Signs and Symptoms, Fractures, and Complications
- Osteoporosis is often asymptomatic until a bone is broken.
- Fractures from osteoporosis occur in situations where healthy people wouldn't normally break a bone.
- Common fragility fractures occur in the vertebral column, rib, hip, and wrist.
- People with osteoporosis may experience acute and chronic pain.
- Vertebral collapse can cause sudden back pain, radicular pain, and loss of height.
- Fractures are a common symptom of osteoporosis.
- Osteoporotic fractures can result in disability and early mortality.
- Fractures may be asymptomatic.
- Common osteoporotic fractures occur in the wrist, spine, shoulder, and hip.
- Multiple vertebral fractures can lead to a stooped posture and reduced mobility.
- Osteoporosis can lead to disability and increased risk of death after fractures.
- Decreased quality of life and increased healthcare costs are associated with osteoporosis.
- Fractures from osteoporosis can result in disabilities.
- Osteoporosis can have financial costs to healthcare systems.
- Osteoporosis is a recognised complication of specific diseases and disorders.

Risk Factors
- Age and sex are risk factors for osteoporosis.
- Nonmodifiable risk factors include advanced age and female sex.
- Ethnicity, particularly European or Asian ancestry, predisposes individuals to osteoporosis.
- Family history of fracture or osteoporosis increases the risk.
- Medication use can also contribute to osteoporosis risk.

Potentially Modifiable Factors
- Alcohol intake greater than three units/day may increase the risk of osteoporosis.
- Consuming 0.5-1 drinks a day may have 1.38 times the risk compared to non-alcohol consumers.
- Low circulating Vitamin D is common among the elderly worldwide.
- Mild vitamin D insufficiency is associated with increased parathyroid hormone production.
- Tobacco smoking is associated with decreased bone health.
- Smoking inhibits the activity of osteoblasts.
- Smoking is an independent risk factor for osteoporosis.
- Malnutrition plays a role in maintaining good bone health.
- Risk factors include low dietary calcium, phosphorus, and other essential nutrients.
- Imbalance of omega-6 to omega-3 polyunsaturated fats is a risk factor.
- Physical inactivity can lead to significant bone loss.
- Weight-bearing exercise increases peak bone mass achieved in adolescence.
- Endurance training can lead to decreased bone density in female athletes.
- Cadmium and lead exposure are strongly associated with bone disease.
- Soft drinks may increase the risk of osteoporosis in women.
- Proton pump inhibitors can increase the risk of bone fractures.

Medical Disorders
- Immobilization causes bone loss.
- Localised osteoporosis can occur after prolonged immobilization.
- Hypogonadal states can cause secondary osteoporosis.
- Estrogen deficiency is a common cause of osteoporosis in females.
- Testosterone deficiency is a cause of osteoporosis in males.
- Endocrine disorders such as Cushing's syndrome and hyperparathyroidism can induce bone loss.
- Malnutrition and malabsorption can lead to osteoporosis.
- Rheumatologic disorders increase the risk of osteoporosis.
- Chronic kidney disease can lead to renal osteodystrophy.
- Hematologic disorders such as multiple myeloma are linked to osteoporosis.
- Several inherited or genetic disorders are linked to osteoporosis.
- Scoliosis of unknown cause is associated with a higher risk of osteoporosis.
- Bone loss can be a feature of complex regional pain syndrome.
- Parkinson's disease is associated with a higher risk of broken bones.
- People with Parkinson's disease may experience altered calcium metabolism.

Medication
- Glucocorticosteroids and anticonvulsants are associated with an increase in osteoporosis risk.
- Prednisone, a synthetic glucocorticoid prescription drug, is a main candidate for steroid-induced osteoporosis (SIOP) after prolonged intake.
- Some guidelines recommend prophylaxis in patients taking the equivalent of more than 30mg hydrocortisone (7.5mg of prednisolone) for more than three months.
- Calcium or Vitamin D is recommended for prevention.
- Barbiturates, phenytoin, and some other antiepileptics may accelerate the metabolism of vitamin D.
- L-Thyroxine over-replacement may contribute to osteoporosis, similar to thyrotoxicosis.
- Several drugs induce hypogonadism, such as aromatase inhibitors, methotrexate, depot progesterone, and gonadotropin-releasing hormone agonists.
- Long-term use of heparin is associated with a decrease in bone density.
- Warfarin and related coumarins have been linked to an increased risk of osteoporotic fracture in long-term use.
- Proton pump inhibitors inhibit stomach acid production, potentially interfering with calcium absorption.
- Chronic phosphate binding may occur with aluminium-containing antacids.
- Thiazolidinediones (used for diabetes) like rosiglitazone and pioglitazone have been linked to an increased risk of osteoporosis and fracture.
- Chronic lithium therapy has been associated with osteoporosis.