Osteoporosis is a condition that weakens bones, making them fragile and more likely to break.
It’s a fairly common condition that affects around millions of people in the world. More than 300,000 people receive hospital treatment for fragility fractures (fractures that occur from standing height or less) every year as a result of osteoporosis.
Wrist fractures, hip fractures and fractures of the vertebrae (bones in the spine) are the most common type of breaks that affect people with osteoporosis. However, they can also occur in other bones, such as in the arm, ribs or pelvis.
There are usually no warnings you’ve developed osteoporosis and it’s often only diagnosed when a bone is fractured after even minor falls.
What causes Osteoporosis?
During childhood, bones grow and repair very quickly, but this process slows as you get older.
Bones stop growing in length between the ages of 16 and 18, but continue to increase in density until you’re in your late 20s.
You gradually start to lose bone density from about 35 years of age. Women lose bone rapidly in the first few years after the menopause (when monthly periods stop and the ovaries stop producing an egg).
Losing bone is a normal part of the ageing process, but for some people it can lead to osteoporosis and an increased risk of fractures.
Other factors that increase your risk of developing osteoporosis include:
- inflammatory conditions, such as rheumatoid arthritis, Crohn’s disease and chronic obstructive pulmonary disorder (COPD)
- conditions that affect the hormone-producing glands, such as an overactive thyroid gland (hyperthyroidism) or an overactive parathyroid gland (hyperparathyroidism)
- a family history of osteoporosis, particularly history of a hip fracture in a parent
- long-term use of certain medications that affect bone strength or hormone levels, such as oral prednisolone
- malabsorption problems
- heavy drinking and smoking
Osteoporosis is often diagnosed after weakened bones have led to a fracture.
If you’re at risk of developing osteoporosis, your GP may refer you for a bone mineral density scan, known as a dual energy X-ray absorptiometry (DEXA, or DXA) scan.
Normal X-rays are a useful way of identifying fractures, but they aren’t a reliable method of measuring bone density.
DEXA (DXA) scan
A DEXA scan can be used to help diagnose osteoporosis. It’s a quick, safe and painless procedure that usually takes about five minutes, depending on the part of the body being scanned.
The scan measures your bone mineral density and compares it to the bone mineral density of a healthy young adult and someone who’s the same age and sex as you.
The difference between the density of your bones and that of a healthy young adult is calculated as a standard deviation (SD) and is called a T score.
Standard deviation is a measure of variability based on an average or expected value. A T score of:
- above -1 SD is normal
- between -1 and -2.5 SD is defined as decreased bone mineral density compared with peak bone mass
- below -2.5 is defined as osteoporosis
Although a bone density scan can help diagnose osteoporosis, your bone mineral density result isn’t the only factor that determines your risk of fracturing a bone.
Your age, sex and any previous injuries will need to be taken into consideration before deciding whether you need treatment for osteoporosis.
Your doctor can help you take positive steps to improve your bone health. If you need treatment, they can also suggest the safest and most effective treatment plan for you.
The FRAX tool
The World Health Organization (WHO) has developed a 10-year Fracture Risk Assessment Tool to help predict a person’s risk of fracture between the ages of 40 and 90.
The tool is based on bone mineral density and other relevant risk factors, such as age and sex.
The algorithms used give a 10-year probability of hip fracture and a 10-year probability of a major fracture in the spine, hip, shoulder or forearm.
Symptoms of Osteoporosis
Osteoporosis develops slowly over several years.
There are often no warning signs or symptoms until a minor fall or a sudden impact causes a bone fracture.
Healthy bones should be able to withstand a fall from standing height, so a bone that breaks in these circumstances is known as a fragility fracture.
The most common injuries in people with osteoporosis are:
- wrist fractures
- hip fractures
- fractures of the spinal bones (vertebrae)
Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine.
In older people, a fractured bone can be serious and result in long-term disability. For example, a hip fracture may lead to long-term mobility problems.
Although a fracture is the first sign of osteoporosis, some older people develop the characteristic stooping (bent forward). It happens when the bones in the spine have fractured, making it difficult to support the weight of the body.
Is Osteoporosis painful?
Osteoporosis isn’t usually painful until it causes a fracture.
Although not always painful, spinal fractures are the most common cause of long-term (chronic) pain associated with osteoporosis.
Treatment for osteoporosis is based on treating and preventing fractures and using medication to strengthen bones. Acupuncture and Reflexology can also be used to correct certain aspects of the bone.
The decision about what treatment you have – if any – will depend on your risk of fracture. This will be based on a number of factors, such as your age and the results of your DXA scan.
Your genes are responsible for determining your height and the strength of your skeleton, but lifestyle factors such as diet and exercise influence how healthy your bones are.
Regular exercise is essential. Adults aged 19 to 64 should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week.
Weight-bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis.
As well as aerobic exercise, adults aged 19 to 64 should also do muscle-strengthening activities on two or more days a week by working all the major muscle groups, including the legs, hips, back, abdomen, chest, shoulders and arms.
If you’ve been diagnosed with osteoporosis, it’s a good idea to talk to your GP or health specialist before starting a new exercise programme to make sure it’s right for you.
Weight-bearing exercises are exercises where your feet and legs support your weight. High-impact weight-bearing exercises, such as running, skipping, dancing, aerobics, and even jumping up and down on the spot, are all useful ways to strengthen your muscles, ligaments and joints.
When exercising, wear footwear that provides your ankles and feet with adequate support, such as trainers or walking boots.
Read more about choosing sports shoes and trainers.
People over the age of 60 can also benefit from regular weight-bearing exercise. This can include brisk walking, keep-fit classes or a game of tennis. Swimming and cycling aren’t weight-bearing exercises, however.
Resistance exercises use muscle strength, where the action of the tendons pulling on the bones boosts bone strength. Examples include press-ups, weightlifting or using weight equipment at a gym.
If you’ve recently joined a gym or haven’t been for a while, your gym will probably offer you an induction. This involves being shown how to use the equipment and having exercise techniques recommended to you.
Always ask an instructor for help if you’re not sure how to use a piece of gym equipment or how to do a particular exercise.
Eating a healthy balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease, diabetes and many forms of cancer, as well as osteoporosis.
Calcium is important for maintaining strong bones. Adults need 700mg a day, which you should be able to get from your daily diet. Calcium-rich foods include leafy green vegetables, dried fruit, tofu and yoghurt.
Vitamin D is also important for healthy bones and teeth because it helps your body absorb calcium. Vitamin D can be found in eggs, milk and oily fish.
However, most vitamin D is made in the skin in response to sunlight. Short exposure to sunlight without wearing sunscreen (10 minutes twice a day) throughout the summer should provide you with enough vitamin D for the whole year.
Certain groups of people may be at risk of not getting enough vitamin D. These include:
- people who are housebound or particularly frail
- people with a poor diet
- people who keep covered up in sunlight because they wear total sun block or adhere to a certain dress code
- women who are pregnant or breastfeeding
If you’re at risk of not getting enough vitamin D through your diet or lifestyle, you can take a vitamin D supplement. For adults, 10 micrograms a day of vitamin D is recommended.
The recommended amount for children is 7 micrograms for babies under six months, and 8.5 micrograms for children aged six months to three years.
Other lifestyle factors that can help prevent osteoporosis include:
- quitting smoking – smoking is associated with an increased risk of osteoporosis
- limiting your alcohol intake – the recommended daily limit is 3-4 units of alcohol for men and 2-3 units for women; it’s also important to avoid binge drinking
Living with osteoporosis
Having osteoporosis doesn’t mean you’ll definitely have a fracture.
There are measures you can take to reduce your risk of a fall or break.
Making some simple changes at home can help reduce the risk of fracturing or breaking a bone in a fall.
Check your home for hazards you may trip over, such as trailing wires. Make sure rugs and carpets are secure, and keep rubber mats by the sink and in the bath to prevent slipping.
Have regular sight tests and hearing tests. Some older people may need to wear special protectors over their hips to cushion a fall. Your GP can offer help and advice about changes to your lifestyle.
Healthy eating and exercise
Regular exercise and a healthy diet are important for everyone, not just people with osteoporosis. They can help prevent many serious conditions, including heart disease and many forms of cancer.
You should ensure you have a balanced diet that contains all the food groups to give your body the nutrition it needs. Exercising regularly can increase bone strength, relieve stress and reduce fatigue.