Untreated osteoporosis leads to weak and brittle bones that make people more susceptible to fractures. That’s when a person may notice symptoms of osteoporosis.

Compression fractures are the most common type of fracture associated with osteoporosis. These fractures are breaks in the vertebrae that can eventually cause the vertebrae to collapse. This can lead to a loss of height and abnormal curvature in the spine (kyphosis).

Compression fractures can evolve slowly. They may be discovered incidentally during imaging tests (such as with an X-ray) for a separate health concern. However, these fractures can also cause a sudden onset of pain, especially after coughing, bending, laughing, or even driving over a speed bump.

This pain can make it difficult to perform everyday activities, such as bending, reaching, lifting, and walking up and down stairs. It also leads to chronic back pain in most cases.

Leaving osteoporosis untreated can also increase the risk of fractures from a fall. People who fall on their hip could break their femur or pelvis. An outstretched hand to catch a fall could lead to fractured bones in the wrist, arm, or collarbone.

Getting proper treatment for osteoporosis can help reduce the likelihood of fractures, pain, and other complications.

People who have fractures associated with osteoporosis have a higher likelihood of having more fractures, being hospitalized, and experiencing other complications that can lead to death.

Many people with untreated osteoporosis need assistance walking and doing their daily activities. People with vertebral fractures may deal with chronic pain.

Osteoporosis fractures can also have a psychological impact. This can include changes in mood, self-esteem, and body image.

Ample research, including a large-scale 2010 study involving more than 57,000 postmenopausal women in 10 countries, has found that having a fracture can lead to a lower quality of life.

Osteoporosis affects life span only when it involves fractures. The risk of death after a fracture increases when it occurs after age 75. This risk goes up even higher after a subsequent fracture.

Researchers have found that the risk of death increases more substantially in the first 30 to 180 days after a fracture, but the risk stays elevated for 360 days after a fracture.

Fractures in the hip are the most frequent cause of death in people with osteoporosis, followed by fractures in the pelvis, vertebra, skull, ribs, and multiple places in the body at the same time.

There’s also a higher risk of death from complications during and after surgery to treat fractures.

The bottom line is that preventing fractures is key to longevity in people with osteoporosis.

Making lifestyle adjustments to reduce the risk of falls and fractures is an important part of managing osteoporosis, but there are also medications to treat the condition.

The most common initial treatment is an antiresorptive medication. These drugs work to slow activity in the cells that break down bone (osteoclasts), which gives the body time to make new bone.

Bisphosphonates are the most commonly prescribed antiresorptive medications. They include:

  • alendronate
  • risedronate
  • ibandronate
  • zoledronic acid
  • denosumab
  • raloxifene

Most of these medications can be taken orally. Denosumab and zoledronic acid are only administered through injection.

The choice between these medications is usually based on a person’s ability to tolerate the drug and its side effects. Doctors also consider kidney function, breast cancer risk, and gastrointestinal history when recommending a medication.

Another class of medication called anabolic agents can also treat osteoporosis. These are rarely used as a first-line treatment, and are typically prescribed for severe osteoporosis. They are injected under the skin and help stimulate bone formation and repair.

Anabolic agents for osteoporosis include:

  • teriparatide
  • abaloparatide
  • romosozumab

Of this group, teriparatide is most commonly prescribed because of its safety profile.

The most common way to tell whether your osteoporosis treatment is working is by monitoring your bone mineral density through dual-energy X-ray absorptiometry (DXA or DEXA).

This test compares your bone mineral density to that of a young adult. Doctors use it to diagnose osteoporosis and monitor how well treatment is working.

A score of zero means your bone density is “normal,” or equal to that of a typical young adult. Scores between +1 and -1 are also considered normal.

If your bone density score is between -1 and -2.5, you are considered to have the stage before osteoporosis called osteopenia. A score of less than -2.5 indicates osteoporosis.

People with osteoporosis typically need DXA scans about every 2 years after starting treatment. Bone remodeling is a slow process. It can take a while to see improvements in bone mineral density from treatment.

If a medication, like a steroid, is causing the osteoarthritis, or if severe disease associated with fractures develops, the scan may be done more frequently.

Osteoporosis progresses slowly. To understand why, it helps to know a bit about how the body builds bone using different types of cells.

One type is responsible for building new bone (osteoblasts). The other type breaks down bone (osteoclasts). These cells work together to remodel our bones through different stages of our lives. By age 30, we will have regenerated five complete skeletons!

Peak bone density occurs between ages 30 and 35. At some point in our lives, the body starts breaking down bones more quickly than building them, which can lead to bone loss.

From ages 45 to 55, bone loss occurs more rapidly in women due to the loss of estrogen during menopause. Women can lose 10% to 20% of their bone density during menopause, usually at a rate of about 2% per year.

Men can experience the same thing as they lose testosterone around ages 60 to 65.

In the last stage of osteoporosis, bone loss becomes visible. The loss of bone density leads to bone softening and fractures, which can cause deformity in the spine.

When the vertebrae collapse, it typically occurs in the front of the spine. That can lead to a hunchback-like curvature of the spine called kyphosis.

End-stage osteoporosis can be associated with pain and difficulty managing activities of daily living.

Osteoporosis has no current cure, but treatments can help slow bone loss and strengthen your bones.

Both antiresorptive medications and anabolic agents can help increase bone mineral density and reduce fractures.

In addition to taking medications, making lifestyle changes is also an important part of managing osteoporosis.

If you smoke, doctors typically recommend quitting. Smoking one pack of cigarettes per day has been associated with a reduction in bone density. Smoking can also counter the effects of medications prescribed to improve bone density.

Tips for living well with osteoporosis include:

  • staying active
  • eating nutritious, well-balanced meals
  • avoiding heavy alcohol use
  • smoking cessation

When it comes to exercise, many people focus on cardiovascular activities but may not prioritize building muscle and improving balance. Activities like yoga, tai chi, and Pilates can be very helpful, though.

A physical therapist can help you design a safe home exercise program. There are also many free videos online that instruct on exercises for people with osteoporosis and lead beginners through tai chi and yoga exercises.

People with osteoporosis can also make sure they’re getting the recommended amount of calcium and vitamin D, which are important for bone health.

Suggested daily calcium intake is 1,000 milligrams (mg) for most adults, but increases to 1,200 mg for women ages 51 and up and for men starting at age 70.

The National Osteoporosis Foundation recommends that postmenopausal women and men ages 50 and up get between 800 and 1,000 international units (IUs) of vitamin D per day.

Some people may need to take an over-the-counter supplement for calcium, vitamin D, or both to get the recommended amount. Talk with a doctor to see whether this is right for you.

Preventing falls is very important as well. Make sure to have railings on your stairs. Consider installing railings in your bathroom around your toilet and in the shower. Your community’s department of aging may be able to help you make home improvements to prevent falls.

Also, make sure to communicate to your doctor any medication side effects, like drowsiness or dizziness, which could increase your risk of falls.

Dr. Angela M. Bell is an ABMS board certified physician, specializing in internal medicine and sports medicine. She practices in the south side of Chicago.