Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a minor fall or sudden impact causes a bone fracture.
The most common injuries in people with osteoporosis are:
- wrist fractures
- hip fractures
- fractures of the spinal bones (vertebrae)
However, they can also occur in other bones, such as in the arm or pelvis. Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine.
Osteoporosis isn't usually painful until a fracture occurs, but spinal fractures are a common cause of long-term (chronic) pain.
Although a fracture is the first sign of osteoporosis, some older people develop the characteristic stooped (bent forward) posture. It happens when the bones in the spine have fractured, making it difficult to support the weight of the body.
Osteoporosis affects over three million people in the UK.
More than 500,000 people receive hospital treatment for fragility fractures (fractures that occur from standing height or less) every year as a result of osteoporosis.
Causes of osteoporosis
Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures.
Women also lose bone rapidly in the first few years after the menopause (when monthly periods stop and the ovaries stop producing an egg). Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45).
Many other factors can also increase the risk of developing osteoporosis, including:
- long-term use of high-dose oral corticosteroids
- other medical conditions – such as inflammatory conditions, hormone-related conditions, or malabsorption problems
- a family history of osteoporosis – particularly history of a hip fracture in a parent
- long-term use of certain medications which can affect bone strength or hormone levels
- having a low body mass index (BMI)
- heavy drinking and smoking
Risk assessment tools
If your doctor suspects you have osteoporosis, they can make an assessment using an online programme, such as FRAX or Q-Fracture.
These tools help to predict a person's risk of fracture between the ages of 40 and 90. 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.
They may also refer you for a DEXA (DXA) scan to measure your bone mineral density. It's a short, painless procedure that takes about five minutes, depending on the part of the body being scanned.
Your bone mineral density can be compared to the bone mineral density of a healthy young adult and someone who's the same age and sex as you. The difference 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
You may be diagnosed with osteopenia if bone density tests show you have decreased bone density, but not enough to be classed as osteoporosis.
Your doctor may still recommend some of the treatments described below, depending on your results and your risk of fracture.
Treatment for osteoporosis is based on treating and preventing fractures, and using medication to strengthen bones.
The decision about whether you need treatment depends on your risk of fracture. This will be based on a number of factors such as your age, sex and the results of your DEXA scan.
If you need treatment, your doctor can suggest the safest and most effective treatment plan for you.
If you're at risk of developing osteoporosis, you should take steps to help keep your bones healthy. This may include:
- taking regular exercise
- healthy eating – including foods rich in calcium and vitamin D
- taking a daily supplement containing 10 micrograms (mcg) of vitamin D
- making lifestyle changes – such as giving up smoking and reducing your alcohol consumption
Living with osteoporosis
If you're diagnosed with osteoporosis, there are steps you can take to reduce your chances of a fall, such as removing hazards from your home and having regular sight tests and hearing tests.
To help you recover from a fracture, you can try using:
- hot and cold treatments such as warm baths and cold packs
- transcutaneous electrical nerve stimulation (TENS) – where a small battery-operated device is used to stimulate the nerves and reduce pain
- relaxation techniques
Speak to your GP or nurse if you're worried about living with a long-term condition. They may be able to answer any questions you have.
You may also find it helpful to talk to a trained counsellor or psychologist, or other people with the condition.
The National Osteoporosis Society can put you in touch with local support groups, and they also have an online discussion forum.
Osteoporosis often affects women, particularly after the menopause (when monthly periods stop). However, it can also sometimes affect men, younger women and children.
Other groups who are at risk of developing osteoporosis include:
- people who have been taking steroid medication for more than three months
- women who have had their ovaries removed
- people with a family history of osteoporosis
- people with an eating disorder, such as anorexia or bulimia
- people who don't exercise regularly
- people who smoke or drink heavily