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Osteoporosis is a progressive disease, and where we are in the regular cycle of breaking down and rebuilding our bones is key to determining the stages of osteoporosis.

May 6, 2025

By Carolyn Franklin, MD
WellMed at Kingsville
Kingsville, Texas

Osteoporosis affects many people as they get older.

I see many patients with osteoporosis. In some cases, individuals have come to me having already dealt with the disease for several years. At times, I am the physician who advises them of the diagnosis. Regardless of their condition when coming to me, many of my patients say the same thing to me, “I had no idea I had osteoporosis.”

This is not surprising. There are usually no symptoms with the first stages of osteoporosis, but before we get into the symptoms and treatments of this bone disease, let’s discuss what it is.

When we are young, our bones rebuild more than they break down – resulting in strong, growing bones. As we age, our bones break down faster than they rebuild, making them less dense, more fragile and more prone to breaks. Osteoporosis is synonymous with this condition of our bones.

Stages of osteoporosis

At some point in our 20s and 30s, we begin breaking down and rebuilding bones at the same rate. This equilibrium is often considered the first stage of osteoporosis, since you are no longer rebuilding bone faster than you are losing it.

Stage 2 occurs when your body begins breaking down and losing bone faster than it rebuilds bone. Whether you are in stage 1 or 2, you will likely have no symptoms.

As the bones become more fragile, breaks and fractures become more common. This is Stage 3, and the point at which many patients are initially diagnosed.

Stage 4 is marked by extreme symptoms, including increasing pain when doing even simple activities. The softening of your bones can also cause deformities, including a bent-over appearance (kyphosis) that results from weak bones in your spine.

Risk and prevention

Regular bone density tests are crucial to determining your level of bone loss. The dual energy X-ray absorptiometry (DEXA) scan provides a reading of the mineral density in each square centimeter of bone. The sooner you know your bone-density score, the sooner you can take steps to slow its progression. There are dozens of factors that can put someone at risk for osteoporosis. Unfortunately, being a woman is one of those factors.

Why is the disease more common in women? One factor is the role estrogen plays in bone health. This hormone drives the formation of new bones. During menopause, women lose estrogen. Thus, your bone cells are no longer getting the signal to form new bones. Women also have lighter, thinner bones than men. Women also tend to live longer, thus they have more time to develop this degenerative disease.

Gender, hormone changes, age, body stature, medical conditions – these are some of the risk factors that are beyond our control.

But there are also lifestyle measures you can adopt to stave the progression of the disease:

  • Smoking: Nicotine and other toxic substances affect the body’s ability to absorb calcium, an essential nutrient for bone health. So if you smoke, now’s the time to quit.
  • Alcohol: Heavy drinking can lead to a thinning of the bones, making fractures more likely.
  • Diet: Vitamin D and calcium supplements can aid in the prevention or treatment of bone loss. But a diet that is rich in these nutrients is even better.
  • Exercise: Staying active as we age is key. There are also types of exercise that support bone health, including:
    • Weight-bearing exercises
    • Balancing exercises
    • Free weights
    • Rowing

You cannot always prevent osteoporosis. But you can slow its progression. Regular bone screenings can be key to detecting the disease when it’s in the early stages. The more you know, and the sooner you know, about your bone health, the more power you have to optimize your quality of life.

Bibliography

  1. Branch, N. S. C. a. O. (2025, January 8). Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoporosis
  2. Osteopenia. (2025, February 6). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21855-osteopenia
  3. Osteoporosis – Diagnosis and treatment – Mayo Clinic. (n.d.). https://www.mayoclinic.org/diseases-conditions/osteoporosis/diagnosis-treatment/drc-20351974
  4. World Health Organization: WHO & World Health Organization: WHO. (2023, July 14). Osteoarthritis. https://www.who.int/news-room/fact-sheets/detail/osteoarthritis
  5. The 4 Stages of Osteoporosis: Changing Bone Density (2022, April 20). https://osteoporosis.newlifeoutlook.com/stages-of-osteoporosis/
  6. What Are the Stages of Osteoporosis? (2024, May 19). https://www.verywellhealth.com/stages-of-osteoporosis-5202548

Carolyn Franklin, MD, is a family medicine physician and the medical director for WellMed at Kingsville in Kingsville, Texas. She is a graduate of UT Health San Antonio, where she also did her residency. She did an internship at the South Texas Veterans Health Care System.

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