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Back Pain & Osteoporosis




Lower back pain.

Gradual loss of height and stooping posture.

Wrist, hip, or vertebral fractures.

When To Call Your Doctor

See a doctor with any symptoms of osteoporosis.

If you have osteoporosis and pain develops after any strain or injury, call a doctor immediately.

What Is It?

Osteoporosis is characterized by a loss of bone mass due to an imbalance of bone formation and bone resorption, a depletion of calcium and phosphorus essential to bone formation, or both. Affected bones become porous and brittle and susceptible to fractures. The wrists and hips, and vertebrae in the spine are the most common fracture sites. The disorder is very common among people over age 70; it affects women four times more often than men, owing to hormonal changes that occur with menopause.

What Causes It?

Some degree of loss of bone mass is a normal consequence of aging, but a number of factors hasten osteoporosis: reduced estrogen levels after menopause; dietary calcium deficiency; physical inactivity; smoking; excessive alcohol use; and being underweight.

Hereditary factors may be involved. For example, Caucasian women have a higher incidence of osteoporosis than others.

Osteoporosis may occur as a consequence of an underlying condition, such as hyperthyroidism, premature menopause (before age 45), chronic lung diseases, and Cushing’s disease (excessive production of corticosteroids by the adrenal glands). It may also arise from long-term use of corticosteroid drugs or heparin (an anticoagulant).


Estrogen replacement is highly effective in preventing osteoporosis in postmenopausal women. Estrogen must be started soon after menopause because bone loss accelerates rapidly at that time.

A diet rich in calcium and vitamin D protects against osteoporosis. Older men and postmenopausal women should get 1,500 milligrams of calcium daily through diet and calcium supplements.

Regular weight-bearing exercise is important.


Patient history and physical examination.

Bone density scan.

Blood or urine tests or a bone biopsy to detect or rule out other causes of bone loss.

X-rays or other imaging tests, such as CT (computed tomography) scans. Routine x-rays, however, do not detect osteoporosis until 25 percent or more bone mass has been lost.

How To Treat It

Over-the-counter analgesics are effective for pain.

Prompt estrogen replacement therapy can slow the progress of osteoporosis in postmenopausal women.

Bisphosphonate therapy (with drugs such as alendronate and etidronate) slows bone resorption and builds bone. Calcium supplements may be advised.

High doses of calcitonin (a hormone that regulates the body’s calcium usage) can slow bone loss and possibly add bone mass.

The drug raloxifene (Evista) may be an option for some people.

Exercise and physical therapy may preserve function.


From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.



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Back Pain & Osteoporosis

The Back Pain and Osteoporosis White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.

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