Signs and Symptoms of Osteoporosis

Osteoporosis, in which low bone mass and micro-structural deterioration of bone tissue lead to increased bone fragility, is the most common metabolic bone disease in the United States. Osteoporosis can result in devastating physical, psychosocial, and economic consequences. Still, it is often overlooked and undertreated, in large part because it is clinically silent; there are no symptoms before a fracture occurs.

Signs and symptoms

Osteoporosis does not become clinically apparent until a fracture occurs and so is sometimes referred to as the “silent disease.” Two-thirds of vertebral fractures are painless, although patients may complain of the resulting stooped posture and height loss. Typical findings in patients with painful vertebral fractures may include the following:

• The episode of acute pain may follow a fall or minor trauma.
• Pain is localized to a specific, identifiable, vertebral level in the midthoracic to lower thoracic or upper lumbar spine.
• The pain is described variably as sharp, nagging, or dull; movement may exacerbate pain; in some cases, pain radiates to the abdomen.
• Pain is often accompanied by paravertebral muscle spasms exacerbated by activity and decreased by lying supine.
• Patients often remain motionless in bed because of fear of exacerbating the pain.
• Acute pain usually resolves after 4-6 weeks; in the setting of multiple fractures with severe kyphosis, the pain may become chronic.

Patients who have sustained a hip fracture may experience the following:

• Pain in the groin, posterior buttock, anterior thigh, medial thigh, and/or medial knee during weight-bearing or attempted weight-bearing of the involved extremity
• Diminished hip range of motion (ROM), particularly internal rotation and flexion
• External rotation of the involved hip while in the resting position

On physical examination, patients with vertebral compression fractures may demonstrate the following:

• With acute vertebral fractures, point tenderness over the involved vertebra
• Thoracic kyphosis with an exaggerated cervical lordosis (dowager's hump)
• Subsequent loss of lumbar lordosis
• A decrease in the height of 2-3 cm after each vertebral compression fracture and progressive kyphosis

Patients with hip fractures may demonstrate the following:

• Limited ROM with end-range pain on a FABER (flexion, abduction, and external rotation) hip joint test
• Decreased weight-bearing on the fractured side or an antalgic gait pattern

Patients with Colles fractures may have the following:

• Pain on movement of the wrist
• Dinner fork (bayonet) deformity

Patients with pubic and sacral fractures may have the following:

• Marked pain with ambulation
• Tenderness to palpation, percussion, or both
• With sacral fractures, pain with physical examination techniques used to assess the sacroiliac joint (eg, FABER, Gaenslen, or squish test)

Balance difficulties may be evident, especially in patients with an altered center of gravity from severe kyphosis. Patients may have difficulty performing tandem gait and performing single-limb stance.

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Media Contacts, 
Jessica Aaron
Associative Editor
Journal of Pharmacological Reviews and Reports