate that keeps bones strong. As the rate of healthy bone growth decreases, bones become weaker and the risk of fracture goes up.

It occurs most often in two groups:

Postmenopausal women often experience changes that affect their hormonal balance. These changes can slow the rate of bone growth and accelerate the rate at which bone breaks down.
Aging women and men frequently experience a slower rate of bone growth, resulting in fragility and an elevated risk of fracture. Osteoblasts — your bone-building cells — typically start to slow down after age 30, which begins the decline in bone strength.

Secondary osteoporosis

Secondary osteoporosis includes a loss in bone strength due to factors not associated with genetics or age — including lifestyle behaviors and healthcare choices.

Factors commonly linked to bone loss

Smoking
Drinking alcohol
Sedentary lifestyle
Medication use
Weight loss drugs (e.g. Ozempic, Wegovy, Mounjaro)
Age — bones weaken over time
Sex — women are affected more often, but men get it too
Ethnicity — Caucasian and Asian women show higher risk

Medications that can lead to bone density loss

Drug-induced osteoporosis is common, and the list of medications that can harm bone continues to grow. As part of routine health maintenance, practitioners should recognize the drugs that increase bone loss and take measures to mitigate these effects to help avoid osteopenia and osteoporosis.

— Cleveland Clinic Journal of Medicine

Category	Common examples
Glucocorticoids / anti-inflammatory steroids	Prednisone, cortisone, Flovent, Pulmicort
Reflux / heartburn drugs (proton pump inhibitors)	Prilosec, Prevacid, Losec, Pantoloc, Tecta, Pariet, NexiumPrescription and over-the-counter
Depression medications (SSRIs)	Prozac, Lexapro, Zoloft, Paxil, Celexa
Anti-seizure & anti-migraine medications	Tegretol, phenytoin (Dilantin)
Breast cancer drugs (aromatase inhibitors)	Anastrozole, letrozole, exemestane
Diabetes medications	Avandia, Actos
Osteoporosis medications (bisphosphonates)	Alendronate, Fosamax, Boniva, risedronate, Actonel, ReclastSee the note below — this one needs care

A note on bisphosphonates. Bisphosphonates are the most commonly prescribed medications for osteoporosis, and have been shown in studies to increase the risk of fracture and lower bone density when used for extended periods. The New England Journal of Medicine reported that “the incidence of atypical fractures increased as duration of bisphosphonate use increased.” If you've been on one of these long-term, it's worth a conversation with your physician about monitoring.

Please don't stop any medication on your own. This list is educational. Every one of these medications treats a real condition, and the decision to continue, adjust, or stop one belongs to you and your physician together — not to a website. Bring this list to your next appointment and ask whether your bone health should be monitored.

Common questions

What T-score means osteoporosis?

According to World Health Organization criteria, osteoporosis is defined as a bone mineral density with a T-score of -2.5 or below. A T-score between -1.0 and -2.5 is classified as osteopenia, which is lower than normal bone density but not yet osteoporosis. Both a DEXA and a REMS scan can measure your T-score.

Is osteoporosis more common in women or men?

It's more common in women, but men are affected far more than most people realize. Among adults 50 and older, up to 1 in 2 women and up to 1 in 4 men will break a bone due to osteoporosis.

Can osteoporosis be caused by medication?

Yes. Drug-induced osteoporosis is common, and the list of medications that can harm bone continues to grow. Glucocorticoids, proton pump inhibitors, SSRIs, certain anti-seizure drugs, aromatase inhibitors, and some diabetes medications have all been associated with bone density loss. If you take any of these long-term, it's worth asking your physician about your bone health.

Can I have osteoporosis and not know it?

Yes — that's the defining feature of the disease. Osteoporosis develops silently over years with no symptoms until a bone breaks. This is why screening matters, and why early detection through bone density testing is the only reliable way to know where you stand.

Osteoporosis has no symptoms. A scan does.

A REMS bone density scan takes about 15 minutes and uses no radiation — so it can be repeated for monitoring as often as your physician recommends. Serving patients across New York and New Jersey.

Schedule My Bone Scan Call 833-454-7263

Next: how a REMS scan works or browse the published research behind it.