What’s the difference between osteoporosis and osteoarthritis?

An estimated 50 million Americans live with chronic pain, and as many as 1 in 5 adults live with some type of arthritis, according to federal data. For many, osteoporosis and osteoarthritis are to blame.

Orthopaedic experts from the University of Chicago Medicine explained more about these conditions, their distinguishing factors and what people can do to help prevent them.

What is osteoporosis?

Osteoporosis — or loss of bone — is a highly prevalent disease, particularly in older people. This disease causes bones to become fragile and to break more easily.

It is considered a "silent" disease because it often goes undetected unless someone is screened preventatively (or, more commonly, after suffering a fracture or injury).

Osteoporosis diagnoses have grown exponentially over the last several decades, and they are expected to continue increasing. This is partly due to better screening and diagnostic tools, as well as medical advancements and longer life expectancies.

“Thousands of years ago, we weren't living into our 80s, so osteoporosis is really a condition of the modern age," said Mary Kay Erdman, MD, an orthopaedic surgeon at UChicago Medicine. "We’re now aging to the point where we're wearing out our skeletal systems.”

Osteoporosis risk factors and diagnosis

Osteoporosis is a disorder of bone metabolism, and it doesn’t typically have symptoms. Often, a fracture or a broken bone is the first sign of osteoporosis before any of the following risk factors are present:

• Estrogen deficiency from early menopause or no period for a long time
• History of bone fracture as an adult
• Family history of osteoporosis or bone fracture
• Small, thin frame and/or low body weight
• Low levels of calcium, vitamin D
• Lack of exercise
• Cigarette smoking, excessive alcohol intake
• Medical problems that contribute to bone loss — including thyroid and parathyroid conditions, digestive problems, eating disorders, kidney disease, rheumatoid arthritis, asthma, cancer and paralysis
• Use of certain medications that weaken bones
• Overuse of thyroid hormone, blood thinners, anticonvulsants and diuretics

DXA scans are one important tool for diagnosing osteoporosis early. Quick and painless, these screenings are similar to getting an X-ray. Your physician will receive a report with a score comparing your bone density to other healthy adults in your age range. A score below a certain threshold means you have osteoporosis.

“The same way you get routine mammograms and colonoscopies, you should also get a DXA scan,” Erdman said. “Ideally, what happens is you get routine screening with your primary care doctor, it gets diagnosed early, and you get started on appropriate medical treatment before you suffer a catastrophic injury.”

The U.S. Preventive Service Task Force recommends routine bone scans for women 65 and older, as well as postmenopausal women who are younger than 65 but at increased risk of osteoporosis.

While there are no current recommendations for men, several professional associations such as the American Orthopedic Association suggest earlier screening can be beneficial for many.

Osteoarthritis vs osteoporosis: How are they different?

Osteoarthritis is a degenerative joint disease that primarily impacts the cartilage in your joints.

Unlike osteoporosis, osteoarthritis is an inflammatory condition and the symptoms don’t hide. Osteoarthritis causes the cartilage cap at the end of bones to wear away, causing painful bone-on-bone friction in a person's joints.

Causes of osteoarthritis include genetic factors, acute injury or fracture, or even infection. Post-traumatic osteoarthritis can also begin after a joint injury — even one that happened many years ago.

An unhealed injury "can leave the integrity of the joint impaired at some level, which can then cause the cartilage within that joint to degenerate at a higher rate over time than it would have if they hadn’t injured it at all,” said Sara Shippee Wallace, MD, MPH, an orthopaedic surgeon at UChicago Medicine.

“Like with most orthopedic issues, prevention is key to long-term health.”

Treatment options for osteoarthritis

Osteoarthritis can’t be cured — only managed. But there are many treatment options, depending on the severity of the condition and how it’s impacting the patient’s daily life.

Early treatment typically begins with activity modification, physical therapy, and/or the use of anti-inflammatories like Ibuprofen or Motrin. If those interventions aren’t adequate, some people may try steroid injections into the joint.

If a patient has moved through these early interventions and is still having significant problems with day-to-day pain and functionality, it’s often time to consider joint replacement surgery.

Erdman said the planning stage for joint replacement surgery also offers a good opportunity to catch and diagnose osteoporosis, which can lead to better long-term outcomes for the patient and allow them to take steps to strengthen their overall bone health.

Ways to improve your bone and joint health

“The biggest thing patients can do to prevent arthritis or to slow the progression of arthritis is to keep their weight down at a healthy level,” Erdman said. “When you gain significant weight, that additional stress to the joint is magnified.”

Exercise is beneficial for patients with osteoarthritis and good for cartilage, but the type of exercise may depend on the severity of your condition and it should be discussed with your physician. Weight-bearing exercise is also good for bone density and bone health, which can help prevent osteoporosis.

"Bones respond to stress, so the more you exercise and stay fit, the stronger your bones will be,” Wallace said.

Other key steps include quitting smoking and eating a well-balanced diet. For patients with osteoarthritis, an anti-inflammatory diet can help lessen symptoms, as can adding more plant-based meals into your routine. And for all patients, make sure your diet has adequate amounts of calcium and Vitamin D.

“Vitamin D is an issue in our area, because it’s Chicago and it's not sunny all that much," Erdman said. "But Vitamin D and calcium have to go together because you don’t absorb one without the other.”

The biggest thing you can do? Prevent falls and injury.

Falls are a significant cause of visits to emergency departments, and they can be especially dangerous to older folks. Assess tripping hazards in your home, such as loose carpets and exposed cords. Wear clean glasses and well-fitting shoes, and get regular vision checks.

It’s also important to ask for help. “We see a lot of patients who haven't progressed to using a cane or a walker when maybe they should have," Erdman said. “I see people who use banisters or the back of furniture to get around their homes but then they break a hip and suffer unnecessarily.”