Editing Osteoporosis (section)

==Signs and symptoms==
[[File:Blausen 0686 Osteoporosis 01.png|thumb|left|Illustration depicting normal standing posture and osteoporosis]]

Osteoporosis has [[asymptomatic|no symptoms]] and the person usually does not know that they have osteoporosis until a bone is broken. Osteoporotic [[fractures]] occur in situations where healthy people would not normally break a bone; they are therefore regarded as [[fragility fractures]]. Typical fragility fractures occur in the [[vertebral column]], [[rib]], hip and [[wrist]].<ref name=niams/> Examples of situations where people would not normally break a bone include a fall from standing height, normal day-to-day activities such as lifting, bending, or coughing.<ref name="niams">{{Cite web |date=1 December 2022 |title=Osteoporosis |url=https://www.niams.nih.gov/health-topics/osteoporosis |access-date=16 September 2023 |publisher=National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health |language=en}}</ref>

===Fractures===
Fractures are a common complication of osteoporosis and can result in disability.<ref>{{Cite book|title=Harrison's principles of internal medicine.| vauthors = Jameson JL, Kasper DL, Longo DL, Fauci AS, Hauser SL, Loscalzo J |isbn=9781259644047|edition= Twentieth|publisher=McGraw-Hill Education|location=New York|oclc=990065894 |date=2018-02-06}}</ref> Acute and chronic pain in the elderly is often attributed to fractures from osteoporosis and can lead to further disability and early mortality.<ref>{{cite journal | vauthors = Old JL, Calvert M | title = Vertebral compression fractures in the elderly | journal = American Family Physician | volume = 69 | issue = 1 | pages = 111–116 | date = January 2004 | pmid = 14727827 | url = http://www.aafp.org/afp/2004/0101/p111.html | access-date = 31 March 2011 | url-status = live | archive-url = https://web.archive.org/web/20110805184810/http://www.aafp.org/afp/2004/0101/p111.html | archive-date = 5 August 2011 }}</ref> These fractures may also be asymptomatic.<ref>{{cite journal | vauthors = Yang J, Mao Y, Nieves JW | title = Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: A systematic review and meta-analysis | journal = Bone | volume = 136 | pages = 115358 | date = July 2020 | pmid = 32268210 | doi = 10.1016/j.bone.2020.115358 | s2cid = 215620114 }}</ref> The most common osteoporotic fractures are of the wrist, spine, shoulder and hip. The symptoms of a [[vertebra]]l collapse ("[[compression fracture]]") are sudden [[back pain]], often with [[radicular pain]] (shooting pain due to nerve root compression) and rarely with [[spinal cord compression]] or [[cauda equina syndrome]]. Multiple vertebral fractures lead to a stooped posture, loss of height, and chronic pain with resultant reduction in mobility.<ref>{{cite journal | vauthors = Kim DH, Vaccaro AR | title = Osteoporotic compression fractures of the spine; current options and considerations for treatment | journal = The Spine Journal | volume = 6 | issue = 5 | pages = 479–487 | year = 2006 | pmid = 16934715 | doi = 10.1016/j.spinee.2006.04.013 | s2cid = 28448924 }}</ref>

Fractures of the long bones acutely impair mobility and may require [[surgery]]. [[Hip fracture]], in particular, usually requires prompt surgery, as serious risks are associated with it, such as [[deep vein thrombosis]] and [[pulmonary embolism]]. There is also an increased risk of mortality associated with osteoporosis-related hip fracture, with the mean average mortality rate within one year for Europe being 23.3%, for Asia 17.9%, United States 21% and Australia 24.9%.<ref>{{cite journal | vauthors = Downey C, Kelly M, Quinlan JF | title = Changing trends in the mortality rate at 1-year post hip fracture - a systematic review | journal = World Journal of Orthopedics | volume = 10 | issue = 3 | pages = 166–175 | date = March 2019 | pmid = 30918799 | pmc = 6428998 | doi = 10.5312/wjo.v10.i3.166 | doi-access = free }}</ref>

Fracture risk calculators assess the risk of fracture based upon several criteria, including [[bone mineral density]], age, smoking, alcohol usage, weight, and gender. Recognized calculators include [[FRAX]],<ref>{{cite web|url= http://courses.washington.edu/bonephys/FxRiskCalculator.html|title= Fracture Risk Calculator|author= Susan Ott|archive-url= https://web.archive.org/web/20091014090245/http://courses.washington.edu/bonephys/FxRiskCalculator.html|archive-date=2009-10-14|date=October 2009}}</ref> the Garvan FRC calculator and  QFracture as well as the open access FREM tool.<ref>{{cite journal | vauthors = Rubin KH, Möller S, Holmberg T, Bliddal M, Søndergaard J, Abrahamsen B | title = A New Fracture Risk Assessment Tool (FREM) Based on Public Health Registries | journal = Journal of Bone and Mineral Research | volume = 33 | issue = 11 | pages = 1967–1979 | date = November 2018 | pmid = 29924428 | doi = 10.1002/jbmr.3528 | s2cid = 49312906 | doi-access = free }}</ref> The FRAX tool can also be applied in a modification adapted to routinely collected health data.<ref>{{cite journal | vauthors = Yang S, Leslie WD, Morin SN, Lix LM | title = Administrative healthcare data applied to fracture risk assessment | journal = Osteoporosis International | volume = 30 | issue = 3 | pages = 565–571 | date = March 2019 | pmid = 30554259 | doi = 10.1007/s00198-018-4780-6 | s2cid = 54632462 }}</ref>

The term "established osteoporosis" is used when a [[fragility fracture|broken bone due to osteoporosis]] has occurred.<ref name=WHO1994>{{cite book |title=Assessment of fracture risk and its application to screening for postmenopausal osteoporosis |series=World Health Organization Technical Report Series |date=1994 |volume=843 |pages=1–129 |publisher=World Health Organization |isbn=978-92-4-120843-7 |hdl=10665/39142 |pmid=7941614 }}{{page needed|date=July 2024}}</ref> Osteoporosis is a part of [[frailty syndrome]].

===Risk of falls===
[[File:Menopause - Osteoporosis -- Smart-Servier (cropped).jpg|thumb|left|Progression of the shape of vertebral column with age in osteoporosis]]

There is an increased risk of falls associated with aging. These falls can lead to skeletal damage at the wrist, spine, hip, knee, foot, and ankle. Part of the fall risk is because of impaired eyesight (e.g. [[glaucoma]], [[macular degeneration]]), [[balance disorder]], [[movement disorder]]s (e.g. [[Parkinson's disease]]), [[dementia]], [[sarcopenia]] (age-related loss of [[skeletal muscle]]), and collapse (transient loss of postural tone with or without loss of consciousness). Causes of [[syncope (medicine)|syncope]] are manifold, but may include [[cardiac arrhythmia]]s (irregular heart beat), [[vasovagal syncope]], [[orthostatic hypotension]] (abnormal drop in blood pressure on standing up), and [[seizure]]s. Removal of obstacles and loose carpets in the living environment may substantially reduce falls. Those with previous falls, as well as those with gait or balance disorders, are most at risk.<ref>{{cite journal |vauthors=Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ | title = Will my patient fall? | journal = JAMA | volume = 297 | issue = 1 | pages = 77–86 | year = 2007 | pmid = 17200478 | doi = 10.1001/jama.297.1.77 }}</ref>

=== Complications ===
As well as susceptibility to breaks and fractures, osteoporosis can lead to other complications. Bone fractures from osteoporosis can lead to disability and an increased risk of death after the injury in elderly people.<ref name="mayo">{{Cite web |title=Osteoporosis - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968 |access-date=2022-03-25 |website=Mayo Clinic |language=en}}</ref> Osteoporosis can decrease the quality of life, increase disabilities, and increase the financial costs to health care systems.<ref name="sozen">{{cite journal |vauthors=Sözen T, Özışık L, Başaran NÇ |title=An overview and management of osteoporosis |journal=European Journal of Rheumatology |volume=4 |issue=1 |pages=46–56 |date=March 2017 |pmid=28293453 |pmc=5335887 |doi=10.5152/eurjrheum.2016.048}}</ref>