What Are the Stages of Osteoporosis? (2024)

There are four stages of osteoporosis, a common condition in which the bones get weaker and more fragile over time.

The first two stages are more like precursors to the actual disease and don't cause symptoms; instead, these changes are diagnosed with a bone density test. The last two stages can cause pain,frequent fractures or breaks, and even deformities from bone loss.

This article will explain the stages of osteoporosis, as well as how it is diagnosed and what you can do to prevent and treat the condition.

How Do You Determine the Severity of Osteoporosis?

Bone density testing is the most precise way to determine your level of bone loss. Your healthcare provider will start by taking your personal and family medical history, get a list of your health conditions and any medications you are taking, and do a physical exam.

Bone density measurements are taken with a dual energy X-ray absorptiometry (DEXA) scan. This test is similar to an X-ray, but it provides a reading of the mineral density in each square centimeter of bone.

Bone mass and density are expressed with a measurement called a T-score. The lower the T-score, the lower your bone mass is.

Stages of Osteoporosis

Here's what to know about the four stages of osteoporosis:

Stage 1

When you're young, your bones grow faster than they break down. At some point in your 20s and 30s, bone resorption and new bone formation reach an equilibrium—meaning that you lose and form bone at the same rate. This can be considered the first stage of osteoporosis because the formation of bone is no longer outpacing bone loss.

You will have no symptoms at this stage. Your bone density scores (T-score) will be normal and range from +1 to -1.

Stage 2

At this stage, you still have no symptoms, but your bone loss is now happening faster than your bone growth. If you experience an injury or have bone mass testing done for another reason, you might be diagnosed with osteopenia, or low bone mass. With this type of bone loss, your bones are weakening, but you are not classified as having osteoporosis. With osteopenia, you have a T score between -1 and -2.5..

Stage 3

When you have reached this stage, you officially have osteoporosis. Again, you may not notice any symptoms, but you are at a higher risk of breaks and fractures even from simple injuries like hitting your leg against a door. In this stage, your T-score is -2.5 or lower.

Stage 4

In this stage, your T-score is well below -2.5 and most people have had one or more breaks or fractures by the time they reach stage 4. Outside of breaks and fractures, this is the only stage where you may actually notice bone loss. The softening and weakening of your bones can cause deformities, including a bent-over appearance called kyphosis that results from weak bones in your spine.

How Can I Stop Bone Loss?

You cannot prevent all forms of osteoporosis—especially those that are caused by underlying diseases or the aging process. However, you can try to slow the process.

Treating osteoporosis usually involves taking nutritional supplements to boost your bone health, strengthening the muscles that help support your bones, and taking medications that can reduce bone loss or increase bone density.

Lifestyle Measures

Your age, your sex, and your genetics are not factors that you can control, but there are several lifestyle factors that contribute to osteoporosis that you can control. These include:

• Quitting smoking
• Exercising regularly
• Eating a well-balanced diet
• Limiting alcohol use
• Reducing caffeine
• Preventing falls
  

Supplements

Vitamin D and calcium supplements are often used to treat or prevent bone loss. Below are the usage recommendations for these supplements (but always check with your health provider for the dosages that are right for you):

• Adults age 50 and under: 1,000 milligrams (mg) of calcium and 400 to 800 international units (IU) of vitamin D daily
• Women age 51 to 70: 1,200 mg of calcium and 400 to 800 IU of vitamin D daily
• Men age 51 to 70: 1,000 mg of calcium and 400 to 800 IU of vitamin D daily
• Adults over age 70: 1,200 mg of calcium and 800 IU of vitamin D daily

If you can, it's best to obtain these nutrients directly from your diet. Try to include foods that are rich in calcium and vitamin D and use supplements only to make up for shortages. Your provider may also recommend other dosages of these supplements for you based on your health and risk factors and taking into account any medications or supplements you are already taking.

Exercise

You cannot directly exercise your bones, but you can strengthen the muscles that are around them. While staying active overall is most important, there are particular activities that can help preserve your bone density.

Types of exercise that support your bones include:

• Weight-bearing exercises
• Free weights
• Balancing exercises
• Rowing

These exercises should be done for at least 30 minutes three times a week. However, you should avoid exercises that could increase your risk of injury or falls.

Medications

Medications are sometimes used to help slow or stop bone loss, or to help improve overall bone health. You may not need to take these medications forever. In some cases, you may need to take the medication for only a few years, depending on your risk.

Examples of medications that may be used to treat osteoporosis and bone loss include:

• Bisphosphonates
• Denosumab
• Teriparatide or abaloparatide
• Romosozumab
• Estrogen receptor modulators
• Calcitonin

Summary

There are four stages of osteoporosis. The first two do not cause symptoms but can be identified with a bone scan. The latter two stages can cause symptoms such as pain, susceptibility to fractures, and deformities of the bone.

You cannot always prevent osteoporosis, but you can slow its progression by changing certain lifestyle habits and taking vitamin supplements. The later stages of the disease are often treated with medications.

Talk to your healthcare provider about prevention and screening for osteoporosis. Identifying and modifying risk factors in the early stages of the disease can help slow or stop its progression.