How will I know if I have osteoporosis? Are there any signs or symptoms?
Because osteoporosis and osteopenia are not painful conditions, you will not know that you have either one unless you break a bone or you have bone mineral density testing.
Naturally, if you suspect you have broken a bone, get medical help immediately. But in the following situations, you may be uncertain, so it is still wise to call your clinician:
• Pain and bruising following a fall that occurred without a lot of force or trauma could indicate that you have broken a bone. Don't say to yourself,
"It was only a little fall—I couldn't have broken a bone." While not common, it is important to discuss such injuries with your clinician.
• Back pain that comes on suddenly in the spine can mean that you have one or more vertebral fractures resulting from osteoporosis. This is different from the back pain associated with a muscle spasm. Even if you have just bent forward to reach for something or slipped in the bathtub, you can still get a fracture in your spine if you have osteoporosis.
One physical sign indicating that you have osteoporosis is loss of height. So, if you shrink in height as measured in your annual physical exam, you should ask to be screened for osteoporosis, particularly if your clinician doesn't notice or doesn't recommend screening.
If osteoporosis doesn't hurt, what impact does it have on my health?
Osteoporosis can affect your health in many ways, directly and indirectly:
• You become much more susceptible to fractures. Fractures, depending on which bone you break, can cause physical immobility and impairment of your general health, as well as financial problems and social isolation. Fractures can lead to death. If you are 50 or older with osteoporosis, you have a 1 in 2 chance of having an osteoporosis-related fracture during the remainder of your lifetime.
• Vertebral fractures caused by osteoporosis can severely affect the quality of your life in many areas,
such as social functioning, overall health, emotional health, bodily pain, and vitality. The acute back pain associated with vertebral fractures and the healing process can be very debilitating. Being unable to do activities of daily living without pain can cause you to stop moving physically and mentally: physically because of pain or physical impairment, and mentally because of fears of further injury and resulting isolation and possibly depression. Pain associated with fractures in other bones can cause similar scenarios with fear, frustration, and reluctance to do the activities to which you've become accustomed. There are many hazards to being immobile, all of them affecting your health in a negative way (see Question 83).
• Getting shorter and, in some cases, developing a deformity of your back can cause problems physically and emotionally. A deformity called kyphosis (sometimes called "dowager's hump") develops when the front edges of the bones of the spine collapse due to osteoporosis and tiny fractures. Figure 6 depicts the changes in your spine resulting from osteoporosis. The deformed spine does not just make you shorter; it can compress organs in your chest and abdomen, making it difficult for you to breathe and digest food appropriately (see Question 84). Men and women with this disfigurement can have poor body image or low self-esteem, sometimes causing them to withdraw from social activities. Even finding clothes that fit well and look right can be difficult, further contributing to social isolation and depression.
• Depression can be a direct result of osteoporosis, fractures, the fear of falling, and the resulting social isolation. You may become depressed because you are isolated from friends and family as a result, for
Figure 6 Progression of spine deformity and the loss of height. Note that organs become compressed or shifted in position with progression of osteoporosis. Courtesy of the National Association of Nurse Practitioners in Women's Health (NPWH).
example, of a hip fracture. Later, when your hip has healed, you might become fearful of venturing out again, causing you ongoing isolation from friends and family (see Question 82).
• Over 65,000 women die from hip fractures every year. But if you survive, chances are you will be disabled. Just one hip fracture that results from osteoporosis can give you lasting disability. Twenty percent of women with fractures will never leave a nursing home. Another 50% will be permanently incapacitated.
• Your overall health can suffer when you have osteoporosis. You may be malnourished from not getting enough of the nutrients that keep your bones healthy. As a result of fractures, you may become less physically active, causing further weakening of your bones and muscles. This loss of strength can cause rapid deterioration in your overall health.
-  Safe, painless, and noninvasive tests to evaluate bone mineral density.
-  A fracture of the body of a vertebra (spine bone) that collapses it and makes it thinner and weaker. Usually results from osteoporosis but can also result from complications of cancer or some injuries.
-  A type of physical deformity that develops when the front edges of the bones of the spine collapse because of osteoporosis and tiny fractures. Also called dowager's hump.