Because bone loss is gradual and painless, there are usually no symptoms to indicate a person is developing osteoporosis. This is why osteoporosis is often referred to as the silent disease. Often the first symptom of osteoporosis is a fracture. Most commonly, osteoporotic fractures occur at the spine, the wrist or the hip, although osteoporotic fractures can occur in other bones as well.

While most limb fractures (such as at the wrist or hip) are obvious, spinal fractures can be more difficult to diagnose. This is because they might be painless, or if there is pain, a person may not know it is caused by a fracture due to the many different causes of back pain.  More obvious signs of spinal fractures are:

  • Loss of height
  • Development of a curved upper back (sometimes called a Dowager's Hump)

Since there are usually no outward signs of osteoporosis developing, doctors will often recommend diagnostic testing depending on your age and if you have other risk factors for the disease1.

What are your osteoporosis risk factors?

A risk factor is anything that increases your chance of getting a disease. Having a risk factor, or even several, does not mean that you will have osteoporosis. However, the more risk factors you have, the greater your chance of developing a disease and also, the greater the level of each risk factor, the greater the risk2. There are different kinds of risk factors - fixed and modifiable. Some factors, such as age or gender, cannot be changed; whereas, others are linked to personal lifestyle choices, such as smoking, alcohol intake and diet.

Fixed risks

Although fixed risk factors cannot be changed, people need to be aware of them so that they can take steps to reduce bone mineral loss. Fixed risk factors also include what is termed ‘secondary risk factors’ – disorders and medications that weaken bone and affect balance (heighting the risk of fracture due to falling). Fixed risk factors include3-6:

  • Age
  • Female gender
  • Family history of osteoporosis
  • Previous fracture
  • Ethnicity
  • Menopause/hysterectomy
  • Long term glucocorticoid therapy
  • Rheumatoid arthritis
  • Primary/secondary hypogonadism in men

Read more information about fixed risk factors including secondary risk factors.

Modifiable risks

Most modifiable risk factors directly impact bone biology and result in a decrease in bone mineral density (BMD), but some of them also increase the risk of fracture independently of their effect on bone itself. These include7,8:

  • Alcohol
  • Smoking
  • Low body mass index
  • Poor nutrition
  • Vitamin D deficiency
  • Eating disorders
  • Insufficient exercise
  • Low dietary calcium intake
  • Frequent falls

Read more information about modifiable risk factors.

Individuals can take action to reduce modifiable risks and, although there is no way to control fixed risks, there are strategies that can lessen their effect.

Take our risk awareness test

Do you know your personal risk factors for osteoporosis? Take the IOF One Minute Osteoporosis Risk Awareness Test and find out.


1. World Health Organisation. Assessment of fracture risk and its implication to screening for postmenopausal osteoporosis: Technical report series 843. Geneva: WHO,1994
2. De Laet C, Odén A, Johansson H, Johnell O, Jönsson B, Kanis J A. The impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach. Osteoporosis Int. 2005;16:313-18
3. Kanis JA, Johnell O, Odén A, Dawson A, De LAet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnosis thresholds. Osteoporosis Int 2001;12:989-95
4. Kanis JA, Johansson H, Odén A, Johnell O, De LAet C, Eisman JA, McCloskey EV, Mellström D, Melton LJ III, Pols HA, Reeve J, Silman AJ, Tenenhouse A. A familiy history of fracture and fracture risk: a meta-analysis. Bone 2004;35:1029-37
5. Kanis JA, De LAet C, Delmas P, Garnero P, Johansson H, Johnell O, Kriger H, McCloskey EV, Mellstrom D, Melton LJ III, Odén A, Pols H, Reeve J, Silman A, tenehouse A. A meta-analysis of previous fracture and fracture risk. Bone 2004 35;375-82
6. Kanis J A, Johansson H, Odén A, Johnell O, De Laet C, Melton LJ III, Tenenhouse A, Reeve J, Silman AJ, Pols H, Eisman JA, McCliskey EV, Mellström D. A meta-analysis of prior corticosteroid use and fracture risk. J Bone and Miner Res 2004;19.893-99
7. Kanis JA. Johansso H, Johnell O, Odén A, De Laet C, Eisman J, Pols H, Tenenhouse A. Alcohol intake as a risk factor for fracture. Osteoporosis Int 2005;16:737-42
8. Kanis JA, Johnell O, Odén A, Johansson H, De Laet C, Eisman JA, Fujiwara S, Kroger H, McCloskey, Mellstrom D, Melton LJ III, Pols H, Reeve J, Silman A, Tenehouse A. Smoking and fracture risk: a meta-analysis. Osteoporosis Int. 2005;16:155-62