Silent Bone Loss: Why Many Patients Don’t Know They Have Osteoporosis Until a Fracture

Every May, National Osteoporosis Awareness & Prevention Month shines a light on a condition that often progresses unnoticed — until it suddenly doesn’t. Osteoporosis, a disease characterized by weakened bones and increased fracture risk, is frequently called a “silent disease” for a reason: most people don’t know they have it until a minor fall leads to a serious break.

Understanding why osteoporosis goes undetected — and what can be done about it — is critical to preventing life-altering injuries.

What Is Osteoporosis—and Why Is It ‘Silent’?

Osteoporosis occurs when bone density and quality decline over time, making bones more fragile. While bone is living tissue that constantly rebuilds, aging and certain risk factors can tip the balance toward bone loss.

The challenge is that this process rarely causes symptoms.

“Bone loss happens gradually and without pain, so patients often feel completely normal while their bones are becoming more fragile,” explains Maria Kyriacou, M.D., a primary care sports medicine physician with Baptist Health Orthopedic Care. “By the time symptoms appear, the disease is usually advanced.”

Unlike conditions that produce warning signs, such as chest pain or shortness of breath, osteoporosis quietly progresses in the background. This lack of early symptoms is why many diagnoses occur only after a fracture.

The First Sign: A Fracture

For many patients, the first indication of osteoporosis is a broken bone from a low-impact event, such as:

• A fall from standing height
• Bending over or lifting something light
• Even coughing in severe cases

Common fracture sites include the hip, spine, and wrist.

“Osteoporotic fractures are often described as ‘fragility fractures’ because they occur from minimal trauma,” said James Ross, M.D., is an orthopedic surgeon at Baptist Health Orthopedic Care. “A fracture that shouldn’t happen under normal bone strength is often the first red flag.”

Spinal fractures, in particular, may go unnoticed at first but can lead to height loss, stooped posture, and chronic pain over time.

Who Is at Risk?

Osteoporosis can affect anyone, but certain groups are at higher risk:

• Women over age 50, especially postmenopausal
• Older adults (both men and women)
• Individuals with a family history of osteoporosis
• People with low body weight
• Smokers or heavy alcohol users
• Those with sedentary lifestyles
• Patients on long-term steroid medications

Hormonal changes—especially the drop in estrogen after menopause—play a major role in accelerating bone loss.

“Many patients are surprised to learn that bone loss can begin years before they would ever expect symptoms,” Dr. Kyriacou notes. “That’s why risk assessment and early screening are so important.”

Why Screening Often Gets Missed

Despite clear risk factors, osteoporosis screening is still underutilized. A simple bone density test (DEXA scan) can detect early bone loss, but many people don’t receive one until after a fracture.

There are several reasons:

• Lack of awareness about osteoporosis risk
• Misconception that it only affects elderly women
• Absence of symptoms prompting evaluation
• Missed opportunities during routine medical visits

“Too often, osteoporosis is treated as a secondary issue instead of a primary prevention concern,” says Dr. Ross. “We should be identifying at-risk patients before fractures occur—not after.”

The Impact of Osteoporotic Fractures

A fracture related to osteoporosis is not just a temporary injury—it can have long-term consequences.

Hip fractures, for example, are associated with:

• Loss of independence
• Decreased mobility
• Increased risk of complications
• Higher mortality rates in older adults

Spinal fractures can lead to chronic pain, reduced lung capacity, and diminished quality of life.

“One fracture significantly increases the risk of future fractures,” Dr. Ross emphasizes. “That’s why the first fracture is a critical moment to intervene and prevent the next one.”

Prevention Starts Early

The good news is that osteoporosis is largely preventable—and manageable when detected early.

Key prevention strategies include:

1. Nutrition

Adequate intake of calcium and vitamin D is essential for bone health.

• Calcium: Found in dairy products, leafy greens, and fortified foods
• Vitamin D: Obtained from sunlight, fatty fish, and supplements

“Nutrition lays the foundation for lifelong bone strength,” Dr. Kyriacou says. “It’s never too early—or too late—to improve your intake.”

2. Physical Activity

Weight-bearing and resistance exercises help maintain bone density.

Examples include:

• Walking or jogging
• Strength training
• Yoga or balance exercises

“Exercise not only strengthens bones but also improves balance, reducing the risk of falls,” Dr. Kyriacou adds.

3. Lifestyle Choices

Avoiding smoking and limiting alcohol intake can significantly reduce bone loss.

4. Screening and Monitoring

Bone density testing is recommended for:

• Women aged 65 and older
• Men aged 70 and older
• Younger individuals with risk factors

The Role of Specialized Care

For patients diagnosed with osteoporosis, or those who have already experienced a fracture, coordinated care is essential.

Programs such as Bone Health & Fracture Prevention Program/Clinic at Baptist Health Orthopedic Care are designed to address this need.

“These programs focus on identifying patients at risk after a fracture and ensuring they receive the evaluation and treatment needed to prevent future injuries,” Dr. Ross explains. “It’s about closing the gap between fracture care and long-term bone health management.”

Such programs often include:

• Bone density testing
• Medication management
• Fall risk assessment
• Physical therapy recommendations
• Ongoing monitoring and education

Treatment Options

When osteoporosis is diagnosed, treatment may include medications that:

• Slow bone loss
• Increase bone formation
• Reduce fracture risk

These medications are often combined with lifestyle changes for optimal results.

“Treatment is highly individualized,” says Dr. Kyriacou. “The goal is not just to improve bone density numbers, but to reduce the patient’s overall fracture risk and maintain their quality of life.”

Dr. Kyriacou emphasizes the importance of seeing a physician to go over what else needs to be addressed to reduce the risk of falls, such as going over their home environment, shoes they are using, renewing  prescriptions for glasses, and reviewing medications. “At times, patients are over medicated and that can increase the risk of fall depending on what they're taking,” she adds.

Why Awareness Matters

National Osteoporosis Awareness & Prevention Month serves as an important reminder that bone health should not be overlooked. Because osteoporosis is silent, awareness becomes the first line of defense.

“Patients shouldn’t wait for a fracture to take bone health seriously,” Dr. Kyriacou emphasizes. “Proactive screening and prevention can make a significant difference.”

Dr. Ross agrees: “The earlier we identify and treat osteoporosis, the better we can protect patients from the cascade of complications that often follow a fracture.”