What’s the Difference Between Arthritis and Osteoporosis?

Symptoms

Arthritis and osteoporosis both affect your bones, but they do not develop or present in the same way. Arthritis symptoms are often more noticeable. Many people don’t realize they have osteoporosis until they break a bone.

Arthritis symptoms

There are more than 100 types of arthritis. However, since all of them affect the joints in some way, there are often shared general symptoms.

These include:

• pain and stiffness in joints
• swelling in joints (sometimes warm to the touch)
• fatigue

Common types of arthritis

Here’s a closer look at some distinguishing symptoms for common types of arthritis, per the National Institutes of Health (NIH):

• Osteoarthritis (OA). Not to be confused with osteoporosis, osteoarthritis is the most common type of arthritis and usually develops with age. It is degenerative wear-and-tear arthritis with an inflammatory component. Anyone can develop OA, but genetics, prior injury, and lifestyle play a role. Symptoms include pain, stiffness, and loss of motion.
• Rheumatoid arthritis (RA). RA is an autoimmune condition where your body attacks the joints by mistake. Rheumatoid arthritis can lead to swollen, stiff, and painful joints. RA may affect multiple joints in the body. It can also cause fever and fatigue.
• Psoriatic arthritis (PsA). If you have psoriasis, you may be at an increased risk of developing arthritis symptoms in your joints, as well as where tissues attach to your bones, which is called enthesitis. Psoriatic arthritis is a member of a family of inflammatory diseases called the spondyloarthropathies. This also includes reactive arthritis and most commonly ankylosing spondylitis.
• Reactive arthritis (previously Reiter’s syndrome). This type of spondyloarthritis is triggered by an infection, most often bacterial or a sexually transmitted infection. Reactive arthritis usually presents with pain in lower joints, and urinary tract and eye inflammation. Reactive arthritis typically resolves within months, but some patients may have persistent, chronic symptoms.
• Juvenile idiopathic arthritis (JIA). JIA develops before age 16 years. It may cause warm, swollen, and painful joints. Children with JIA may also have joint stiffness and reduced range of motion, as well as growth problems.
• Viral arthritis. Viruses such as Hepatitis B or C, and parvovirus such as fifth disease, can present with a short lived polyarthritis that can be mistaken for more chronic arthritis such as RA. Joint pain typically goes away within weeks to months with no long term complications.

Arthritis may also be involved in, or comorbidity (co-occurring condition) with, other health conditions.

These include:

• psoriasis
• gout
• lupus
• fibromyalgia

Osteoporosis symptoms

Unlike arthritis, osteoporosis is considered an “invisible” or “silent” illness in the early stages. You may not know you have low bone mass and low bone density, which cause osteoporosis, until you’ve broken (fractured) a bone.

Since osteoporosis does not usually have obvious symptoms early on, screening and timely diagnosis are important to help prevent related bone fractures.

However, some people may still experience the following symptoms before diagnosis, according to NIH:

• a hunched or stooped posture
• loss of height
• back pain, which may be severe

Fractures from osteoporosis may occur spontaneously or from seemingly minor accidents and falls. In some cases, fractures may develop from typical daily functions like bending or lifting.

Diagnosis

Talking with a doctor about your symptoms is the first step in getting a diagnosis for either arthritis or osteoporosis. Your doctor may start with a physical exam and then ask you questions about your medical and family history.

Arthritis diagnosis

If your doctor suspects arthritis, they may order the following tests:

• Blood tests to rule out inflammatory arthritis. Your doctor may look for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which may indicate inflammation.
• Blood screening test for rheumatoid factor (RF), cyclic citrullinated peptide (CCP), antinuclear antibody (ANA), which are indicators of rheumatic autoimmune diseases, uric acid, HLA-B27, and other biomarkers associated with autoimmune disease. Conditions can be present without these markers as well.
• X-rays or MRIs to look for joint damage in both OA and inflammatory arthritis.

Other blood tests are used to rule out infections like Lyme disease, a bacterial infection, and hepatitis, a viral infection, as well as other viral infections that can be associated with joint inflammation.

Osteoporosis diagnosis

A specialized X-ray called a dual energy X-ray absorptiometry, or DEXA scan, is used to diagnose osteoporosis. These types of X-rays are shorter and do not emit as much radiation as traditional ones, which can make them safer for repeated use in the future.

A DEXA scan usually only takes an average of 10 to 15 minutes to complete. It measures your bone density in comparison with the bones of an average 30-year-old, and your results are assigned a “T-score.”

Here’s how the scores are broken down, according to AAOS:

A DEXA scan is recommended for adults over age 50 who may have had a recent fracture from a minor accident, but it’s especially recommended for the following individuals:

• all women over age 65
• women under age 65 who may have risk factors for osteoporosis
• all men over age 70
• men under age 70 who smoke, have loss of height, or other osteoporosis risk factors

Learn more >> Here’s what you need to know about osteoporosis screening

Genetics

While the risk for developing osteoporosis increases with age, you may be at a higher risk if one or both of your parents have this condition or another bone disease. This is especially true if there’s a history of maternal hip fracture before age 50.

Researchers are currently looking into whether specific genes and biomarkers could indicate a specific risk for osteoporosis. There have been some tentative findings, including connections between osteoporosis and the genes DAAM2, VDR, and BMP2.

Similar to osteoporosis, osteoarthritis develops due to age and natural wear and tear, anyone can develop it. But other types of arthritis may have unique genetic components in addition to environmental factors. Autoimmune diseases, such as RA, may run in families, but many patients have no family history of disease.

The American College of Rheumatology (ACR) notes that up to 30 percent of the general worldwide population carry a gene called HLA-DR4, which has been linked to rheumatoid arthritis. However, not everyone with this gene will develop the condition (only around 1 percent of the general population has RA).

Also, while juvenile idiopathic arthritis itself typically does not run in families, children may be at an increased risk of developing JIA if there’s a family history of chronic arthritis.

Takeaway

Having a family history of osteoporosis or arthritis is one of the most important indicators of your chance of developing either or both conditions. Tell your doctor about all hereditary autoimmune diseases and chronic conditions.

Other risk factors

In addition to your family history, there are other health and environmental factors that can influence your chance of developing osteoporosis or arthritis.

The risk factors for arthritis vary by type and may include:

• Age. Your skeleton goes through a lot in life, and decades of movement take their toll on our joints and bones. For example, it’s estimated that up to 30 percent of adults over age 45 may have OA of the knee.
• Being overweight or having obesity. Having more body weight may place additional stress on your knee joints, leading to osteoarthritis.
• Repeat injuries. This can weaken your joints, leading to OA later in life.
• Personal history of psoriasis. Some people with this skin condition develop PsA 7 to 10 years later.

Factors that increase your chance of developing osteoporosis include:

• Age. Older adults lose bone mass more quickly, causing further bone weakening and potential fractures.
• Gender. Due to hormonal changes, such as estrogen loss during menopause, cisgender women and certain people assigned female at birth are at a higher risk of developing osteoporosis.
• Body size. Having a naturally smaller frame means you may already have less bone mass. This can cause the effects of bone loss or damage to appear sooner.
• Taking certain medications. If you’re receiving treatment for RA or another autoimmune disease, you may be at risk of developing low bone mass due to taking certain medications. This risk often increases when medications are taken long term. Examples of these medications include:
  • corticosteroids
  • lithium
  • thyroid hormone medications
  • drugs used to treat breast and prostate cancer
  • anti-seizure medications
  • certain immunosuppressive drugs
• Having a nutrient deficiency. Getting the right nutrients is one of the most important things you can do to prevent osteoporosis. Calcium and vitamin D deficiencies cause bone loss and weakness. Always consult a doctor or nutritionist before starting a supplement.
• Smoking or drinking alcohol. NIH reports that tobacco use is associated with decreased bone density, and higher chance of fracture. Too much alcohol consumption can interfere with calcium and hormones in the body, and also increase risk of falling and fracture due to intoxication.
• Exercise. The World Health Organization (WHO) recommends adults ages 18–64, including those with chronic conditions, aim for at least 75–150 minutes of moderate and vigorous physical activity throughout the week.

Older research published in 2003 showed that osteoporosis is more prevalent in white women and Asian women.

However, white women are estimated to be twice as likely to get a DEXA screening for osteoporosis than Black women, according to a multiyear study involving a small percentage of Medicare beneficiaries under 65 years old. The research was conducted between 1999 and 2005.

It’s also important to note that Black people are at an increased risk for negative health outcomes, including being more likely to die from a hip fracture and experiencing longer hospital stays, per a 2011 study. Racial disparities likely influence these adverse outcomes.

Treatments

It’s important to follow your treatment plan carefully and to discuss any concerns with your doctor before making changes. Some activity recommendations, such as regular, low impact exercises, can benefit both osteoporosis and arthritis.

Here’s a breakdown of key treatment approaches for each condition:

Arthritis treatment

Possible treatment options for arthritis may include a combination of the following:

• maintaining a moderate weight, which places less stress on your joints
• physical therapy and regular exercise
• wearing braces or wraps to support your joints
• corticosteroid injections to lower localized inflammation
• topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs)
• disease-modifying anti-rheumatic drugs (DMARDs)
• other immune modifying drugs, including biologics (brand names include Humira, Enbrel, and Cimzia)
• surgery to replace damaged joints

Osteoporosis treatment

To help treat low bone density and prevent further loss of bone mass, your doctor may recommend the following options for osteoporosis:

• Antiresorptive medications. This class of prescription medications slow bone from breaking down and can help prevent fractures. This includes bisphosphonates and selective estrogen receptor modulators (SERMs).
• Anabolic medications. These medications can increase bone formation and help prevent fractures. The FDA-approved anabolics for osteoporosis are teriparatide and abaloparatide. Recently, romosozumab-aqqg was FDA approved for use in postmenopausal women with osteoporosis.
• Calcium and vitamin D supplements. These nutrients are essential for your bone health. Not getting enough of them in your diet can increase your risk of osteoporosis and fractures.
• Reducing your alcohol intake. Too much alcohol can interfere with your body’s calcium balance, vitamin D production, and cause hormone deficiencies.
• If you smoke, consider quitting. Avoiding secondhand smoke is important, too.

Physical therapy is an important treatment and prevention approach for osteoporosis. It can help strengthen bones to prevent future fractures. Your physical therapist will work with you during sessions to develop an exercise routine and usually assign you exercises to complete at home as well.

For fractures related to osteoporosis, rest and wearing a brace or cast may be necessary. In some instances, surgery may be required.

Comparison

It’s possible to have both arthritis and osteoporosis, but there are key differences between the conditions to consider.

Here’s a breakdown:

Outlook

Arthritis and osteoporosis are both diseases that affect your bones. Arthritis causes inflammation in your joints. Osteoporosis involves the loss of bone density and mass. You can have both arthritis and osteoporosis at the same time.

It’s important to see a doctor for a correct diagnosis and the right treatment.

Eating a nutrient-dense diet and living an active lifestyle are the best ways to prevent osteoporosis. Once it develops, osteoporosis is not reversible. However, symptoms can be managed.

Arthritis may develop regardless of whether you take precautions, but physical therapy and medication can help treat symptoms and reduce flares.

Age and family history are key risk factors for both conditions.

It’s important to tell your doctor if your parents have osteoporosis or if there’s a family history of autoimmune diseases. They can order screening blood and imaging tests to help determine your chance of developing arthritis and osteoporosis.