Osteoporosis Fractures: Causes, Prevention, and Treatment

Dr. James - Orthopaedic Surgeon in Singapore

Medically reviewed by Dr. James Tan

Osteoporosis is an all too common ailment that causes your bones to become weak and brittle. This condition increases your odds of having an osteoporosis fracture, which can be caused by even a minor accident or fall. Dealing with a broken bone when you have osteoporosis can have a serious and lasting impact on your life. 

To avoid broken bones, the first key is to prevent osteoporosis. Hormone changes, ageing, genetics, poor diet, smoking, sedentary lifestyle, and certain medications are key osteoporosis risk factors. Fortunately, there is a broad range of effective strategies for preventing osteoporosis. If you have already been diagnosed with osteoporosis, early evaluation and treatment can give you effective relief.  

Here is your complete guide to the causes, prevention, and treatment of osteoporosis and osteoporosis bone breaks. 

What is Osteoporosis?

Image Credits: Cleveland Clinic

Osteoporosis literally means porous bone. It is a common bone disease that causes your bones to become less dense and more fragile. This happens when your body loses too much bone mass or produces too little bone. This bone weakening increases your chance of having broken bones. 

To understand how osteoporosis works, the first thing that you should know is that your bones are constantly evolving throughout your entire life. At every age, each one of your bones is always being broken down as a new bone is formed to replace it. This is a normal process of regeneration that happens without you even realising it. You develop osteoporosis when the balance shifts and more bone is lost than gained. This causes your bones to gradually lose their structure and strength. Ultimately that means that even a minor bump or fall can cause a serious fracture. 

Helpful Tip: What’s the difference between a fracture and a break? People often confuse these but they are one and the same. If you have a fractured bone, you have a broken bone. “Fracture” and “break” are just two different words to refer to the same thing. 

Osteoporosis most often affects older women after menopause. That is because your naturally declining level of oestrogen promotes bone loss. While being a woman of a certain age is a common risk factor, it is important to keep in mind that the condition can happen to men and younger women as well. Certain risk factors like family history, ethnicity, weight, body size, smoking, medications, poor nutrition, and inactivity can all increase your odds of developing osteoporosis. 

Because the deterioration of bone tissue happens slowly and silently over many years, people are rarely aware that they have an issue. Osteoporosis does not usually cause symptoms until you fracture a bone. The most common osteoporotic fractures happen in people’s hips, spines, and wrists. These breaks often lead to chronic pain, long-term disability, and a reduced quality of life as well as being more prone to sports injuries.

What Is Osteoporosis Fracture? 

An osteoporosis fracture happens when your bone breaks as a result of the bone-weakening effects of the disease. As you know, osteoporosis causes your bones to become weak and brittle. This leaves your bones prone to breakage. To understand what is going on during a bone break, you should be aware of the different kinds of bone tissue. 

There are two main types of bone tissue. In each one, you have the cortical bone and the trabecular bone. The cortical bone is the dense outer layer of bone that forms a hard shell around your bones. The trabecular bone has a spongy, honeycomb-like structure on the inside of your bones. Osteoporosis causes deterioration of both of these types of bone tissue. With less cortical and trabecular bone to provide structural support, your skeleton becomes fragile and susceptible to breaks. Even small forces like bending over, lifting a grocery bag, or minor falls can cause your bones to break.

The most common spots for osteoporotic fractures are your hip, spine and wrist. A hip fracture is a break in the upper part of the thigh bone or femur, usually near the hip joint. Spine fractures occur when the bony vertebrae that make up the spinal column collapse, which can cause a stooped posture called dowager’s hump. Wrist fractures happen when a person tries to break a fall by landing on an outstretched hand, and the bones in the forearm called the radius and ulna fracture near the wrist joint. 

Other less common locations for osteoporotic fractures are the upper arm, pelvis, ribs and other bones. The long bones in the arms and legs are also susceptible to fractures due to weakened bone structure from osteoporosis. Fractures of the shoulder, knee, ankle and hand bones have also been linked to osteoporosis.

If you are experiencing intense pain in your wrists or ankles, it could be a sign of bone fracture. Talk to our wrist injury doctors today or seek immediate ankle injury treatment at our orthopaedic clinic here in Singapore.

Causes and Risk Factors of Broken Bones 

Osteoporosis results from an imbalance in bone remodelling where bone tissue is resorbed by your body faster than it can be replenished. Certain factors can increase a person’s risk of developing osteoporosis and suffering an osteoporotic fracture:

  • Age – Bone mass peaks around age 30 and then steadily declines as we age. The rate of bone loss normally accelerates in women starting at menopause around age 50 due to declining oestrogen levels.
  • Gender – Women have a higher lifetime risk of osteoporosis fractures due to menopause-related bone loss as well as having thinner bones compared to men.
  • Ethnicity – Your ethnicity and heritage matter. If you are a white or Asian woman, you have a higher risk. 
  • Family history –  Genetics play a role in bone health. Having a parent who fractured a hip or spine due to osteoporosis increases your fracture risk.
  • Small body size – Petite, slender and thin women with naturally lower bone mass are at greater risk of osteoporosis. 
  • Nutrition – Low intake of calcium and vitamin D can contribute to bone weakening. An unbalanced diet lacks bone-supporting nutrients.
  • Inactivity – A sedentary lifestyle increases risk. Lack of weight-bearing and muscle-strengthening exercise fails to stimulate new bone growth. 
  • Smoking – Smoking impairs bone metabolism. Cigarette smoking can lead to earlier bone loss and higher fracture risk. 
  • Excessive alcohol – Heavy or chronic drinking interferes with your body’s ability to form new bones and maintain proper bone mass.
  • Medications – Long-term use of steroid medications, anticonvulsants, cancer therapy drugs and certain other medications can cause bone loss and fragility. 

Osteoporosis usually develops due to some combination of these risk factors disrupting normal bone remodelling. The more risk factors present, the greater a person’s chance of experiencing an osteoporotic fracture. Focusing on tackling your unique risk factors is critical to keep your bones healthy and safe.

Common Symptoms 

Unfortunately, there are rarely any warning signs. For many people, the first symptom of osteoporosis is an osteoporotic fracture. Osteoporosis progresses silently without any symptoms until a fracture occurs. In some cases, you might avoid a break and eventually notice the signs of some people with severe osteoporosis eventually develop

  • Loss of height – Gradual height loss results in vertebrae weakening and collapse due to osteoporosis. A stooped posture may occur.
  • Back pain – Fractured or collapsing spinal vertebrae can cause moderate to severe back pain. Pain may worsen with activity.
  • Dowager’s hump – A rounding of the upper back occurs due to vertebral fractures and compression in the thoracic spine. You may find that clothes don’t fit properly around a dowager’s hump.

After an osteoporotic fracture, symptoms depend on the location of the break. A hip fracture often causes sudden, severe pain in the hip or groyne area. It usually causes an inability to bear weight on the affected leg. A vertebral fracture can cause acute back pain, but sometimes vertebral fractures are asymptomatic. Wrist fractures cause pain, tenderness, swelling, bruising and deformity around the wrist. Breaks at other sites like your arm, ribs or pelvis cause pain localised near the fracture.

Getting a Diagnosis

Healthcare professionals use several diagnostic tests and assessments such as X-rays, CT scans and MRIs to evaluate your bone health, detect osteoporosis, and determine your future risk of a bone fracture, including the following:

  • Dual-energy x-ray absorptiometry (DXA) scan – This special x-ray test measures bone mineral density at your hip and spine. This scan can diagnose osteoporosis based on World Health Organisation definitions and T-scores.
  • X-rays – These are commonly used to detect fractures and vertebral compression. X-rays provide images of bone and can show alignment after a fracture.
  • CT scan – This scan is more detailed than X-rays so you can see subtle fractures via a cross-sectional 3D view of bone to detail fractures. 
  • MRI  – This type of test uses safe magnetic fields to produce detailed images of the soft tissues and can spot the bone marrow abnormalities associated with osteoporosis.
  • Lab tests – Blood and urine tests check for vitamin D deficiency, parathyroid or thyroid problems and other conditions that will affect your bone health. 
  • Bone marker tests – Specialised blood and urine tests are able to measure bone turnover markers that can show the rate of bone remodelling.
  • FRAX fracture risk assessment tool – This kind of test looks at your clinical risk factors such as your age, sex, weight, smoking history, medications you’re on, and your family history to estimate your probability of a major osteoporotic fracture over the next ten years.

In all cases, your healthcare professional will assess your medical history and do a physical exam to check your posture and spine for any fractures. From there, your doctor may recommend certain fall prevention strategies as well as bone-strengthening medications that can help if you have a high fracture risk.

Treating an Osteoporosis Fracture

Treatment for an osteoporosis fracture focuses on relieving pain, stabilising the fractured bone, restoring function through rehabilitation, and preventing future fractures. Here are some of the treatment options that your doctor may recommend: 

  • Pain medication – Over-the-counter NSAIDs or prescription drugs will help you with the pain of a broken bone.
  • Immobilisation – Casts, splints and slings will help to stabilise the fracture and promote healing. Traction may be used in the case of a hip fracture.
  • Surgery – Pins, plates, rods and screws can internally fix more serious fractures. Hip and spine fractures often require surgical repair.
  • Rehabilitation – Physical and occupational therapy can help you with your recovery via exercises and instruction on using aids like canes or walkers to prevent falls.
  • Medications – Antiresorptive drugs help you to maintain bone mass and density, reducing fracture risk. 
  • Anabolic therapy – There is medication available that will help you stimulate bone formation to increase bone mineral density.
  • Nutrition – Making sure that you get an adequate intake of calcium and vitamin D, along with proper protein and nutrients, will help to support your bone health.
  • Exercise – Weight-bearing like deadlifts, resistance training, balance exercises, and tai chi are all helpful in promoting bone strength, posture and stability.
  • Fall prevention – Creating a safer home environment, getting proper vision correction, doing balance training, using assistive devices like canes, and removing tripping hazards go a long way in preventing dangerous falls.  
  • Quitting smoking and limiting your alcohol intake will help fracture healing and osteoporosis management.

Treating the fracture while also addressing the underlying bone health through medication, nutrition, exercise and fall prevention is the real key. With proper care, most people recover well, but it is still important to note that having one osteoporotic fracture significantly increases the risk of future breaks.

Preventing Broken Bones 

The most effective way to prevent painful osteoporotic fractures is to build strong, healthy bones earlier in life and take steps to preserve bone mass through adulthood and ageing. Here are a few of the recommended prevention strategies that you can use at any age:

  • Sufficient calcium intake – Adults up to age 50 need at least 1000 mg of calcium daily, while older adults need 1200 mg per day. Experts say that it’s best to get your calcium through food sources like dairy, and certain greens, as well as fortified foods and beverages. Calcium supplements can fill gaps in your diet but shouldn’t be your only source of calcium. 
  • Sufficient vitamin D intake – 600 IU of vitamin D daily is recommended for adults up to age 70, and 800 IU for those over 70. Vitamin D helps your body with calcium absorption for bone mineralisation, which makes it even more important to your diet. Sunlight, fortified foods, and supplements are all good sources of vitamin D.
  • Weight-bearing exercise – Workouts like walking, jogging, tennis, and stair climbing that force your muscles and bones to work against gravity are key for stimulating bone growth. Overexertion during such exercises as running might injure you. Hence, it is recommended to do some light stretches to prevent muscle cramps.
  • Resistance training – Lifting weights or bodyweight exercises like yoga and pilates build strength to improve bone density, balance and stability.
  • Don’t smoke – Avoid tobacco use, which is associated with increased bone loss, lower bone density and higher fracture risk. Smoking impairs oestrogen production and bone metabolism.
  • Limit alcohol – Heavy, chronic drinking interferes with your body’s bone remodelling process. Moderation is the best policy. 
  • Balanced diet – Get an adequate amount of protein, fruits, vegetables, calcium, vitamin D and omega-3s for bone health as well as your overall well-being. 
  • Healthy lifestyle – Managing stress, getting sufficient sleep and avoiding substance abuse supports healthy bones. 
  • Treat underlying conditions – Medical attention for eating disorders, hormonal imbalances, autoimmune disorders and other diseases that can affect bone health may be warranted. 
  • Bone medications – Certain bone medications can effectively treat osteoporosis and reduce fracture risk when needed.

Getting enough calcium, vitamin D and exercise is crucial when you want to prevent broken bones. Avoiding tobacco and limiting alcohol intake will keep you healthy while supporting your bones.  Building strong bones starting in childhood, adolescence and early adulthood can help prevent osteoporosis and fractures later in life. Those at higher risk, including postmenopausal women, may require medical treatment to maintain bone health and strength. With proper prevention strategies, osteoporosis fractures can often be avoided.

Broken Bones from Osteoporosis 

Osteoporosis fractures of your hip, spine and wrist are debilitating injuries that can severely affect your quality of life. These fractures result from osteoporosis weakening the structural integrity of bones. Age, gender, family history, small body frame, poor nutrition, sedentary lifestyle, smoking, and certain medications increase the risk of developing fragile bones prone to fracture. 

While osteoporosis progresses silently without symptoms, fractured bones cause sudden, severe pain, and disability. DXA scans, x-rays, advanced imaging, and lab tests diagnose low bone density and fractures. Treatment focuses on fracture stabilisation, osteoporosis medication, nutrition, rehabilitation and fall prevention to minimise disability and prevent future breaks. Building healthy bones early in life through proper exercise and nutrition, avoiding tobacco, limiting alcohol intake, and proactively addressing risk factors can help prevent osteoporosis and avoid painful bone fractures later on. Osteoporotic fractures can be devastating, but many can be prevented through healthy lifelong bone habits and early intervention when bone loss is detected.

Treating Osteoporosis in Singapore

Want to prevent broken bones as you get older? Are you looking for ways to stay healthy despite past injuries? Whatever your goal and however old you are, we are here to help. The team of experts at Ray of Health will listen to your concerns and guide you to a healthy life. Our orthopaedic surgeons at Ray of Health also offer tennis elbow treatment as well as shoulder pain treatment.

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Dr. James - Orthopaedic Surgeon in Singapore

About the Author

Dr James Tan is a skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.

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