DEXA Osteoporosis

Osteoporosis Symptoms: What Are the Early Warning Signs of Osteoporosis?

This guide to osteoporosis symptoms will help you identify early warning signs, and decide when to get a DEXA scan for osteoporosis.

Written by Chelsea Okonkwo
Last updated 3 Jun, 2024

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As you age, the integrity of your bones becomes a crucial aspect of your overall health. Osteoporosis is a condition that gradually weakens bones without any obvious symptoms in the early stages. If you're wondering whether your bones are weakening or you might be at risk of osteoporosis, you've just landed on the right page. 

This comprehensive guide will explain osteoporosis, its early warning signs and symptoms, how it can affect different parts of the body, and the risks of the condition worsening if it's not detected early. We will also discuss booking a DEXA scan to assess your bone density so you feel confident enough to manage your bone health proactively.  

What is osteoporosis?

Bone tissue is composed of a protein called collagen and minerals, particularly calcium salts. Through a complex process known as bone remodelling, mature bone tissue is continuously broken down and replaced with newly formed tissue. This process helps maintain a strong, healthy skeletal system, repair microdamage from daily activities, like running up and down stairs, and heal more serious injuries such as fractures (broken bones).

When you are young, the rate at which bone tissues are formed typically outpaces their breakdown, allowing you to achieve peak bone mass by your early 20s and meet your functional demands, such as your level of physical activity. However, after the age of 40, an imbalance can begin where bone tissue isn't replaced as fast as it is broken down—a normal part of ageing. However, osteoporosis can occur when this imbalance becomes significant enough to lower your bone's mineral density or mass. 

Osteoporosis is a metabolic bone condition characterised by dangerously low bone mineral density or mass. It causes bone weakness and fragility and an increased risk of fractures from even a minor fall or accident. Sometimes, even sneezing or coughing may cause a rib to break or one of the bones in the spine to collapse. 

Inside, your bone is a spongy tissue full of tiny holes, like a honeycomb, which make it lighter and springy and allow different types of soft tissues, such as blood vessels, nerves, and cartilage, to pass through. The word osteoporosis literally means porous bones or bones with holes because it causes the tiny holes in the bone’s honeycomb-like inner structure to become larger and the outer solid walls to thin out.

What are the causes of osteoporosis?

Osteoporosis causes may include:

  • Ageing.

  • Being female. Having lower peak bone mass than men, women are more likely to show a faster or significant decline in bone density.

  • Medical conditions like chronic kidney disease, hormone disorders, coeliac disease, rheumatoid arthritis, hyperthyroidism, anorexia, certain types of cancer, or diabetes. 

  • Genetics.

  • Certain medications like hormone blockers, glucocorticoids, and proton pump inhibitors. 

  • Poor lifestyle habits, including smoking, excess alcohol consumption, physical inactivity, and eating a diet low in calcium or vitamin D levels. 

What are the early warning signs of osteoporosis?

Osteoporosis is sometimes called the ‘silent thief’ because it is believed to present no symptoms even as it progresses until one breaks a bone and experiences intense pain, limited mobility, swelling, and other bone fracture symptoms. However, this is not entirely true. There are a few changes in your body that might let you know to check your bone density or health and seek early intervention. These early warning signs of osteoporosis may include:  

  • Reduced grip strength. You may find it difficult to carry or hold onto objects. 

  • Weak or brittle nails. Increased brittleness or frequent nail breakage can indicate declining bone health.

  • Receding gums and tooth loss. Your jawbone supports your gums and teeth. As it loses density and becomes weak, your gums may recede away from your teeth. This can change the alignment of your teeth, increase the risk of bacterial infections, and potentially lead to loose teeth or tooth loss.

  • Bone pain or tenderness. Mild, persistent aches or sensitivity in bones, often noticed in your neck or lower back, may suggest low bone density and bone weakness. 

Also, there are ‘late’ warning signs of osteoporosis that may result from fractures that escape diagnosis or aren’t easily recognized. These fractures usually occur along the spinal column and are known as osteoporotic spine fractures or vertebral compression fractures. Depending on the location of the fractures, they may cause the following osteoporosis signs and symptoms:  

  • Shortness of breath. Bone loss or fracture may cause your thoracic spine (spinal bones starting from the base of the neck to the middle back region) to press down on each other, compressing your chest cavity and reducing the space available for your lungs to expand during breathing.

  • Gastrointestinal (GI) problems. Issues like abdominal pain, feelings of fullness, reduced appetite, bloating, or constipation can arise from compression fractures in the lumbar spine (bone in the lower back). These fractures can reduce the space within the abdominal cavity, similar to how thoracic spine fractures can affect lung capacity.

  • Unintentional weight loss.

  • Loss of height. It is normal to get shorter as we age, but a height reduction greater than 1.5 inches (~4 cm) can be a telltale sign of osteoporosis. As the spinal bones, especially in the middle and lower back, lose density and weaken, they can collapse against each other, causing you to lose height. It might also cause you to develop kyphosis (hunched upper back), which will make you appear shorter.

What are low bone density symptoms?

Low bone density symptoms (also known as brittle bones symptoms or bone thinning symptoms) can be subtle and go unnoticed until a fracture occurs. Osteopenia (moderately low bone density) is a precursor to osteoporosis (dangerously low bone density). 

You might notice increased discomfort in your back or neck, including persistent pain and stiffness, which are signs that the vertebrae in the spine are becoming more fragile. You may also notice a stooped back and a decrease in height.

How does osteoporosis affect the body?

Osteoporosis can affect various body parts, with the spine, neck, and hips being the most common sites. Let's explore the specific symptoms in these areas:

  • Osteoporosis in spine symptoms: Compression fractures in the spine often cause severe back pain or a dull ache that worsens with activity, gradual height loss greater than 6cm (~2 inches), and a stooped or hunched posture (kyphosis). 

Symptoms such as numbness, tingling, muscle fatigue, and loss of bladder control can occur if compression fractures in your lower back cause disc problems (such as a herniated disc) or spinal stenosis (narrowing of the space between vertebral bones where nerve roots exit the spinal cord to travel around the body). 

  • Osteoporosis neck symptoms: Severe neck pain is the most prominent symptom when osteoporosis affects the neck. 

  • Osteoporosis hip symptoms: Due to bone tenderness or in the event of an osteoporotic hip fracture, a person might experience pain, stiffness and discomfort in the hip, groin, or buttocks area that worsens with weight-bearing activities (such as walking/jogging, stair climbing, and dancing). This pain can also radiate downward, affecting the knees and feet. 

Does osteoporosis make you tired?

The effects of osteoporosis may cause you to feel tired, even though the condition itself doesn't directly cause fatigue. Pain from compression fractures, muscle discomfort, dental issues, and digestive problems, combined with the psychological distress suffered when osteoporosis symptoms disrupt your movement, sleep, and daily routines, can leave you feeling tired. 

It's also worth noting that fatigue may be a side effect of some medications prescribed to treat osteoporosis.

What are the effects of osteoporosis over time, and what can osteoporosis cause?

If the osteoporosis early symptoms are not investigated early and the condition gets progressively worse, the consequences can be significant, though they can be managed. They may include:

  • Fractures. Commonly occurring in the spine, hips, and wrists, fractures are considered the most challenging effect of osteoporosis due to the pain, nerve impairments, limited mobility, and the potential need for hospitalisation they can cause. 

Not only does osteoporosis increase the likelihood of breaking a bone even from a minor impact or fall, but having one osteoporotic fracture raises the risk of subsequent ones. There's also the risk of complications, including urinary tract infections, pressure ulcers, and pneumonia.

  • Limited mobility or permanent disability. Severe osteoporosis might require complete or partial dependence on others for everyday activities. Some people may lose the ability to dress themselves, stand, and walk. 

  • Poor mental health. Osteoporosis can adversely affect moods, self-esteem, body image, and confidence, leading to withdrawal from social interactions. Also, a heightened fear of falling or breaking another bone might cause people with osteoporosis to cultivate self-limiting beliefs that force them to become immobile and affect their self-care behaviours.

It is important to pay close attention to your body and watch for any signs of bone weakness. Early diagnosis can be the difference between improving your bone health and facing more significant challenges later on.

What should I do if I’m experiencing osteoporosis early symptoms?

If you are experiencing some early signs of osteoporosis, suspect you might have low bone density (osteopenia), or could be at risk of osteoporosis, your healthcare provider may order a dual-energy X-ray absorptiometry (DEXA) scan. It is the gold-standard test for checking bone mineral density (BMD) and getting the answers you need. 

Scan.com is the UK’s largest imaging network, with over 150 scanning centres nationwide. In a matter of minutes, you can browse our network, compare prices, check for the earliest appointment time, and book a DEXA scan at a location near you. No GP referral is needed. No NHS waiting lists. No hidden costs. Results are also available in just a matter of days.

As the name suggests, a DEXA scan uses low-dose X-rays (ionising radiation). It measures how much X-rays are absorbed by your bones, uses the information to determine your BMD and compares it with the average healthy adult of the same sex, known as a T-score. 

A T-score of:

  • -1.0 and greater = Healthy bones

  • -1 to -2.4 = Osteopenia

  • Less than -2.5 = Osteoporosis 

  • Less than -2.5 and fragility fracture = Severe osteoporosis

If you are under 30 years, you may find another parameter known as Z-score on your DEXA scan report. It is derived by comparing your BMD with the average of people your age, gender, body size, and ethnicity.

It's important to know that a score of -2.5 on a DEXA scan could also indicate another condition called osteomalacia (soft bone disease), as the scan cannot definitively differentiate between osteoporosis and other bone diseases. Therefore, further testing might be necessary to confirm the diagnosis and guide effective treatment.

Not sure if the DEXA is the right scan for you? Book a consultation for £50 to speak with an expert clinician who’ll offer a no-obligation referral to the scan best suited to your specific needs. 

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