Osteoporosis: Symptoms, Diagnosis & Latest Treatment

Quick answer

Osteoporosis is a silent disease in which bone mass falls and bone structure weakens, so bones break after minor falls — most often the spine, wrist and hip. It is usually painless until a fracture happens. It is diagnosed with a bone density (DEXA) scan (T-score −2.5 or lower) and treated with adequate vitamin D and calcium plus osteoporosis medicines such as bisphosphonates, the 6-monthly Prolia injection or yearly zoledronic acid, together with exercise and fall prevention.

✅ Last medically reviewed by Prof. Dr. Ibrahim Shaarawi, Professor of Orthopaedic Surgery, on 5 October 2026

About your surgeon: Prof. Dr. Ibrahim Shaarawi

Professor of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University.
Visiting Professor of Orthopaedic Surgery, Ohio, USA.
Certificate in complex fractures and trauma, University of Maryland, USA.
He treats fragility fractures in older adults: he has performed 1,400 bipolar hip hemiarthroplasties (used mainly for femoral neck fractures), 650 total hip replacements and 250 dual-mobility hips, plus 55 reverse shoulder replacements.
Rated 4.9 and 5.0 on Google by about 300 patients.

He sees patients at his clinics in Nasr City, Mohandeseen and New Cairo (5th Settlement).

Most fractures I operate on in older patients — hip, shoulder, wrist and spine — are fragility fractures caused by osteoporosis. The good news is that modern treatment cuts the fracture risk substantially. This guide explains the disease and the options, and links to our detailed guides on diagnosis and treatment.

What is osteoporosis?

Bone is living tissue that is constantly broken down and rebuilt. Osteoporosis develops when bone loss outpaces bone formation, leaving bone thinner and more porous. It develops slowly over years and is often diagnosed only when a fall or a minor strain causes a fracture.

Progression of osteoporosis with spinal compression fractures and stooped posture — As osteoporosis progresses, spinal compression fractures cause a stooped back and height loss

Common osteoporotic fractures

Wrist fractures after a fall on the outstretched hand.
Hip fractures — see femoral neck fracture in older adults.
Vertebral compression fractures, which cause back pain, height loss and stooping.
Shoulder (proximal humerus) fractures — see proximal humerus fractures in older adults.

Risk factors

Age and female sex, especially after menopause.
Long-term steroid tablets (3 months or more).
Family history, especially a parent with a hip fracture.
Low body weight, smoking and heavy alcohol use.
Inflammatory and hormonal conditions, malabsorption, and some cancer treatments.
Vitamin D deficiency and low calcium intake — see vitamin D deficiency.

Video: do soft drinks cause osteoporosis?

Prof. Dr. Ibrahim Shaarawi answers a common question about soft drinks and osteoporosis (in Arabic).

Diagnosis: the DEXA scan

T-score	Interpretation
−1 or higher	Normal
Between −1 and −2.5	Low bone mass (osteopenia)
−2.5 or lower	Osteoporosis
−2.5 or lower with a fragility fracture	Severe (established) osteoporosis

Table 1: WHO classification of bone density.

Full details on who needs the test and how to read it are in the bone density (DEXA) test. Before treatment we also check vitamin D, calcium and kidney function and exclude osteomalacia.

Key numbers to know

In the FREEDOM trial, Prolia cut new vertebral fractures by 68% (2.3% vs 7.2%) and hip fractures by 40% (Cummings et al., NEJM 2009).
In the HORIZON trial, yearly zoledronic acid cut vertebral fractures by 70% and hip fractures by 41% over 3 years (Black et al., NEJM 2007).
Calcium supplements lowered overall fracture risk by about 11% in randomised trials but did not reduce hip fractures (Bolland et al., BMJ 2015).

At Prof. Dr. Ibrahim Shaarawi’s clinics in Nasr City, Mohandeseen and New Cairo (5th Settlement) we review your vitamin D, calcium and bone density results and examine the cause of pain or fracture before deciding on the right dose or osteoporosis treatment.

Prevention

Weight-bearing and resistance exercise.
1,000 mg calcium daily (1,200 mg for women over 50 and men over 70), mainly from food.
600–800 IU vitamin D daily, with treatment of any deficiency.
Stop smoking, limit alcohol, and prevent falls — see preventing falls and fractures in older adults.

Comparing osteoporosis treatments

Medicine	How it is given	How it works	Key points
Alendronate / risedronate	Weekly or monthly tablet	Reduces bone breakdown	Empty stomach, full glass of water, stay upright 30 minutes
Zoledronic acid	Yearly intravenous infusion	Reduces bone breakdown	Cut vertebral fractures by about 70% in HORIZON; needs good kidneys and adequate vitamin D
Denosumab (Prolia)	Injection under the skin every 6 months	Blocks bone-resorbing cells	Cut vertebral fractures by about 68% in FREEDOM; must not be stopped abruptly — the 6-monthly osteoporosis injection (Prolia)
Teriparatide	Daily injection under the skin	Builds new bone	Severe osteoporosis or multiple fractures, for a limited time
Romosozumab	Monthly injection for 12 months	Builds bone and reduces breakdown	Severe osteoporosis, followed by a maintenance drug

Table 2: Osteoporosis medicines (chosen by severity and risk).

Important: denosumab should never be stopped or delayed without a plan from your doctor; stopping it abruptly can cause rapid bone loss and multiple spinal fractures. Before bisphosphonates or denosumab we also review dental health because of a rare risk of jaw osteonecrosis.

Frequently asked questions about osteoporosis

What are the symptoms of osteoporosis?

Usually none until a fracture after a minor fall, or height loss and a stooped back from spinal fractures. Diffuse bone pain with muscle weakness should prompt tests for osteomalacia.

How is osteoporosis diagnosed?

With a DEXA scan: a T-score of −2.5 or lower means osteoporosis, between −1 and −2.5 means low bone mass. A fragility fracture of the spine or hip also establishes the diagnosis.

What is the best treatment for osteoporosis?

It depends on severity: bisphosphonate tablets or yearly zoledronic acid, the 6-monthly Prolia injection, or bone-building drugs for severe cases — always with vitamin D, calcium, exercise and fall prevention.

Does vitamin D deficiency cause osteoporosis?

Chronic deficiency contributes to bone loss and fractures, while severe deficiency mainly causes osteomalacia. We check and correct vitamin D before starting osteoporosis drugs.

Can Prolia be stopped?

Not abruptly. Stopping without a follow-on drug can cause rapid bone loss and multiple spinal fractures; your doctor usually plans a switch to a bisphosphonate.

Do men get osteoporosis?

Yes, although less often than women. Men aged 70 or older, or younger men with risk factors such as steroids or a previous fracture, should have a bone density test.

To have your bones assessed and your tests reviewed, book a consultation, call +20 155 240 4488 or message us on WhatsApp at +20 155 554 7181.

Medically reviewed by Prof. Dr. Ibrahim Shaarawi, Professor of Orthopaedic Surgery. This article is general medical education and does not replace an examination or the treatment plan your doctor sets for you. See our medical disclaimer.

Related vitamin D and bone health guides

Detailed guides in our osteoporosis and vitamin D series:

Osteoporosis: Symptoms, Causes, Diagnosis and the Latest Treatments