People may use the term “end stage osteoporosis” to describe stage 4, or severe, osteoporosis. Stage 4 osteoporosis is associated with significant pain, impaired mobility, and stooped posture.

A person has stage 4 osteoporosis if their bone mineral density score is more than 2.5 standard deviations below the healthy average for a young adult and they have had at least one fracture. People with this type of osteoporosis typically require medications that help reduce bone mineral loss.

They also have a much higher risk of experiencing falls and bone fractures.

Read on to learn more about stage 4 osteoporosis, including its symptoms, causes, and treatment options.

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“End stage” usually refers to the last stage of a disease. However, osteoporosis is not a terminal illness, so doctors do not use this term when discussing it.

They also do not typically use a formal staging system when diagnosing the condition. Instead, they look at bone mineral density numbers to assess how severe the condition is.

These figures and their meaning are as follows:

  • Stage 1: There is no stage 1 osteoporosis. A person with bone mineral density numbers similar to a young person does not have osteoporosis.
  • Stage 2: A person with low bone mass is someone whose bone mineral density is 1–2.5 standard deviations below the healthy adult average. They do not yet have osteoporosis but are at risk of developing it. The medical term for this is osteopenia.
  • Stage 3: This means that a person has osteoporosis and their bone mineral density is more than 2.5 standard deviations below the adult average.
  • Stage 4: Severe osteoporosis means a person has had a fracture and their bone mineral density is more than 2.5 standard deviations below the adult average.

In most cases, doctors will give a diagnosis rather than a disease stage.

Most people with osteoporosis do not have symptoms, even if they have very weak bones.

A broken bone defines the advanced stage of osteoporosis, so a history of bone fractures is a key symptom. In some cases, a person may have other symptoms, such as:

  • changes in posture, gait, or mobility
  • pain
  • frequent unexplained falls
  • multiple bone fractures

Primary osteoporosis occurs when the bones lose bone mineral density, usually as a result of aging. The risk is higher in the following groups:

  • white or Asian people
  • females
  • older adults
  • people who smoke
  • those with a low body mass index
  • people with a family history of osteoporosis

Secondary osteoporosis occurs when a medical condition causes bone mineral density loss. Hyperparathyroidism, some medications, Cushing’s disease, and kidney failure may cause secondary osteoporosis.

People with a bone mineral density score more than 2.5 standard deviations below the healthy average need treatment. The standard treatment for osteoporosis is a group of drugs to reduce bone mineral loss and potentially restore bone mineral density.

This category includes drugs such as:

  • bisphosphonates, which are the standard first-line treatment
  • calcitonin
  • various hormone therapies
  • sclerostin inhibitor
  • rank ligand inhibitor

Lifestyle changes such as the following may reduce the risk of fractures and improve a person’s quality of life:

  • exercising, especially weight bearing exercise and activities to improve balance, such as yoga and weightlifting
  • increasing protein intake
  • asking a doctor about vitamin D and calcium supplements
  • reaching or maintaining a moderate body weight

Having emotional support to make lifestyle changes may also help, especially for people who have been sedentary for a long time. A person should talk with their doctor before making major lifestyle changes, since osteoporosis may affect the safety of certain exercises.

Osteoporosis is not a terminal illness and does not directly influence life expectancy. However, having a fracture can affect it.

For example, a 2021 study found that older adults living in a care facility who experienced a hip fracture had a 25% death rate after 3 months. The death rate during the study period of 1.2 years was 62.1%. Older age and co-occurring health conditions likely affected the participants’ life expectancy.

Although recent studies have not assessed survival rates in people with an osteoporosis diagnosis, a 2015 study did.

Researchers used a Danish population sample and compared 58,637 people with osteoporosis to 225,084 age- and sex-matched controls. They found that people with osteoporosis had an elevated risk of death, especially shortly after diagnosis, because of their increased risk of fractures.

Despite this, survival rates were good when people had osteoporosis treatment.

Men who began treatment at age 50 had a life expectancy of 18.2 years, while the life expectancy for a man beginning treatment at 75 was an average of 7.5 years. For women, the figure was 26.4 years for those beginning treatment at 50 and 13.5 years for those beginning treatment at 75.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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People at risk of osteoporosis should contact a doctor to discuss having a bone mineral density test. Additionally, those who already have an osteoporosis diagnosis should ask their doctor how often they should check their bone mineral density.

A person should also contact a doctor if they:

  • have bone pain
  • develop a stooped posture or mobility issues
  • experience a fracture or broken bone
  • have side effects from osteoporosis medication

End stage osteoporosis is not a medical diagnosis, and doctors do not typically use a formal staging system when diagnosing severe osteoporosis. Instead, they assess bone mineral density and any symptoms a person may have.

While more advanced osteoporosis may increase the fracture risk, staging does not reveal much about the outlook. People with osteoporosis should work with a healthcare professional to determine the right course of treatment and reduce their risk of complications.