Are You Shrinking? What Your Height Says About Your Spine

This article originally appeared in The Neurotransmitter, Dr. Grunch’s weekly newsletter.

“When was your last bone density scan?”

I ask that question in my office all the time, and the answer I get most often is a blank stare. A lot of the people sitting across from me have never had one. Not once. Many of them are well past the age when screening is recommended, and most of them are there to see me because their back hurts.

That drives me a little crazy, because a bone density scan is quick, painless, and one of the most useful tests we have for protecting your health as you get older. It’s also one of the most overlooked. So with World Spine Day yesterday and World Osteoporosis Day on Tuesday, October 20, I want to talk about what thin bones do to your spine, and why I want you to ask about this test at your next checkup.

What Osteoporosis Does to Your Spine

Each bone in your spine, called a vertebra, has a hard outer shell. The inside is spongy bone (trabecular bone), and under a microscope it looks a lot like a honeycomb: thin walls of bone with open spaces in between.

Your body is always tearing down old bone and building new bone. When that balance tips and you lose bone faster than you make it, the walls of that honeycomb get thinner and the holes get bigger. That’s osteoporosis, which literally means “porous bone.” From the outside, the bone looks normal. Inside, there’s a lot less holding you up.

Estrogen helps keep bone building on track, which is why bone loss speeds up after menopause. Testosterone does a similar job for men. Age, genetics, certain medicines, and how active you are all play a role too.

Now picture setting something heavy on a honeycomb with paper-thin walls. Eventually the front edge caves in. That’s a vertebral compression fracture: the front of the bone collapses into a wedge. And with weak enough bone, it doesn’t take a fall or a car accident. A sneeze, a cough, picking up a grandchild, or bending over to grab the laundry basket can be enough.

Who Gets It (Hint: Not Only Women)

About 10 million Americans have osteoporosis, and roughly 44 million more have low bone density, which puts them at higher risk [1]. In a national CDC survey of adults 50 and older, about 1 in 5 women (19.6%) and about 1 in 23 men (4.4%) had osteoporosis, and more than 4 in 10 adults (43.1%) had low bone mass [2].

Over a lifetime, about 1 in 2 women and up to 1 in 4 men over 50 will break a bone because of osteoporosis [1]. Men get it too. They just almost never get tested for it.

Your risk goes up with:

• Age, and for women, the years after menopause
• A parent who broke a hip
• Low body weight
• Smoking or heavy drinking
• Long-term steroid pills like prednisone
• Conditions such as rheumatoid arthritis
• A broken bone from a minor fall as an adult

The Fracture You Didn’t Feel

If you break your hip, you know it. You can’t walk, and you end up in the ER. Spine fractures are sneakier. Only about one-third of them cause enough pain to send someone to a doctor [3]. The rest happen quietly, or the ache gets written off as a pulled muscle or “just arthritis.”

Even when a spine fracture shows up on an X-ray taken for some other reason, it often gets missed. One review found radiology reports missed them in 29% to 46% of cases [3].

This is the part I really want you to hear: one spine fracture is a warning that more may be coming. In a large study of postmenopausal women, about 1 in 5 (19.2%) who had a new spine fracture had another one within a year [4]. You may not have felt the first one, but your spine is telling you something.

The Test Most People Never Get

Here’s what frustrates me. We have a simple test that can find osteoporosis before you ever break a bone, and most people who should have it never do.

It’s called a DXA scan (dual-energy X-ray absorptiometry). You lie on a table for a few minutes while a scanner measures the bone density in your hip and spine. No needles, no prep, and a very small amount of radiation.

Your result comes back as a T-score, which compares your bones to a healthy young adult’s:

• -1.0 or higher: normal
• Between -1.0 and -2.5: low bone mass (osteopenia)
• -2.5 or lower: osteoporosis

A spine or hip fracture from a minor fall can also mean osteoporosis, whatever the number says.

The U.S. Preventive Services Task Force updated its guidance in January 2025 [5]:

• All women 65 and older should be screened.
• Postmenopausal women younger than 65 should be screened if a risk calculator shows they’re at higher risk.
• For men, the task force says there isn’t enough evidence yet to recommend for or against routine screening, so talk it through with your doctor.

Those recommendations have been around for years, and we’re still not following them. A study of more than 1.6 million insured U.S. women found that only about 1 in 4 women ages 65 to 79 had a bone density test in a two-year period [10]. That lines up with what I see in my office every week.

I think there are a few reasons. Bone loss has no symptoms, so nobody comes in asking about it. Annual visits are busy, and a screening test that isn’t urgent is easy to push to “next time.” And a lot of people think osteoporosis is just part of getting older. It doesn’t have to be.

If you’re a woman 65 or older and you’ve never had a DXA scan, ask for one. If you’re younger but have risk factors, ask whether you qualify. And if you’ve lost height, ask whether you need spine imaging too. National guidance recommends it for people who have lost 1.5 inches (4 cm) from their tallest adult height, or about 0.8 inch (2 cm) since a previous measurement [6].

Signs to Watch For

Some spine fractures cause sudden, sharp pain in the mid or low back that’s worse when you stand or walk and better when you lie down. Others don’t hurt at all. Watch for these quieter clues:

• Losing height
• A new or worsening curve in your upper back (sometimes called a “dowager’s hump,” or kyphosis)
• Clothes fitting differently, or your ribs feeling closer to your hips
• Feeling full quickly or short of breath, because a shorter spine leaves less room for your belly and lungs

See a doctor right away if you have back pain plus any of these:

• New weakness, numbness, or tingling in your legs
• Trouble controlling your bladder or bowels, or numbness in your groin or inner thighs
• Fever, chills, or unexplained weight loss
• A history of cancer
• Pain after a real injury, like a car accident or a hard fall
• Pain that wakes you up at night or keeps getting worse

Most compression fractures don’t press on the nerves. These red flags help us catch the ones that do, plus problems that can look like a simple fracture, such as an infection or cancer in the bone.

What Actually Helps

When I see a compression fracture, I’m thinking about two things: helping that fracture heal, and protecting every other bone in your body.

Healing the fracture

Most compression fractures heal on their own in about 6 to 12 weeks. Treatment usually means pain control, staying as active as your pain allows, and sometimes a brace for comfort. Long bed rest works against you, because bone and muscle both get weaker when you don’t use them.

You may have heard of vertebroplasty, where cement is injected into the broken bone through a needle. When researchers compared it with a “sham” procedure (where patients don’t know if cement went in), a 2018 Cochrane review found no meaningful benefit for pain, function, or quality of life [8]. Kyphoplasty, a similar procedure that uses a small balloon first, has fewer sham-controlled studies, and spine specialists still debate who benefits most. These procedures are usually saved for people whose pain isn’t improving with time and conservative care. Open surgery is uncommon and is mainly for fractures that pinch the spinal cord or nerves or make the spine unstable.

Protecting the rest of your skeleton

This is the step that gets skipped. In one study of hospitalized older women with spine fractures, only about a quarter were on osteoporosis treatment [3]. The American College of Physicians recommends bisphosphonates as the first choice for most people [7]. These include pills like alendronate (Fosamax), or a once-a-year IV infusion of zoledronic acid (Reclast). If those aren’t a good fit, denosumab (Prolia), a shot every 6 months, is next. For people at very high risk, like someone who has already had spine fractures, bone-building medicines such as romosozumab (Evenity) or teriparatide (Forteo) may come first [7].

Every medicine has trade-offs. Rare side effects of bone medicines include jaw bone problems and an unusual type of thigh fracture, and your doctor will weigh those against your fracture risk [7]. One important tip: don’t stop denosumab on your own. Stopping it without a plan to switch to another medicine can lead to rapid bone loss.

What You Can Do Starting This Week

Bones respond to how you treat them, at any age. Here’s where I’d start:

1. Ask about a DXA scan. If you’ve never had one and you’re a woman 65 or older, this is step one.
2. Get enough calcium and vitamin D. Women 51 and older and men 71 and older need about 1,200 mg of calcium a day, and men 50 to 70 need about 1,000 mg. Food first, supplements to fill the gap. Most adults 50 and up need about 800 to 1,000 IU of vitamin D a day [6].
3. Lift something. In the LIFTMOR trial, postmenopausal women with low bone mass did supervised, high-intensity strength and impact training twice a week for 8 months. Their spine bone density went up 2.9%, while the comparison group lost 1.2% [9]. That program was closely supervised, so start with a physical therapist or trainer who knows how to work with osteoporosis.
4. Fall-proof your home. Most broken bones start with a fall. Clear the clutter, add grab bars and night lights, get your eyes checked, and ask whether any of your medicines make you dizzy [6].
5. Quit smoking and keep alcohol low. Both speed up bone loss.
6. Measure your height once a year. It’s free, and it’s one of the best early clues that something is going on in your spine.

Questions to bring to your next appointment:

• Have I ever had a bone density scan? If not, should I?
• I’ve lost some height. Should we take a look at my spine?
• Are any of my medicines bad for my bones?
• If I need treatment, which medicine fits me best, and for how long?
• Can you refer me to a physical therapist for safe strength training?

Before You Go

If you take one thing from this issue, let it be this: ask about your bone density at your next visit. It’s one of the easiest tests you’ll ever have, and it can keep you out of my office with a broken back.

And if you’ve noticed your pants getting a little longer, don’t brush it off. Get measured, and tell your doctor.

Key Takeaways

• Osteoporosis thins the inside of your vertebrae, and a spine fracture can happen from something as simple as bending over or coughing.
• About two-thirds of spine fractures never come to a doctor’s attention [3], so height loss and a rounding upper back are clues worth checking.
• One spine fracture raises the risk of another; about 1 in 5 women had a second within a year [4].
• A bone density (DXA) scan is recommended for all women 65 and older [5], but only about 1 in 4 women ages 65 to 79 got one in a two-year period [10]. If you’ve never had one, ask.
• Medicine, strength training, calcium and vitamin D, and fall prevention all lower your risk, and it’s never too late to start.

References

1. Bone Health & Osteoporosis Foundation. Osteoporosis Fast Facts. Accessed October 16, 2026. https://bonehealthandosteoporosis.org/wp-content/uploads/Osteoporosis-Fast-Facts-2.pdf

2. Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017–2018. NCHS Data Brief No. 405. Hyattsville, MD: National Center for Health Statistics; 2021. https://www.cdc.gov/nchs/products/databriefs/db405.htm

3. Lems WF. Clinical relevance of vertebral fractures. Ann Rheum Dis. 2007;66(1):2-4. https://doi.org/10.1136/ard.2006.058313

4. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285(3):320-323. https://doi.org/10.1001/jama.285.3.320

5. US Preventive Services Task Force; Nicholson WK, Silverstein M, Wong JB, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2025;333(6):498-508. https://doi.org/10.1001/jama.2024.27154

6. LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022;33(10):2049-2102. https://doi.org/10.1007/s00198-021-05900-y

7. Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, et al. Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: a living clinical guideline from the American College of Physicians. Ann Intern Med. 2023;176(2):224-238. https://doi.org/10.7326/M22-1034

8. Buchbinder R, Johnston RV, Rischin KJ, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev. 2018;11(11):CD006349. https://doi.org/10.1002/14651858.CD006349.pub4

9. Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211-220. https://doi.org/10.1002/jbmr.3284

10. Gillespie CW, Morin PE. Trends and disparities in osteoporosis screening among women in the United States, 2008-2014. Am J Med. 2017;130(3):306-316. https://doi.org/10.1016/j.amjmed.2016.10.018

Disclaimer: This article is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. If you have symptoms or questions about your own health, please consult your healthcare provider. If you think you are having a medical emergency, call 911.

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