Osteoporosis 101: Symptoms, Causes, Treatment Options and Relationship With Ozempic.

What is Osteoporosis?

Osteoporosis is a condition where bones become weak and brittle and making them more likely to break. It happens when the body loses too much bone and makes too little bone or both. It’s common in older adults especially women and can cause to fractures, pain and posture changes.

Statistics About Osteoporosis

Global Statistics Of Osteoporosis

• Prevalence: About 18.3% of the global population is effected by osteoporosis and its a higher prevalence in women (23.1%) compared to men (11.7%).
• Effected Population: An estimated 500 million people worldwide have osteoporosis; 6.3% of men and 21.2% of women over the age of 50 being effected.

Fracture Risk Of Osteoporosis

• Lifetime Risk: Globally; 1 in 3 women and 1 in 5 men over the age of 50 will experience an osteoporotic fracture.
• Hip Fractures: Hip fractures are a significant concern because of their association with increased mortality and morbidity. Up to 37 million fragility fractures linked to osteoporosis were thought to occur in people over the age of 55 worldwide in 2019.

Economic Impact Of Osteoporosis

• Healthcare Costs: In the European Union; osteoporosis-related fractures were estimated to cost €37 billion annually as of 2010. In the United States; the annual direct costs were estimated at $19 billion and with projections reaching $25.3 billion by 2026.

Regional Variations Of Osteoporosis

• Prevalence by Region: Osteoporosis prevalence varies by region, with rates ranging from 8% in Oceania to 26.9% in Africa. Developing countries have a higher prevalence (22.1%) compared to developed countries (14.5%).
• Ethnic Differences: White and Asian populations are at greater risk of developing osteoporosis compared to other ethnic groups. People of African descent have a lower risk of fractures but experience higher mortality rates following an osteoporotic fracture.

What Are The 6 Symptoms Of Osteoporosis?

1. Bone Fractures (Most Common Symptom)

• Fragile bones can break easily from minor falls, sudden movements, or even coughing.
• Common fracture sites;
  • Hip fractures – Serious injuries, often requiring surgery and long-term rehabilitation.
  • Wrist fractures – Can happen from trying to catch oneself during a fall.
  • Spinal (vertebral) fractures – Often happen without trauma and cause to back pain and height loss.

2. Back Pain (Due to Spinal Compression Fractures)

• Osteoporosis weakens the vertebrae and lead to them to collapse.
• This can cause to;
  • Chronic or sudden back pain.
  • Sharp, intense pain that worsens with movement.
  • Nerve compression and lead to radiating pain in the arms or legs.

3. Loss of Height (Over Time)

• Spine becomes compressed as vertebrae weaken and collapse.
• People can lose several centimeters or inches in height over the years.

4. Stooped or Hunched Posture (Kyphosis)

• Spine curves forward because of collapsed vertebrae and cause to a hunched back.
• This can lead;
  • Breathing difficulties because of reduced lung space.
  • Digestive issues from compressed abdominal organs.
  • Muscle weakness and imbalance so increasing fall risk.

5. Weak Grip Strength and Brittle Nails

• Weaker hand strength can indicate declining bone health.
• Brittle or weak nails may also be an early sign of low bone density.

6. Unexplained Fractures or Slow Healing

• Some people only realize they have osteoporosis when they suffer fractures from simple activities (e.g., sneezing or bending over).
• Fractures take longer to heal because of poor bone quality.

What Are The 9 Causes Of Osteoporosis?

1. Aging and Bone Loss

• Bone is constantly being broken down and rebuilt throughout life in a process called bone remodeling.
• Bone breakdown happen faster than bone formation and cause to gradual bone loss after age 30.
• By the time people reach their 50s and beyond bones have lost significant density so making fractures more likely.
• Men and women both lose bone with age but postmenopausal women lose it more rapidly because of hormonal changes.

2. Hormonal Imbalances

Hormones play a key role in maintaining bone density. Any hormonal imbalance can contribute to osteoporosis;

Estrogen Deficiency (Women)

• Estrogen protects bones by slowing down the breakdown of bone tissue.
• Menopause causes a sharp decline in estrogen, cause to rapid bone loss.
• Women can lose up to 20% of their bone mass in the first 5–7 years after menopause.
• Early menopause (before age 45) or hysterectomy (removal of ovaries) increases osteoporosis risk.

Testosterone Deficiency (Men)

• Testosterone helps maintain bone strength and low levels can cause to gradual bone loss.
• Conditions like hypogonadism (low testosterone) can accelerate osteoporosis.

Thyroid Hormones

• Hyperthyroidism (overactive thyroid) speeds up bone loss.
• Excessive thyroid hormone replacement therapy (for hypothyroidism) can weaken bones if not carefully monitored.

Parathyroid and Adrenal Gland Disorders

• Overactive parathyroid glands (hyperparathyroidism) lead to excessive calcium to be removed from bones.
• High cortisol levels (Cushing’s syndrome) can cause to bone loss.

3. Poor Nutrition and Dietary Deficiencies

Calcium Deficiency

• Calcium is a key component of bone tissue.
• When calcium intake is too low the body pulls calcium from bones to maintain blood levels and weakening them.
• Recommended daily intake:
  • Adults: 1,000–1,200 mg per day (varies by age and gender).

Vitamin D Deficiency

• Vitamin D is essential for calcium absorption. Calcium from food isn’t properly absorbed and cause to bone loss without it.
• Lack of sunlight exposure (the main source of vitamin D) can contribute to deficiency.
• Recommended daily intake:
  • 600–800 IU per day (change by age and risk factors).

Low Protein Intake

• Protein is crucial for bone structure and repair.
• Too little protein can cause to reduced bone mass and while excess protein can increase calcium loss in urine.

Excessive Salt, Caffeine or Soda

• High salt intake increases calcium loss through urine.
• Caffeine (in coffee, tea, and energy drinks) may slightly decrease calcium absorption.
• Soft drinks (sodas) containing phosphoric acid may negatively effect bone density.

4. Lack of Physical Activity & Sedentary Lifestyle

Risk Factors Include:

• Sedentary lifestyle (sitting for long periods).
• Lack of weight-bearing exercise (e.g., walking, jogging, resistance training).
• Prolonged bed rest (e.g., after an injury or illness).

Best Exercises for Bone Health:

• Weight-bearing exercises (walking, running, dancing).
• Resistance training (weightlifting, bodyweight exercises).
• Balance and flexibility exercises (yoga, Tai Chi) to prevent falls.

5. Genetics & Family History

• Genetic factors account for 60–80% of bone density.
• If a parent or sibling has osteoporosis the risk increases.
• People with small body frames tend to have lower bone mass and a higher risk of fractures.

Ethnic Differences:

• Caucasian and Asian women are at the highest risk.
• African and Hispanic women tend to have higher bone density but are still at risk.

6. Certain Medical Conditions

• Autoimmune diseases (rheumatoid arthritis, lupus).
• Gastrointestinal disorders (celiac disease, Crohn’s disease) that effect nutrient absorption.
• Kidney disease (affects calcium and vitamin D balance).
• Liver disease (reduces vitamin D metabolism).
• Diabetes (especially Type 1, which affects bone formation).
• Cancer treatments (chemotherapy and radiation therapy).
• Eating disorders (anorexia, bulimia) cause to malnutrition and severe bone loss.

7. Medications That Increase Osteoporosis Risk

• Corticosteroids (e.g., prednisone, cortisone): Used for conditions like asthma, arthritis and lupus but they decrease bone formation.
• Proton Pump Inhibitors (PPIs): Used for acid reflux but long-term use reduces calcium absorption.
• Anticonvulsants (for epilepsy): Can interfere with vitamin D metabolism.
• Hormone treatments for prostate or breast cancer: May lower estrogen or testosterone levels and weakening bones.

8. Smoking & Excessive Alcohol Consumption

Smoking:

• Nicotine disrupts bone-building cells (osteoblasts).
• Smoking lowers estrogen levels in women and testosterone levels in men.
• Smokers have a 30–40% higher risk of fractures than non-smokers.

Alcohol:

• Heavy drinking (more than 3 drinks per day) reduces calcium absorption and weakens bones.
• Chronic alcohol use disrupts bone-forming cells (osteoblasts).

9. Low Body Weight & Eating Disorders

• Underweight individuals (BMI <18.5) have less bone mass making them more prone to fractures.
• Eating disorders (anorexia, bulimia) cause to severe nutrient deficiencies, hormone imbalances and loss of bone density.

Does Ozempic Cause Osteoporosis?

Ozempic (semaglutide) is a GLP-1 receptor agonist used for type 2 diabetes and weight loss. While it is not directly linked to osteoporosis, it may contribute to bone loss in some cases because of its effects on weight loss and nutrient absorption. Here’s how;

Potential Ways Ozempic Could Affect Bone Health

1. Rapid Weight Loss & Bone Density Reduction
   • Ozempic can lead to significant weight loss which may cause to decreased bone density especially in older adults.
   • Fat tissue produces estrogen (which protects bones). Losing too much fat too quickly may lower estrogen levels and increasing osteoporosis risk.
   • Studies suggest that; rapid weight loss (regardless of the method) can cause to increased bone turnover and fragility.
2. Possible Effects on Calcium & Vitamin D Absorption
   • Some people on Ozempic eat less or absorb fewer nutrientsbecause of slowed digestion.
   • Bones may weaken over time if dietary intake of calcium and vitamin D drops.
3. Impact on Bone Remodeling (Unclear Evidence)
   • Some animal studies suggest that GLP-1 medications may influence bone metabolism but human data is limited.
   • Some research indicates GLP-1 receptor activation might be beneficial for bones but more studies are needed to confirm its long-term effects.

What Do Studies Say?

• Limited direct evidence links Ozempic to osteoporosis or fractures.
• But weight loss itself is a known risk factor for decreased bone density. People losing weight rapidly should monitor bone health.

Who Should Be Cautious?

• Older adults (especially postmenopausal women).
• People with existing osteoporosis or low bone density.
• Those at risk of nutrient deficiencies (e.g., low calcium, vitamin D or protein intake).

How to Protect Bone Health While Taking Ozempic?

✔ Ensure adequate calcium (1,000–1,200 mg daily) and vitamin D (600–800 IU daily).
✔ Do weight-bearing and resistance exercises (e.g., walking, weightlifting).
✔ Monitor bone density if at risk (DEXA scan if needed).
✔ Discuss concerns with your doctor especially if you have osteoporosis or a history of fractures.

Bottom Line

Ozempic does not directly cause osteoporosis but rapid weight loss and reduced nutrient intake may increase bone loss risk. Taking steps to support bone health can help minimize any potential effects.

What Are The Treatment Ways For Osteoporosis?

1. Medications for Osteoporosis

A. Bisphosphonates (First-Line Treatment)

• Help slow bone loss and reduce fracture risk.
• Commonly prescribed for postmenopausal women and older adults.
• Examples;
  • Alendronate (Fosamax) – Weekly pill.
  • Risedronate (Actonel, Atelvia) – Weekly/monthly pill.
  • Ibandronate (Boniva) – Monthly pill or IV injection.
  • Zoledronic acid (Reclast, Zometa) – Yearly IV infusion.
• Side Effects: Can include nausea, heartburn or rare jawbone problems (osteonecrosis).

B. Hormone-Related Therapies

• Help maintain bone density by regulating hormones.
• Common in postmenopausal women or those with hormone deficiencies.
• Examples:
  • Estrogen therapy (for early menopause).
  • Raloxifene (Evista) – Mimics estrogen to protect bones.
  • Testosterone therapy (for men with low testosterone).

You can find estrogen therapy for menopause in below:

Conjugated Estrogens: Uses, Side Effects and Key Facts

C. Denosumab (Prolia, Xgeva)

• Injection every 6 months to reduce bone breakdown.
• Used for high-risk patients who can’t take bisphosphonates.
• Side Effects: Can include low calcium levels or rare jawbone issues.

D. Anabolic (Bone-Building) Medications

• Help stimulate new bone growth rather than just slowing loss.
• Used for severe osteoporosis or multiple fractures.
• Examples;
  • Teriparatide (Forteo) – Daily self-injection (2 years max).
  • Abaloparatide (Tymlos) – Similar to Forteo also injected daily.
  • Romosozumab (Evenity) – Monthly injection for 12 months.
• More effective than bisphosphonates but expensive.

You can find clinical trials, side effects and dosage of Tymlos injections in below:

Is Tymlos Safe? Risks, Benefits and Long Term Effects

2. Lifestyle Changes for Bone Health

A. Diet & Nutrition

• Calcium-Rich Foods:
  • Dairy (milk, yogurt, cheese).
  • Leafy greens (kale, bok choy).
  • Almonds, tofu, fortified foods (orange juice, cereals).
• Vitamin D Sources:
  • Sunlight exposure (15–30 min/day).
  • Fatty fish (salmon, sardines).
  • Supplements if needed (600–800 IU/day).
• Protein Intake:
  • Essential for bone structure; get enough from lean meats, eggs and legumes.

B. Weight-Bearing & Strength Training Exercises

• Helps maintain bone density and strength.
• Weight-Bearing Exercises:
  • Walking, jogging, dancing, stair climbing.
• Resistance Training:
  • Lifting weights, resistance bands, bodyweight exercises.
• Balance & Flexibility Exercises:
  • Yoga, Tai Chi (reduce fall risk).

C. Avoid Bone-Damaging Habits

• Quit Smoking – Smoking weakens bones by reducing estrogen and blood flow.
• Limit Alcohol – Excess alcohol interferes with calcium absorption.
• Reduce Caffeine & Soda – Excessive caffeine may reduce calcium levels.

3. Fall Prevention Strategies

✔ Improve home safety (remove rugs, add grab bars, improve lighting).
✔ Wear supportive shoes with non-slip soles.
✔ Get regular vision & hearing check-ups.
✔ Avoid medications that cause dizziness.

4. Regular Bone Density Tests (DEXA Scan)

• Used to track bone health over time.
• Recommended every 1–2 years for high-risk people.

Bottom Line

✔ Mild Osteoporosis → Lifestyle changes, calcium & vitamin D, weight-bearing exercises.
✔ Moderate Osteoporosis → Bisphosphonates or hormone therapy.
✔ Severe Osteoporosis → Bone-building medications like Forteo or Evenity.
✔ Fall Prevention → Essential to reduce fracture risk.

We wish healthy and happy life to you.