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Osteoporosis

Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Next review due June 2024

Osteoporosis is a condition where your bones gradually become weaker and more fragile. This means they’re more likely to break (fracture). Anyone can get osteoporosis.

About osteoporosis

Healthy bones are made up of a strong mesh of protein and minerals (particularly calcium), surrounded by a thick outer layer. This mesh is living tissue that’s constantly renewed by the cells in your bones. These cells usually work in balance, some of them building up bone, others breaking it down. Osteoporosis happens when your body breaks down bone faster than it builds it up.

If you have osteoporosis, it doesn’t mean that your bones will definitely fracture. It just means they’re more likely to. Osteoporosis is more common in women but men can get it too.

Causes of osteoporosis

The main cause of osteoporosis is ageing. Your bones are at their most dense in your 30s. But after about another 20 years, your bones gradually lose their density as a natural part of getting older.

An image showing the structure of bone and bone affected by osteoporosis 

Other things can also increase your risk of getting osteoporosis. These include:

  • your ethnicity – white people are more likely to get osteoporosis
  • a family history of osteoporosis, especially if your parent has broken their hip
  • the menopause
  • not being able to move (being immobile) for a long time
  • being underweight or having lost a lot of weight
  • not getting enough calcium, vitamin D or other minerals in your diet
  • smoking
  • drinking too much alcohol

Some health conditions can increase your risk of osteoporosis. These include:


Some medicines can increase your risk of osteoporosis. These include corticosteroids, epilepsy medicines and some cancer treatments. Ask your doctor to explain the risks and benefits of taking these medicines. Do not stop taking them without discussing it with your doctor first.

Symptoms of osteoporosis

Osteoporosis itself doesn’t cause symptoms. The first sign of osteoporosis may be if you break a bone in a fairly minor fall or accident.

Fractures are most likely to happen in your back (vertebrae), hip and wrist. They can also happen in your arm, pelvis, ribs and other bones.

Fractures will probably be painful. If you fracture your hip, you’ll find it hard to put weight on it and move your leg.

Only one in three people with a fracture of the bones in their back have any symptoms. If you do get symptoms they may include:

  • pain – this may be sudden and be worse when you move; it may go away within weeks or months, or it may remain
  • curving of your spine, which eventually looks like a hump that makes you stoop forwards, particularly if you have more than one fracture in it
  • height loss

Diagnosis of osteoporosis

If you’re at risk of osteoporosis or you break a bone and your doctor suspects osteoporosis, your doctor will assess you. They’ll examine you and ask questions about your lifestyle and family medical history. They may arrange a DEXA (dual energy X-ray absorptiometry) scan to measure the density of your bones.

The scan shows if your bone density is normal, low (this is called osteopenia) or if you have osteoporosis. The lower the bone density, the more likely it is you may fracture a bone.

You may also have some blood tests to rule out other conditions.

Your doctor can put the results of your DEXA scan and other information into an online risk assessment tool. The other information may include your age, sex, if you smoke and if other people in your family have osteoporosis. Your doctor can then estimate your chance of having a fracture in the next 10 years.

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Self-help for osteoporosis

Your GP will give you some advice about how to make some changes to your diet and lifestyle. And they might suggest some changes to your home to help reduce your risk of falls. For more information, see our sections on prevention of osteoporosis and living with osteoporosis.

Your GP may also recommend you take supplements of calcium and vitamin D because these may help to prevent fractures. It’s important to follow your doctor’s advice on which supplements to take and how many.

Treatment of osteoporosis

The aim of treatment for osteoporosis is to keep your bones as strong as possible and to lower the chance of fractures.

Medicines

The main medicines used to treat osteoporosis are listed here.

  • Bisphosphonates – these work by slowing down bone loss. Examples include alendronate and risedronate.
  • Denosumab – this medicine works by blocking the process by which your body makes the cells that break down bone.
  • Raloxifene – this is an artificial hormone that works by copying the effects of oestrogen on your bones.
  • Teriparatide – this is a form of the hormone that regulates calcium levels in your body (parathyroid hormone). This stimulates your cells to make bone.

Most medicines for osteoporosis are only prescribed by hospital specialists. Your doctor will discuss which treatment is best for you. What medicine is suitable for you, if any, will depend on:

  • your age
  • your sex
  • the risk that you’ll have a fracture
  • if you’ve already had a fracture due to osteoporosis

If you have osteoporosis due to low levels of testosterone, your doctor may suggest testosterone replacement therapy.

Always read the patient information leaflet that comes with your medicine. If you have queries, ask your pharmacist.

Complications of osteoporosis

The main complication of osteoporosis is getting a fracture (break) in one of your bones.

If you have osteoporosis, you’re more likely to fracture bones after quite minor accidents like falls or trips or even bending and lifting. Your bones fracture much more easily than you’d expect. You’re most likely to fracture bones in your hips, spine and forearms. But you could fracture other bones too. Fractures are often painful and may cause some difficulties with everyday living. For some people, fractures can cause long-term disability.

Prevention of osteoporosis

If you make some changes to your lifestyle, it could help to reduce your risk of developing osteoporosis. A healthy diet and regular exercise can increase your bone mass when you're young and slow down the rate of bone loss in later life.

Exercise

Weight-bearing exercise helps to build and maintain strength in your bones and muscles. This may improve your balance and reduce the likelihood of falls and fractures.

Try to be active every day and aim to do at least 150 minutes (two and a half hours) of moderately intensive activity (like brisk walking) each week. Also do some activities to strengthen your muscles at least two days a week. If you aren’t used to exercise, start slowly and build up your exercise routine gradually.

If you’d like to be more active, our walk-to-run programme below is a good place to start.

Bupa's walk to run programme

Click to open a PDF version of Bupa’s walk to run programme (0.2MB)

Smoking and alcohol

Smoking can harm your bone strength and can also cause an early menopause. There’s a lot of help available if you decide to give up smoking. Ask your pharmacist and GP practice how they can help. There are also online sources of help to stop smoking.

If you drink more than three units of alcohol a day, it can increase your risk of osteoporosis. If you drink heavily, it can also increase your chance of falls and fracturing a bone. If you drink alcohol, try to keep to sensible amounts.

Healthy diet

It’s important to eat a healthy balanced diet to make sure you get all the vitamins and minerals you need to keep your bones healthy. It’s particularly important to eat a diet that’s rich in calcium. For more information, see our section on calcium and osteoporosis.

Vitamin D

Your body needs vitamin D to absorb calcium properly. Your body produces vitamin D when your skin is exposed to the sun. You can also get vitamin D from foods such as oily fish, eggs and some breakfast cereals.

Calcium and osteoporosis

Calcium in your diet is important to help prevent and treat osteoporosis.

The amount of calcium you need changes at different stages in life.

  • Between 11 and 18, boys need a daily intake of 1000mg calcium and girls need 800mg. Their bones are growing rapidly during this time.
  • Most adults should aim to have 700mg to 1000mg of calcium every day, which you should be able to get through a balanced diet.
  • After the menopause, you need 1200mg calcium a day.
  • If you’re breastfeeding, you need 1250mg.

Good sources of calcium include milk, cheese and yogurt, oily fish, and some green leafy vegetables, such as broccoli. Here’s the amount of calcium in some everyday foods.

  • A 200ml glass of semi-skimmed milk contains 240mg calcium.
  • A 150g pot of fruit or plain yoghurt contains 240mg calcium.
  • Cheddar cheese (matchbox size piece) contains 240mg calcium.
  • Two slices of white bread contain 120mg calcium.
  • Two slices of wholemeal bread contain 60mg calcium.
  • Tinned salmon (half a tin) contains 60mg calcium.
  • Baked beans (small tin, 220g) contains 120mg calcium.

If you don’t eat milk or dairy food, it can be a little harder to get the calcium you need. So, include foods like oily fish, soya beans and tofu, breads and green vegetables like broccoli in your diet.

It might also help to include foods with added calcium in your diet, such as calcium-enriched milk alternatives, orange juice and breakfast cereals.

If you’re at risk of osteoporosis or have been diagnosed with it, your doctor will probably recommend a daily supplement of calcium (together with vitamin D). Follow their advice on how to take them.

Living with osteoporosis

If you have osteoporosis, there’s a lot you can do to keep yourself healthy and reduce the chance that you’ll have a fracture. Some aspects of your life may need to change, but it’s important to keep active and continue to enjoy life.

Avoiding falls

You might worry about falling and breaking a bone, especially as you get older. But there are lots of practical, simple ways to help prevent falls. These include making changes to your home, wearing shoes that fit well, improving your diet and level of exercise, and perhaps changing any medicines you take.

Ask your GP if there’s a specialist NHS falls-prevention service in your area, which can give advice. You may also be able to get help with home aids or modifications from social services. Some charities also offer helpful advice – for contact details, see our section: Other helpful websites.

Being active

If you have osteoporosis, it’s important to try and keep active as it can reduce your risk of falls and fractures. It’s important to start exercise slowly and build it up over time. If you have osteoporosis and other medical problems, check with your GP before you start any vigorous activities.

Fractures

If you have a fracture, it should heal within about six to 12 weeks – osteoporosis doesn’t affect the healing process. Your treatment and recovery will depend on the type of fracture you have.

Over-the-counter painkillers may help with any pain from a fracture. If you have long-term pain, your pharmacist will help you find the right type of pain relief for you. Always read the patient information leaflet that comes with your medicine. If you’re finding it hard to control the pain, contact your GP.

If you have a hip fracture, you may need extra help from healthcare specialists. For example, physiotherapists and occupational therapists to help you get your independence back.

Getting support

You may find it helpful to talk to other people who have osteoporosis, either in local groups or in online forums. Ask your GP practice about local groups. The Royal Osteoporosis Society can offer you information, advice and support – for contact details, see our section: Other helpful websites.

Frequently asked questions



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Related information

Related information


  • Discover other helpful health information websites.
    • Osteoporosis. BMJ Best Practice. bestpractice.bmj.com, last reviewed 27 March 2021
    • NOGG 2017: Clinical guideline for the prevention and treatment of osteoporosis. National Osteoporosis Guideline Group. www.sheffield.ac.uk, updated July 2019
    • Bone biology. International Osteoporosis Foundation. www.osteoporosis.foundation, accessed 27 April 2021
    • Osteoporosis – prevention of fragility fractures. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2020
    • Osteoporosis. NICE British National Formulary. bnf.nice.org.uk, last updated 1 April 2021
    • Osteoporosis. Medscape. emedicine.medscape.com, updated 20 January 2021
    • Osteoporosis. MSD Manuals. msdmanuals.com, last full review/revision February 2020
    • Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated 7 February 2018
    • UK Chief Medical Officers' physical activity guidelines Department of Health and Social Care. www.gov.uk, published 7 September 2019
    • Menopause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2020
    • Management of osteoporosis and the prevention of fragility fractures. Scottish Intercollegiate Guidelines Network (SIGN). www.sign.ac.uk, revised June 2020
    • Osteoporosis and diet: Food fact sheet. British Dietetic Association. www.bda.uk.com, published November 2019
    • Teenagers. British Nutrition Foundation. www.nutrition.org.uk, last reviewed August 2015
    • Calcium: food fact sheet. British Dietetic Association. www.bda.uk.com, published July 2017
    • Osteoporosis. Royal Osteoporosis Society. theros.org.uk, accessed 29 April 2021
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, June 2021
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
    Next review due June 2024

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