Donate to our INSPIRE Foundation

(212) 606-1559


Osteoporosis is a metabolic bone disease that affects people over the age of 50. It reduces bone density, making the bones more prone to breakage. Human bones are living tissue that is in a constant state of renewal — old cells are discarded and replaced, a process known as remodeling. When a person has osteoporosis, the creation of new bone doesn’t keep up with the removal of old bone. As this happens, the bones become less dense and are prone to breaking. As many as 10 million Americans have osteoporosis.

Dr. Girardi uses two minimally invasive surgical procedures to treat osteoporosis patients — kyphoplasty and vertebroplasty.

What Is Osteoporosis?

Osteoporosis is characterized by a decrease in the bone density. When a patient has osteoporosis the bones become abnormally porous; they can become compressible, like a sponge. Bones that are affected by osteoporosis can break with relatively minor injuries or even movements that would never cause a fracture in a healthy person. In an area such as the hips, osteoporosis can lead to cracking of the hipbone — a hip fracture. In the spine, the bone can collapse, such as in a compression fraction of a vertebra.

Osteoporosis-related fractures can occur in almost any bone in the body, but they are most common in the spine, hips, ribs, and wrists.

What Causes Osteoporosis?

It may not seem like it, but our bones are constantly renewing themselves, breaking down old bone cells and producing cells to replace them. This process keeps the bones as strong as possible. When we are young, our body creates new bone faster than it breaks down old bone, so the bone mass increases. In most people, this process peaks in their early 20s. After that, we lose more bone mass than we make. If you were lucky enough to produce more bone mass in your youth, you’re less likely to develop osteoporosis in old age, as you have more bone mass to rely upon.

What Are Some Risk Factors That Increase The Likelihood Of Developing Osteoporosis?

  • Low estrogen levels in women — Bone loss accelerates after menopause, a time when estrogen levels drop quickly. Women in this stage of life have the highest risk of developing osteoporosis. This can also happen in young women who stop menstruating, such as overly thin athletes or girls with anorexia.
  • Low testosterone in men — Men convert testosterone into estrogen, which preserves bone mass. As men age, their testosterone levels drop.
  • Lack of calcium — The bones need calcium to rebuild, but many organs need a constant level of calcium, too. If they don’t have it, the body will steal calcium from the bones.
  • Lack of vitamin D — Vitamin D helps your body absorb and use calcium. Too little leads to weak bones and bone loss.
    Sedentary lifestyle — Bones weaken if they aren’t used. Astronauts in weightless space have been shown to suffer bone mass loss. Weight-bearing exercise, however, helps keep your bone cells turning over.
  • Other causes — Hormone imbalances, thyroid conditions, smoking, taking certain medications, various medical conditions, and too much alcohol consumption can also lead to osteoporosis.

What Are The Symptoms Of Osteoporosis?

The early stages of osteoporosis show no symptoms, but bone loss is progressing. Once the bones have been weakened to a certain degree, you will start to see signs and symptoms such as:

  • Back pain, caused by fractured or collapsed vertebrae
  • Loss of height over time
  • A stooped posture
  • A bone fracture that occurs far too easily

Who Gets Osteoporosis?

Women are much more likely to develop osteoporosis than men. One in three women will develop the condition, while only one in five men will. The older you are the higher your risk. People of white or Asian descent are more likely. If you have a family history, that increases your likelihood. Those with smaller body frames are more likely, as they have less bone mass to draw from as they age.

How Can I Help Prevent Developing Osteoporosis?

Lifestyle changes can be the most effective means to never developing osteoporosis. These healthy habits will keep your bones healthier.

  • Protein. Protein is a building block of bone. Vegetarians and some older adults may not get enough protein in their diet, which increases risk for osteoporosis.
  • Exercise. Your bones and muscles love exercise. Weight-bearing exercises, such as walking, jogging, playing tennis, and dancing are great. Three or four times a week is best. As you get older, incorporating strength and balance exercises will help you avoid falls.
  • Calcium. Since women have a higher risk of developing osteoporosis, studies have shown that 1,000 milligrams of calcium is a good daily target for women prior to menopause, 1,200 milligrams a day after menopause. Eat calcium-rich foods such as milk and dairy products, and dark, leafy vegetables. Or you can add a calcium supplement, but there are risks involved.
  • Vitamin D. Without vitamin D your body can’t absorb calcium. Being out in the sun triggers vitamin D production in your body. You can also get vitamin D from eggs, fatty fish, milk, and supplements.
  • Weight. Maintaining the proper body weight is important for your bones, as well as your general health. Excess weight increases your risk for arm and wrist fractures. Being underweight increases your chances of bone loss and fractures. Stay at your ideal weight to help prevent bone loss.

Osteoporosis and Metabolic Bone Health

Metabolic bone disease refers to abnormalities in bones caused by a broad spectrum of disorders. Conditions that are often considered metabolic bone disorders include osteoporosis, osteomalacia, rickets, hypophosphatemia, and Paget’s disease. Most commonly, these disorders are caused by abnormalities of minerals such as calcium, phosphorus or vitamin D. Some of these disorders have a genetic basis. The HSS Osteoporosis and Metabolic Bone Health Center cares for patients with these types of disorders and consists of physicians and nurse practitioners in the fields of orthopedics, endocrinology, rheumatology and women’s health.

In addition to the standard bone density test, our center can perform trabecular bone score, body composition, vertebral fracture assessment and atypical femoral fracture assessment bone scan. HSS is the only facility in the state of New York that is certified by the International Society for Clinical Densitometry (ISCD). All scans are performed by dedicated, certified full-time DXA technologists. Patients can meet with a nurse practitioner to review test results and discuss a treatment plan that may include calcium, vitamin D and exercise program and perhaps medication.

How Does Dr. Girardi Treat Osteoporosis?

As an orthopedic surgeon, Dr. Girardi comes into the treatment of osteoporosis when conservative treatments have failed to help the patient. He uses two procedures specifically for osteoporosis patients, kyphoplasty and vertebroplasty.


Dr. Girardi makes a tiny incision in the back and then inserts a small tube. The tube is guided into position and then a hollow needle with a balloon on the end is inserted into the vertebra. Dr. Girardi slowly inflates the balloon, which returns the fractured pieces to a more appropriate position, relieving pain and creating a cavity. The balloon is removed and then the cavity is filled with bone cement. This returns strength and elevation to the vertebra in question.


Like kyphoplasty, vertebroplasty involves the injection of bone cement into the collapsed vertebra. But in vertebroplasty, there is no prior manipulation of the vertebra with the balloon. Instead, using fluoroscopy for guidance, Dr. Girardi inserts a hollow needle through the back and into position. Then bone cement is injected directly into the fractured or collapsed vertebra through the needle. The cement mixture will fuse fragments, strengthen the vertebra, and provide pain relief.

What Are The Risks Of These Procedures?

These are low-risk, minimally invasive procedures. They do not involve surgical incisions, but use a small puncture that usually doesn’t require a stitch to close. There are risks, but there are low:

  • A small amount of orthopedic cement can leak out of the vertebra. This doesn’t usually cause a problem, unless it moves to a potentially dangerous location.
  • There is a risk of infection, bleeding, increased back pain, and symptoms such as numbness or tingling.
  • Approximately 10 percent of patients may develop additional compression fractures after these procedures.

What Happens If I Don’t Treat My Osteoporosis?

Osteoporosis will not correct itself. Once the process of bone deterioration has begun, intervention is needed to at least stem the tide. Otherwise, you face a future of crippling bone damage. Innocuous actions such as a sneeze suddenly become dangerous as they can fracture a vertebra. You will become more and more hunched over and will begin to shuffle rather than walk. As your bones basically disintegrate, you will become more and more sedentary until you will end up fully bed ridden and needing a wheel chair to get around.

At a Glance

Dr. Federico Girardi MD

  • Triple fellowship-trained spinal surgeon
  • Performs over 400 spinal surgeries per year
  • Professor of orthopedic surgery at Cornell University
  • Learn more

End of content dots