Osteoporosis

Published by Bupa's Health Information Team, August 2010.

This factsheet is for people who have osteoporosis, or who would like information about it.

Osteoporosis literally means 'porous bones'. It's a condition where bones lose density causing them to become weak, brittle and more likely to break (fracture).

How osteoporosis develops

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About osteoporosis

About one in two women and one in five men over 50 will fracture a bone mainly because of osteoporosis. Osteoporosis can affect all age groups, but it's most common in post-menopausal women. Having osteoporosis doesn't automatically mean that your bones will fracture; it just means that it's more likely.

Symptoms of osteoporosis

You can't see or feel your bones getting thinner, and may only become aware of the condition when you fracture a bone. Osteoporosis weakens the bones in your back (vertebrae), so other signs to look out for include back pain and any changes in your height.

Complications of osteoporosis

People with osteoporosis are more likely to fracture bones in the wrists, hip, pelvis and back. Fractures can, however, occur in any bone. They can result in pain, disability and loss of independence.

Causes of osteoporosis

Healthy bone consists of a strong mesh made of protein and minerals (particularly calcium). This mesh is living tissue that is constantly being renewed by two types of cells. One type (osteoblasts) builds up new bone and the other (osteoclasts) breaks down old bone. Up to our mid-20s our skeleton is strengthened, but from our 40s onwards our bones gradually lose their density as a natural part of ageing. 

Our bone health is largely down to the genes we inherit from our parents. However, there are other factors that can put you at greater risk of osteoporosis.

• Gender - women in their late 40s and early 50s face the menopause. This means they lose the protective effects of the hormone oestrogen and are at higher risk of having osteoporosis.
• Race - Caucasian or Asian races are at greater risk than African-Caribbean people.
• Surgery - women who have a hysterectomy before the age of 45 (especially if both ovaries are removed) are at increased risk of osteoporosis.
• Previous bone injury - bone fractures make the bone weaker so affected bones lose their density quicker.
• Long-term immobility - bones and muscles become weak if your body isn't active.
• Being underweight - 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 dietary calcium means 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 - such as hyperthyroidism or hyperparathyroidism.
• Rheumatoid arthritis - this is when your immune cells enter your joints and cause inflammation.
• A decreased function of the testicles (hypogonadism) - low levels of testosterone in men increases their risk of osteoporosis.
• Digestive disorders - such as Crohn's Disease, chronic liver disease or coeliac disease.

Diagnosis of osteoporosis

Osteoporosis is usually diagnosed in hospital, often after a fall or bone fracture.
Your doctor will measure your bone density using a DEXA 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 a blood and urine tests, MRI scan or an X-ray to rule out other conditions or to understand what is happening with your bones. There is, however, no single blood test which will tell your doctor if you have osteoporosis.

Treatment of osteoporosis

Self-help

If you have osteoporosis you need to be careful of vigorous, high-impact exercise. 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. Beneficial exercise includes swimming, gardening, walking, golf and Tai Chi.

It's important to eat a diet that is rich in calcium to maintain healthy bones. Aim to take 1,000mg of calcium every day, either in your diet or as a supplement. Good sources of calcium include milk and dairy products, such as cheese and yoghurt, dried apricots or figs and some green leafy vegetables such as broccoli and cabbage. Calcium tablets can be purchased at a chemist, but always ask your doctor before taking calcium supplements as your body can only cope with a certain amount of calcium, and if you take too much you may develop kidney stones or other complications.

Your body also needs vitamin D 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, do not let your skin redden. If you are not getting enough vitamin D from sun exposure or diet, your doctor will usually suggest 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.

Medicines

Your doctor may prescribe the following medicines to increase your bone density.

• 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) - this stimulates new bone to grow and reduces bone loss.
• Calcitonin (eg Miacalcic) - this is a hormone usually made by the thyroid gland, it blocks the action of the cells that break down bone.
• Parathyroid hormone peptides (parathyroid hormone (eg Preotact) and teriparatide (eg Forsteo) - these help to regulate calcium levels and the activity of cells involved in bone formation.
• Raloxifene (eg Evista) - this is a synthetic 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, but you probably won't be prescribed it specifically to treat or prevent the condition.
• Denosumab (Prolia) - given as an injection every six months, it's a biological treatment that works by blocking the formation of cells that break down bone.

Pain management

Over-the-counter painkillers can help with any pain you have. Always read the patient information leaflet that comes with your medicine. Physiotherapy, hydrotherapy (exercise in water) and TENS (transcutaneous electrical nerve stimulation) and alternative therapies, like acupuncture, may also help. Always ask your doctor or pharmacist for advice before any treatment.

Treatments for men

If your osteoporosis is caused by hypogonadism, your GP may prescribe testosterone replacement therapy.

Some osteoporosis treatments are only licensed for women who have gone through the menopause. However, there are some treatments that are also licensed for men such as the bisphosphonates alendronate (eg Fosamax) and risedronate (eg Actonel) - ask your doctor for advice on which treatments are available and suitable for you.

Prevention of osteoporosis

Changing your lifestyle could help to reduce your chances of developing osteoporosis. A healthy diet and regular exercise can increase bone mass, especially in younger people with growing bones.

High-impact exercise, where you support your own weight, is best for strengthening bones. The National Osteoporosis Society recommends jogging, aerobics, tennis, weight-training, dancing and brisk walking. If you aren't used to exercising, build up your exercise routine gradually. Talk to your GP before you start a new exercise routine if you have any concerns.

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. You should also be careful not to drink too much alcohol.

Adults should aim to have 700mg of calcium every day, which you should be able to get through healthy eating. Making sure you get enough vitamin D is also important for bone health. If you don't get enough vitamin D through sun exposure and diet, 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 are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.