You can't see or feel your bones getting thinner, and you may only become aware of the condition when you fracture a bone. However, osteoporosis weakens the bones in your back (vertebrae), so some signs to look out for include back pain, your spine becoming curved and any reduction in your height.
Osteoporosis is often diagnosed in hospital, possibly after a fall or bone fracture.
If you have had a fracture or your GP thinks you may be at risk of osteoporosis, he or she may suggest measuring your bone density using a DXA scan. (dual X-ray absorptiometry scan). The scan is painless and takes 10 to 20 minutes. Osteoporosis is diagnosed if your bone density is found to be lower than average. If your bone density is slightly lower than average, it's known as osteopenia.
You may also have other tests, such as blood and urine tests, an X-ray or an ultrasound scan. These are to rule out other conditions or to help your GP understand what is happening with your bones.
Your GP may prescribe the following medicines to increase your bone density. Ask your GP for information and advice about which treatments are available and suitable for you.
- Bisphosphonates – these work by slowing down bone loss. Examples include alendronate (eg Fosamax), etidronate (eg Didronel), risedronate (eg Actonel) and zoledronate (eg Aclasta).
- Strontium ranelate (eg Protelos) – as well as reducing bone loss, this stimulates new bone to grow.
- Calcitonin (eg Miacalcic) – this is a hormone usually made by the thyroid gland that causes less bone to be broken down.
- Medicines that affect the action of your parathyroid gland – parathyroid hormone (eg Preotact) and teriparatide (eg Forsteo) help to increase calcium levels and the activity of bone-producing cells.
- Raloxifene (eg Evista) – this is an artificial hormone that works by copying the effects of oestrogen on your bones.
- Hormone replacement therapy (HRT) – this relieves symptoms of the menopause by restoring hormones to a pre-menopausal level. HRT has also been shown to reduce osteoporosis, so you may be offered it to treat the condition.
- Denosumab (Prolia) – this is a biological treatment that works by blocking the formation of the cells that break down bone.
For men whose osteoporosis is caused by hypogonadism, your GP may prescribe testosterone replacement therapy.
Always ask your GP for advice and read the patient information leaflet that comes with your medicine.
Healthy bone consists of a strong mesh made of protein and minerals (particularly calcium) surrounded by a thick outer layer. This mesh is living tissue that is constantly being renewed by two types of cells. One type of cell (osteoblasts) builds up new bone and the other (osteoclasts) breaks down old bone. Although your bones don’t increase in length after the age of about 18, they continue to strengthen up until your mid-20s. After about the age of 35, your bones gradually lose their density as a natural part of ageing. This happens slowly at first, but the rate increases in women after they have been through the menopause.
Although the genes you inherit from your parents play an important role in how healthy your bones are, there are other factors that can affect your risk of osteoporosis.
- Gender – women in their late 40s and early 50s start to go through the menopause. This means they lose the protective effects of the hormone oestrogen and have a higher risk of developing osteoporosis.
- Race – Caucasian or Asian races are at greater risk than African-Caribbean people.
- Total hysterectomy – women who have their uterus (womb) and ovaries removed before the age of 45 are at an increased risk of osteoporosis.
- Previous bone injury – bone fractures make the bone weaker so affected bones lose their density more quickly.
- Long-term immobility – bones and muscles become weak if your body isn't active and using them regularly.
- Weight – if you're underweight, your body won't have the essential nutrients it needs to repair bones and keep them strong.
- Poor diet – low levels of vitamin D or calcium mean your body can't repair bones and keep them strong.
Some medicines and health conditions can increase your risk of osteoporosis.
- Long-term use of corticosteroids – used to treat severe allergies or inflammation.
- Aromatase inhibitors – used in breast cancer treatment.
- An overactive thyroid gland – such as hyperthyroidism or hyperparathyroidism.
- Rheumatoid arthritis – this is when your immune cells attack your joints and cause inflammation.
- A low level of testosterone in men – this can be caused by decreased function of the testicles (hypogonadism) or as a result of treatment for prostate cancer.
- Digestive disorders – for example Crohn's disease or any other condition that decreases absorption from your digestive system.
If you have osteoporosis, you’re more likely to fracture bones in your wrists, hip and back. Hip fractures are a particular problem for older women – they are usually a result of tripping or falling. However, you can fracture any bone in your body. This may result in pain, disability and loss of independence.
Making some changes to your lifestyle could help to reduce your risk of developing osteoporosis. A healthy diet and regular exercise can increase bone mass, especially in younger people whose bones are still growing.
High-impact exercise, where you support your own weight, is best for strengthening bones and encouraging bones to grow. This type of exercise includes jogging, tennis, dancing and brisk walking. Try also to include some strengthening activity, such as yoga or t’ai chi, as this can help to improve your balance and muscle strength. If you aren't used to exercising, talk to your GP before you start and build up your exercise routine gradually.
Smoking can have a harmful effect on your bone strength and can also cause an early menopause in women. If you smoke, try to give up. Also be careful not to drink too much alcohol.
It’s important to eat a diet that is rich in calcium to maintain healthy bones. Adults should aim to have 700mg of calcium every day, which you should be able to get through healthy eating. Good sources of calcium include milk and dairy products, such as cheese and yoghurt, dried figs or apricots, oily fish, such as sardines, and some green leafy vegetables, such as broccoli and cabbage. See our frequently asked questions for more information.
Making sure you get enough vitamin D is also important for bone health as your body needs this to absorb calcium properly. Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, don’t let your skin redden. If you don’t get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.
Always read the patient information leaflet that comes with your supplements and if you’re pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you’re taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.
If you have osteoporosis, you need to be careful of vigorous, high-impact exercise, such as running. However, leading an active lifestyle will improve your balance, co-ordination and develop muscle strength. This can reduce your risk of falling and fracturing a bone. Doing regular exercise is also good for your heart and your blood pressure. Beneficial exercise includes swimming, gardening, walking, golf and tai chi.
Aim to get 1,000 to 1,200mg of calcium every day, either in your diet or as a supplement. You can buy calcium tablets at a chemist, but always speak to your GP before taking supplements as your body can only cope with a certain amount of calcium – if you take too much, you may develop kidney stones or other complications. See our frequently asked questions for more information.
If you have a fracture, you may wish to take medicines for pain-relief. Over-the-counter painkillers such as paracetamol or ibuprofen may help with this. Always read the patient information leaflet that comes with your medicine. See our frequently asked questions for more information.
Physiotherapy, hydrotherapy (exercise in water), TENS (transcutaneous electrical nerve stimulation) and alternative therapies, such as acupuncture or aromatherapy, may also help. Always speak to your GP or pharmacist for advice before any treatment.
How can I deal with the pain from a broken bone in my back caused by osteoporosis?
Talk to your GP about pain relief for osteoporotic fractures. It's important to explore all the options until you find something that helps you.
About half of all women with osteoporosis will break (fracture) a bone. Men can also fracture bones as a result of osteoporosis, but it’s about six times more likely if you’re a woman. The most common fracture caused by osteoporosis is called an osteoporotic vertebral compression fracture. This is when pressure on weakened bones in your spine (vertebrae) causes them to crack and fracture.
You may or may not feel any immediate pain when the fracture occurs. However, if you do have pain, it can be very severe. You may also have chronic pain even after your bone has healed. Chronic means that it lasts a long time, sometimes for the rest of your life. The term chronic refers to how long you have it, not to how serious it is. Ongoing pain after a fracture can affect your quality of life.
Your GP is likely to suggest trying either over-the-counter or stronger, prescription painkillers. You may also be recommended a short period of bed rest. However, if these don't help control your pain, there are other options to consider. Some examples are listed below.
- Other medicines such as calcitonin may help to control your pain.
- You may find that physiotherapy, hydrotherapy (exercise in water), acupuncture or using a TENS (transcutaneous electrical nerve stimulation) machine may help to relieve your pain.
It's important that your GP helps you to find an approach that works for you. It’s possible that you may need to be referred to a specialist pain clinic.
How much calcium should I be getting to help prevent osteoporosis?
This depends on your age and, if you're a woman, whether you have been through the menopause.
If you're a woman who hasn't been through the menopause, try to get 700mg of calcium per day. This is the daily amount of calcium recommended for adults by the UK Department of Health. If you eat a healthy, balanced diet, you should be able to get 700mg of calcium a day from the food you eat. If you find this difficult, you may need to take a calcium supplement.
Once you reach the menopause, increase the calcium in your diet to 1,000mg a day. This increased level also applies to people diagnosed with osteoporosis. If you're diagnosed with osteoporosis, you may be given a calcium supplement as well as osteoporosis medication.
To give you some idea about how to get enough calcium in your diet, here is the amount in some everyday foods.
- A 200ml glass of semi-skimmed milk contains 240mg calcium.
- A 100g pot of fruit yoghurt contains 122mg calcium.
- 100g Cheddar cheese contains 739mg calcium.
- Four slices of white bread contain 175mg calcium.
- Four slices of wholemeal bread contain 105mg calcium.
- 100g tinned sardines (in oil) contains 500mg calcium.
- 100g tinned salmon contains 91mg calcium.
- 100g baked beans contains 53mg calcium.
I can't eat dairy food so how can I make sure I get enough calcium to help prevent osteoporosis?
There are plenty of non-dairy foods that contain calcium so you should still be able to get enough from your diet.
Even if you don't eat milk or dairy food, there are other options. Good sources of calcium include oily fish such as canned sardines and pilchards, soya beans and tofu, bread, pulses, certain green vegetables including broccoli and watercress, dried fruit (especially figs), nuts and seeds (particularly almonds and sesame seeds). If you use soya, rice or oat milk, choose one with added calcium.
If you're concerned that you may not be getting enough calcium in your diet, talk to your GP or a dietitian.
I read in the newspaper that calcium supplements can increase the risk of having a heart attack. Should I stop taking them?
There is some evidence that calcium supplements increase the risk of heart attacks in women who have gone through the menopause. However, as other studies have reported different findings, more research is needed in this area before conclusions can be drawn. If your GP has recommended that you take calcium supplements because you're at risk of osteoporosis, talk to him or her before stopping.
Calcium supplements are sometimes advised for women who have gone through the menopause to keep their bones healthy. A recent study, however, found that heart attacks were more common in women taking calcium supplements than in women taking a placebo (dummy pills). Scientists don't yet know why calcium supplements could cause this effect, but high calcium levels could lead to a build-up of calcium in the blood vessels. However, more research is needed to understand the link between calcium supplements and heart attacks.
If your GP has recommended that you take calcium supplements, it may be because he or she thinks that you're at risk of osteoporosis. In the UK, the recommended calcium intake is 700mg a day for adults and up to 1,200mg if you have been diagnosed with osteoporosis and are on prescribed drug treatments. If you get adequate calcium from your diet, you may not need calcium supplements. Calcium that you get in your diet doesn’t appear to lead to an increased risk of heart attack.
Always talk to your GP before stopping any medicine or supplement that has been recommended or prescribed for you. It's important to remember that any risks associated with taking calcium supplements must be balanced against the risk of osteoporosis and fractures that may happen if you don't take them.
I think I may be at risk of osteoporosis. Should I have a bone density scan?
Talk to your GP about what is best for you.
Many people don't know that they have osteoporosis until they break a bone – often a hip, wrist or bones in the spine. However, it's possible to find out if you have osteoporosis before you have a break using dual X-ray absorptiometry (DXA) scanning. This is the most common way of diagnosing osteoporosis.
The test is expensive and its availability may be limited. It’s usually only recommended for people at high risk of osteoporosis. You can have a DXA scan at a private clinic or hospital.
If you're concerned that you're at risk of osteoporosis, talk to your GP.
My doctor has told me to eat a low-fat diet. How can I get enough calcium to prevent osteoporosis if I have to limit cheese and milk?
It's best to eat some dairy foods each day as they are good sources of calcium. There are many low-fat dairy products available and often these contain more calcium than full-fat versions.
You can try either switching to lower fat options or using a little less of high-fat foods such as hard cheese. Try changing from:
- whole milk to semi-skimmed or skimmed milk
- Cheddar or Edam cheese to cottage cheese
- cream to yoghurt or low-fat crème fraîche
- butter to low-fat spread
Why isn't spinach a good source of calcium?
Although spinach has a high calcium content compared with other foods, the calcium is bound to a substance called oxalate, which means that your body can't absorb it. So, although spinach is a good source of other vitamins and minerals it isn't a good source of calcium.
The calcium content of spinach is quite high compared with other foods. For example, 100g of boiled spinach contains around 160mg of calcium compared with 75mg in the same amount of spring greens. However, spinach isn't recommended as a calcium-rich source of food because the calcium is bound to a substance called oxalate, which stops your body from absorbing it.
If you're trying to increase the amount of calcium in your diet, there are plenty of other calcium-rich foods that you can eat, such as:
- milk and dairy products
- canned fish with bones, such as sardines
- fortified breakfast cereal
- soya bean products, such as tofu
- other green leafy vegetables
- dried fruit
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