Osteoporosis vs. Osteoarthritis: Understanding the Difference

Many patients are surprised to learn that osteoporosis and osteoarthritis are completely different conditions, even though both affect the bones and become more common with age. Knowing the distinction can help you understand your symptoms, guide your treatment options, and protect your long-term bone and joint health.

What Is Osteoporosis?

Osteoporosis is a condition where the bones become weak, fragile, and more likely to break. It develops when the body loses bone faster than it can rebuild it.

Key Features of Osteoporosis

• Silent disease: Usually no symptoms until a fracture occurs

• Common fracture sites: Hip, spine, and wrist

• Risk factors: Aging, menopause, family history, low calcium/vitamin D, certain medications

• Diagnosis: Bone density scan (DEXA)

• Treatment: Medications to strengthen bone, calcium/vitamin D, weight-bearing exercise

How It Feels

Osteoporosis itself does not cause joint pain. Patients often don’t realize they have it until they sustain a fracture or notice loss of height due to vertebral compression.

What Is Osteoarthritis?

Osteoarthritis (OA) is a degenerative joint condition where the cartilage that cushions the joints gradually wears down. It is the most common form of arthritis.

Key Features of Osteoarthritis

• Symptoms: Joint pain, stiffness, swelling, and reduced mobility

• Common locations: Knees, hips, hands, and spine

• Risk factors: Age, prior injury, excess weight, family history, overuse

• Diagnosis: Physical exam + X-rays

• Treatment: Exercise, physical therapy, weight management, injections, medications, and in advanced cases, surgery

How It Feels

Unlike osteoporosis, osteoarthritis does cause pain. Symptoms typically worsen with activity and improve with rest.

How to Tell Them Apart

Feature	Osteoporosis	Osteoarthritis
Main issue	Bone thinning and fragility	Joint cartilage breakdown
Pain?	No, unless a fracture occurs	Yes, especially with use
Typical symptoms	Fractures, height loss	Joint pain, stiffness, swelling
Diagnosis	DEXA scan	X-ray, exam
Treatment focus	Strengthen bone	Reduce pain, improve joint function

Can You Have Both?

Yes. Many people—especially older adults—have both conditions at the same time, but they require different approaches to treatment, which is why it’s so important to distinguish between them.

How to Seek Care

Orthopedic surgeons like myself specialize in the operative and non-operative management of osteoarthritis but we only deal the with end result of osteoporosis (i.e. fractures). Although we are very familiar with the treatments for osteoporosis we don't usually prescribe medications as these meds can have significant interactions with other ongoing medical conditions.

For management of osteoporosis it is best to talk with your primary care doctor about treatment options. For very advanced cases your PCP may actually recommend consultation with an endocrinologist.