Is a Healthy Sex Life Possible Post-Osteoporosis Diagnosis?

Osteoporosis, a condition in which significant bone density loss can cause an increased risk of fractures, can afflict anyone at any age—but it doesn't have to affect your love life.

A bone fracture is serious business and may be a warning sign of osteoporosis, but experts say it shouldn't shatter your confidence in the bedroom.

What is osteoporosis?

Approximately 10 million Americans have osteoporosis and another 44 million people are estimated to have bone density loss that may place them at a greater risk of fractures, according to the nonprofit Bone Health & Osteoporosis Foundation (BHOF).

Bone loss may need to be discussed with your sexual partner, but it shouldn't hinder either partner's enjoyment in the bedroom. Sexual health experts say something as simple as the addition of a few supportive pillows can make erotic activities more comfortable for everyone involved.

Why osteoporosis is not your grandmother's illness

Osteoporosis can be mischaracterized, to the detriment of the patient, as an illness that only afflicts older adults. That notion is simply not true, said Andrea Singer, M.D., the chief medical officer of Bone Health & Osteoporosis Foundation in Arlington, Virginia.

"This is not just your grandmother's disease," Singer said. "This isn't a disease of little old women."

The "little old ladies" misconception may keep younger individuals at higher risk of developing the disease from seeking preventive treatment and medical help.

"We obviously need to be conscious of bone health throughout the lifespan," Singer said. "There are changes to all of our organ systems, including bone, that happen with increasing age, but it is not an inevitability that somebody is going to develop osteoporosis and fracture. So we ought to be thinking about prevention and treatment."

'It's never too late to take steps, and it's never too late to treat.'

Unfortunately, individuals with low bone density often go untreated and undiagnosed until they experience their first fracture.

"Osteoporosis is commonly called the 'silent disease' because breaking a bone is often the first sign you have osteoporosis," Singer said.

Endocrinologist Keta Pandit, M.D., a board-certified internal medicine specialist with Texas Diabetes and Endocrinology, in Austin, also called the illness a silent disease. One of the most common myths she encounters is the idea that osteoporosis makes itself known to afflicted patients via painful symptoms.

"(Osteoporosis) does not present with any pain unless there is a fracture of a bone deformity that comes from a previous history of fracture," Pandit said.

Who's at risk of getting osteoporosis?

Bone loss can occur at any age, to any gender, at any time, but certain genetic and lifestyle factors increase the chances of getting osteoporosis. Regardless of whether a risk factor is genetic or controllable, medical experts say knowing your bone density, and your risk factors for bone loss, is crucial to having healthy bones in later life.

"It's never too late to do something [about bone loss]," Singer said. "It's never too late to take steps, and it's never too late to treat. I think those are important concepts. Can you replace what's been lost? It depends on the reasons for the [bone] loss, in part."

Bone loss can occur for a number of reasons. Some medications can induce osteoporosis-related bone density loss, a 2014 study suggested.

Genetic and other high-risk factors for osteoporosis may include:

• Age, especially being age 50 or older
• Biology, specifically being female
• Menopause
• A low body weight
• Broken bones or height loss
• A family history of osteoporosis

Peak bone mass typically occurs around the age of 25 to 30, but what happens after that depends on the genetics and lifestyle habits of the individual.

Some behaviors increase the risk of osteoporosis. People at a higher risk of getting an osteoporosis diagnosis earlier than their peers include those who:

• Smoke
• Don't exercise
• Use steroids
• Drink alcohol daily
• Have a vitamin D deficiency
• Have a calcium deficiency
• Consume a diet rich in sodium or caffeine

"If you're healthy and you don't drink too much alcohol and smoke, and you eat well and you exercise, you can maintain your bone mass, whatever that may be your destiny genetically," said Risa Kagan, M.D., an OB-GYN and a clinical professor of obstetrics and gynecology at the University of California, San Francisco.

Kagan advises women and men to get a bone density test sooner rather than later in life.

"If you have a T-score that's less than or equal to minus 2.5 standard deviations below the mean of a young adult, that's the definition of osteoporosis," she said.

No matter the additional risk factors, BHOF and the U.S. Preventive Services Task Force recommend women ages 65 and older, and men over 70, screen for osteoporosis. Men and women with additional osteoporosis risk factors may be eligible for a bone density scan for the illness as early as 50.

How can you make sex safer if you have osteoporosis?

Safe, orgasmic experiences can be achieved post-osteoporosis diagnosis with a few accommodations.

"Sexual pleasure sometimes is on the bottom of the list when somebody's anxious or having chronic pain," Kagan said. "But you can continue with sexual activity."

Sexual health experts, including Kagan, encourage patients to talk to their partners about sexual anxieties surrounding osteoporosis, or anything else, before the big event so you're on the same page.

"If you're a woman and you have osteoporosis, whether you have a fracture or not, you don't want your 200-pound spouse on top of you, whether it's a woman or a man," Kagan said.

No matter the ailment, osteoporosis patients need to openly communicate their sexual needs with their partner.

Sexual positions that provide the osteoporosis-afflicted partner the most control—whether on top or spooning side-by-side—are surefire ways to keep it spicy and take out the pain factor in the bedroom.

"When women are on top, they have more control. They basically aren't afraid that someone's gonna crush their bones," Kagan said.

If the bone-crushing anxiety persists, she said sexual partners with osteoporosis can always lean on the power of nonpenetrative sexual activities.

"Don't forget there's outercourse, as I call it, or other ways of stimulating each other," Kagan said, adding that sex toys such as vibrators can be a welcome addition for male and female partners.

Pillows properly placed to protect the hips or provide support to weaker areas of the body, Kagan said, can make sexual positions more pleasurable for a partner with bone density concerns.

The bottom line

"We do encourage continuation of sexual activity when people have a diagnosis of osteoporosis," Kagan said. "The benefits outweigh any risk."

No matter the ailment, Singer said her most important recommendation for osteoporosis patients is to openly communicate their sexual needs with their partner.

"It's possible to have a satisfying sex life with osteoporosis—if you are careful," she said. "Don't be afraid to try different positions until you find one that is comfortable for both of you."