7 Silent Signs of Osteoporosis Most People Miss

Why osteoporosis is called the "silent" disease

Osteoporosis doesn't hurt while it develops. Bones slowly lose density and strength over years, with no pain, no swelling and nothing to see in the mirror. For many people, the first sign they notice is a broken wrist, hip or spine after a fall that shouldn't have caused one.
 

In Singapore, these fractures remain common as the population ages. Among residents aged 50 and above, about 219 women and 106 men per 100,000 were hospitalised for a hip fracture in 2022, while fractures of the spine, upper arm and wrist affected about 708 women and 323 men per 100,000.
 

What are the silent signs of osteoporosis? The most commonly missed are losing height, a rounding upper back, sudden back pain without an injury, a fracture from a minor fall, clothes that fit differently around the waist, weaker grip and leg strength, and, in more advanced cases, shortness of breath or feeling full quickly. None of these confirms osteoporosis on its own, but each is a reason to ask your doctor about a bone density check.
 

Before reading on, take the quick self-check below.

Quick self-check

Tick any that apply to you. Be honest: this is just for you.

• I'm shorter than I was as a young adult, or someone has said I've "shrunk"
• My upper back looks more rounded, or I find it harder to stand up straight
• I've had back pain that started suddenly, without a clear injury
• I've broken a bone after a fall from standing height or less
• My clothes fit differently around the waist, or my ribs feel closer to my hips
• Opening jars or getting up from a chair without using my arms has become harder
• I get breathless more easily or feel full after small meals, and my posture has changed

Whatever you ticked, read on to see what each sign can mean and what to do next.

The 7 signs, from subtle to serious

1. Weaker grip and legs

Struggling with jar lids, carrying groceries or rising from a low chair can seem like ordinary ageing. But muscle and bone tend to weaken together, and weaker legs make falls more likely. A fall is what turns fragile bone into a fracture, so declining strength is worth taking seriously, especially after menopause or in your late 60s and beyond.

2. Clothes fitting differently around your waist

When small bones in the spine compress, the trunk gets shorter. Waistbands sit lower, trousers seem longer, and some people notice their lower ribs now almost touch the top of their hips. A tummy that sticks out more, without weight gain, can have the same cause.

3. Losing height

Most people lose a little height with age as the discs between the vertebrae thin. Losing more than expected can point to vertebral fractures. Singapore's clinical guidance lists height loss of more than 2 cm within three years as a risk factor for osteoporosis. Compare your height at your next health screening with an older record, such as a past health screening report.

4. A rounding upper back

A stoop, sometimes called a "dowager's hump", often develops when several vertebrae in the upper back collapse slightly at the front and become wedge-shaped. It tends to come on so slowly that family members notice it in photos before you do.

5. Back pain that starts suddenly

Many spinal fractures from osteoporosis happen with everyday movements: lifting a pail of water, bending to pick up a grandchild, even a hard cough or sneeze. The pain is often sudden, felt in the middle or lower back, and may ease over a few weeks, which is why it's often put down to a pulled muscle. Some spinal fractures cause no pain at all. The guidance advises considering an X-ray to look for spinal fractures in older adults with height loss or back pain.

6. A fracture from a minor fall

This is the clearest warning sign of all. A fragility fracture is a break caused by minimal trauma, such as a fall from standing height or less. Common sites include the wrist, hip, spine, pelvis and upper arm. A broken wrist after slipping on a wet floor, or a hip fracture after tripping at home, should always prompt a bone health check. One fragility fracture significantly raises the risk of another.

7. Breathlessness or feeling full quickly

In more advanced cases, a curved spine reduces the space for the lungs and stomach. Some people notice they get breathless more easily or feel full after small meals. These symptoms have many other causes, so they need a doctor's assessment, but alongside a change in posture they can point to significant spinal changes.

What your ticks mean

Who should be assessed in Singapore

Singapore's national clinical guidance on osteoporosis recommends assessing the need for a bone density scan in people with risk factors, particularly all postmenopausal women and men aged 65 and above. Younger men should also be assessed if they have significant risk factors, such as long-term steroid use. Other risk factors it lists include:

• Early menopause, at age 45 or younger
• A family history of osteoporosis or hip fracture
• A previous fragility fracture, or frequent falls
• Long periods of immobility
• Low body weight, smoking, excess alcohol and low calcium intake
• Medical conditions or medicines that weaken bone

A simple score doctors use for women

For postmenopausal women, doctors in Singapore often start with the Osteoporosis Self-Assessment Tool for Asians (OSTA). It takes seconds:
 

OSTA score = your age in years − your weight in kg
 

A score above 20 is considered high risk, and a bone density (DXA) scan is recommended. A score between 0 and 20 is medium risk, and a scan is considered if you have any other risk factor. Below 0 is low risk. For example, a 68-year-old woman weighing 45 kg has a score of 23, which falls in the high-risk group.
 

OSTA is a starting point, not a diagnosis, and it hasn't been validated in local men. Only a DXA scan can confirm osteoporosis.

Checking your bones at IOC

The earlier osteoporosis is found, the more you can do to prevent the first fracture, or the next one. Treatment, exercise, nutrition and fall prevention all work best before a hip or spine fracture changes your independence.
 

International Orthopaedic Clinic (IOC) offers osteoporosis screening and treatment. Patients are seen by Dr Alan Cheung, a Senior Consultant Orthopaedic Surgeon who trained in London and Sydney, and holds the FRCS in Trauma and Orthopaedics.
 

Ticked one or more signs, or in a higher-risk group? Arrange a bone health check at IOC's clinics at Mount Elizabeth Novena or Farrer Park Hospital. If you're booking for a parent, you're welcome to call on their behalf. Book a bone health check or call +65 6253 7111.
 

This article is for general information and does not replace a medical assessment. The self-check above is not a diagnostic test