Osteoporosis is a silent disease because it progresses without visible symptoms. There are no symptoms in the early stages. Most people do not know that they have it until a bone breaks. It can be from a fall or something as slight as a bear hug. A sneeze or sudden movement can be enough to break a bone in someone with severe osteoporosis. Later in the disease you can notice kyphosis or a stooped posture. A dowager’s hump becomes apparent. There can be neck or back pain due to fractures or bone tenderness. Loss of height can occur even up to 5 or 6 inches. Reduced bone density can be seen on a DEXA scan. Your clients over 50 have this routinely done to test bone mineral density. A score of –1 to –2.5 standard deviations indicates osteopenia which indicates the beginning of osteoporosis. A standard deviation of more than- 2.5 is considered osteoporosis. This number is called a t score which compares bone density to a 25 year old. This test focuses on the lower spine and hip. Many times osteoporosis begins in middle age as hormone levels change or at an older age associated with a vitamin D deficiency.