Osteoporosis develops gradually, usually without causing symptoms. A broken bone or fracture, which occurs with minor trauma, such as a fall, is typically the first sign. A diagnosis will be made based on your medical history, physical examination and non-invasive tests to measure the strength and health of your bones (bone density tests). Some people have evidence of multiple spinal compression fractures with height loss and Dowager's hump as their first symptom. Often the spine fracture can occur without significant pain, for unclear reasons. Years later, however, compression fractures can cause chronic pain, especially if they occur in certain parts of the spine or are multiple in number.

At the time of menopause, all women should talk to their health care professionals about osteoporosis and identify their risk for developing it. Some of the common risk factors are:

  • having a small, thin frame
  • personal and/or family history of broken bones in adulthood
  • diet low in calcium
  • excessive thinness
  • smoking
  • excessive alcohol consumption ("moderate drinking" for women and older people is defined by the National Institute on Alcohol Abuse and Alcoholism as one drink per day — one drink equals: 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits)
  • an inactive lifestyle
  • anorexia nervosa
  • absence of menstrual periods or very irregular menses during youth
  • long-term use of such medications as corticosteroids for asthma and arthritis (longer than three to six months)
  • although the disease typically strikes Caucasian and Asian women, African Americans and Hispanic Americans are also at significant risk
  • certain chronic medical conditions including hyperthyroidism, some hyperparathyroidism, some bowel diseases and rheumatoid arthritis
  • certain chemotherapeutic agents have recently been implicated in accelerated bone density loss in breast cancer patients
  • Research sponsored by the National Institute of Mental Health (NIMH) suggests that depression may also be a major risk factor for osteoporosis. A phase IV clinical trial is currently underway that will determine whether women with major depression lose bone mass at a faster rate than women without depression. This study will also determine if the drug alendronate (Fosamax) can maintain or increase bone mass in premenopausal women with major depression and osteoporosis.