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Osteoporosis


Expert reviewer, Dr Sundeept Bhalara, Consultant Physician and Rheumatologist
Next review due January 2022

Osteoporosis is a condition where your bones gradually become weaker and more fragile, which means they’re more likely to break (fracture).

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

Osteoporosis is sometimes confused with osteoarthritis because their names are similar. However, they are different conditions.

Symptoms of osteoporosis

Osteoporosis itself doesn’t cause symptoms. If you have osteoporosis, the first sign may be fracturing a bone in a relatively 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 in your hip and wrist usually follow a fall and will probably be painful. If you’ve fractured your hip, you’ll find it hard to bear weight and to move your leg normally.

A fracture in the bones of your back may cause:

  • pain at the site of the fracture – this may be sudden and made worse by movement; the pain may go away within weeks or months or it may remain
  • curving of your spine eventually giving the appearance of a hump that makes you stoop forwards; this is more likely if you have more than one fracture in the bones of your back
  • loss of height

However, only one in three people with a fracture of the bones in their back have any symptoms at all.

Causes of 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 being renewed by the special 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 building it up.

The main cause of osteoporosis is ageing. Your bones are at their most dense in your early-to-mid 20s. But after about another 10 years, your bones gradually lose their density as a natural part of ageing.

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

As well as your age, there are several other factors that can increase your risk of getting osteoporosis. These include:

  • being female
  • a family history of osteoporosis, especially having a parent who has had a hip fracture
  • having had the menopause or if your ovaries were removed in a total hysterectomy
  • being immobile (unable to move) for a long time
  • being underweight (BMI less than 18.5 kg/m) 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 medical conditions can also increase your risk of osteoporosis. These include:

  • an overactive thyroid gland (hyperthyroidism) or overactive parathyroid glands (hyperparathyroidism)
  • rheumatoid arthritis
  • a low level of testosterone – caused by problems related to your glands (hypogonadism)
  • digestive disorders – for example, Crohn’s disease or any other condition that reduces absorption from your digestive system

Some medicines can increase your risk of osteoporosis. These include long-term corticosteroids, anti-epilepsy medicines and some cancer treatments. Ask your doctor to explain the risks and benefits of taking these medicines. Don’t stop taking medicines without discussing it with your doctor first.

Diagnosis of osteoporosis

If you’re at risk of having osteoporosis, your doctor will carry out an assessment. They’ll examine you, and ask you questions about your lifestyle and family medical history. You may be offered a DEXA (dual energy X-ray absorptiometry) scan. This measures the density of your bones. The scan is painless and takes 10 to 20 minutes.

Osteoporosis is diagnosed if your bone density, as measured by a DEXA scan, is well below average. If your bone density is slightly lower than average, it’s known as osteopenia.

Osteoporosis is sometimes diagnosed after a fracture has happened, possibly after a trip or a fall. If this happens, your doctor may recommend you have a DEXA scan. You may also have some blood tests to rule out underlying conditions.

If your doctor diagnoses osteoporosis, they can put the results of your DEXA scan alongside other information into an online risk assessment tool. The other information will include such things as your age, sex, whether or not you smoke and if other people in your family have osteoporosis. Your doctor can then say what your chance is of having a fracture over the next 10 years.

Treatment of osteoporosis

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

If you’ve been diagnosed with osteoporosis, your GP will probably advise you to make some healthy changes to your diet and lifestyle. They may also suggest changes to your home to help reduce the risk that you might fall. See our sections Prevention of osteoporosis and Living with osteoporosis below for more details.

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

Medicines

A number of different medicines are used to treat osteoporosis. The main ones are listed here.

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

Most of the medicines used for osteoporosis are only prescribed by hospital specialists and/or in special circumstances. Your doctor will discuss with you which treatment is best for you. What medicines you are offered, 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

Some men will have osteoporosis due to low levels of testosterone. If this is found, your doctor may suggest testosterone replacement therapy.

Always read the patient information leaflet that comes with your medicine carefully. If you have queries about taking your medicines, you can 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 falling or tripping or even bending and lifting. Your bones fracture much more easily than you’d expect. You’re most likely to fracture bones in your spine, wrists and hip. However, you can fracture other bones too. Fractures are often painful and can lead to a loss of independence and long-term disability in older people.

For more information, see our section Symptoms of osteoporosis above.

Prevention of osteoporosis

Making some changes to your lifestyle 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

Being physically active should start in childhood and continue throughout all stages of life. Exercise helps to build and maintain strength in your bones and muscles. This can improve your balance and reduce falls and fractures.

You should try to be active every day. Aim for a total of 150 minutes (two and a half hours) of moderately intensive activity (like brisk walking) each week. This may mean doing 30 minutes on at least five days over the week. You should also do activities to strengthen your muscles at least two days a week. If you aren’t used to exercising, start slowly and build up your exercise routine gradually.

We have lots of information about the types of exercise that can help, and tips and hints to help you get started. Read our information on the benefits of exercise, getting started with exercise, and exercise for older people to find out more. And if you’d like to be more active, have a look at our walk-to-run programme below.

Walk to run training programme

Smoking and alcohol

Smoking can have a harmful effect on your bone strength and can also cause an early menopause in women. Smokers may also absorb less calcium from their diet. There’s a lot of help available if you decide to give up smoking. Ask your pharmacist and GP practice how they can help. And you might find it helpful to check online sources of help to stop smoking too.

Drinking more than three units of alcohol a day can increase your risk of osteoporosis. Drinking heavily can also make you more likely to have falls, increasing your chance of fracturing a bone. If you drink alcohol, try to keep to sensible amounts. Doctors recommend that both men and women shouldn’t drink more than 14 units of alcohol a week, and that these should be spread over the course of the week. To find out more about what this means for you see our topic on sensible drinking.

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 Calcium and osteoporosis below.

Vitamin D

Making sure you get enough vitamin D is also important for healthy bones because your body needs vitamin D to absorb calcium properly. Vitamin D is produced naturally by your body when your skin is exposed to sunlight. You can also get it from some foods, such as oily fish, eggs and some breakfast cereals. For more details about how you can get enough vitamin D, see our information on vitamins and minerals.

Calcium and osteoporosis

Getting enough calcium in your diet is important to help prevent and treat osteoporosis.

The amount of calcium you need changes at different stages throughout life. Most adults should aim to have 700mg to 1000mg of calcium every day, which you should be able to get through eating a balanced diet. Between the ages of 11 and 18, boys need a daily intake of 1000mg calcium and girls need 800mg. This is because their bones are growing rapidly during this period. After the menopause, women need 1200mg calcium a day; breastfeeding mothers need 1250mg.

Good sources of calcium include milk, cheese and yogurt, oily fish, and some green leafy vegetables, such as broccoli. To give you some idea about how to get enough calcium in your diet, here’s the amount in some everyday foods.

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

If you’re trying to reduce the amount of fat in your diet, choose low-fat dairy options, which still contain calcium.

If you don’t eat milk or dairy food, it can be a little harder to get the calcium you need. So try to include foods like oily fish, soya beans and tofu, breads and green vegetables like broccoli in your diet. Note that spinach, although a good source of nutrients generally, isn’t a good dietary source of calcium. This is because the calcium found in spinach is bound to a substance called oxalate, which stops your body from absorbing the calcium.

It might also help to include foods with added calcium in your diet. Examples are calcium-enriched milk alternatives (soya, oat, nut), orange juice and some breakfast cereals.

If you’re at risk of osteoporosis or have been diagnosed with it, your doctor will probably recommend you take a daily supplement of calcium (together with vitamin D). It’s important to follow your GP’s advice when taking supplements for osteoporosis.

Living with osteoporosis

If you’re living with osteoporosis, remember that you’re not alone. There are many people going through the same ups and downs as you. 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 that you keep active and continue to enjoy life as normal.

Avoiding falls

Many people with osteoporosis worry about falling and breaking a bone, especially as they get older. There are lots of very practical, simple ways to help prevent falls. These may include making modifications to your home, wearing well-fitted footwear, improving your diet and how much exercise you do, and changing any medications you may 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 a lot of very helpful advice. See our section Other helpful websites below for contact details.

Being active

If you have osteoporosis, it’s important to try and keep active. Regular exercise that is weight bearing and muscle strengthening reduces the 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, you should check with your GP before starting vigorous activities. See our section Prevention of osteoporosis above for more information.

Fractures

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

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. Some people with osteoporosis have long-term pain after fractures. Your pharmacist will be able to help you find the right type of pain relief for your circumstances. Always read the patient information leaflet that comes with your medicine. If you’re finding it hard to control the pain, contact your GP. See our FAQs below for more information about pain in your back.

Older people with hip fractures may need extra help from healthcare specialists such as physiotherapists and occupational therapists to help them get back their independence.

Getting support

Some people 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 – see our section Other helpful websites below for contact details.

Frequently asked questions

  • If you have osteoporosis, pressure on weakened bones in your spine (vertebrae) can cause them to crack and fracture. Many people feel no pain with a spinal fracture, but others notice a sudden pain that may be sharp, ‘nagging’ or dull. And you may have chronic (ongoing) pain even after your bone has healed, especially if there’s been more than one fracture.

    Tell your GP if you’re in pain – they’ll work with you to find a way to lessen it. They’re likely to suggest trying either over-the-counter painkillers or stronger prescription painkillers. They may also recommend a short period of bed rest (24 to 48 hours) if the pain is new.

    However, if these don’t help control your pain, there are other options to consider.

    • You may find that physiotherapy, hydrotherapy (exercise in water) or using a TENS (transcutaneous electrical nerve stimulation) machine may help to relieve your pain. Using a back brace for a while may help. Some people choose to try complementary therapies like acupuncture.
    • Surgical treatments that include injecting cement into the fracture are available. These methods are called vertebroplasty and kyphoplasty. Ask your doctor if these may be an option for you if your pain doesn’t settle as expected.

    It’s possible that you may need to be referred to a specialist pain clinic. You may also find helpful advice on coping with pain from charitable organisations like the National Osteoporosis Society. See our section Other helpful websites below for contact details.

  • You may have heard it said that taking calcium supplements may increase your chance of having a heart attack.

    At the moment, experts really aren’t sure whether there is a link between taking calcium supplements and heart disease. Some scientific studies have found an increase in heart attacks in people talking calcium supplements; others have not. As is often the case, more research is needed before we can be sure.

    Calcium that you get in your diet doesn’t appear to lead to an increased risk of heart problems.

    If your doctor recommends you take calcium supplements, they’ll probably suggest you take vitamin D supplements too. No risk to the heart has been found when these supplements are taken together.

    Getting enough calcium is vital for the health of your bones. If your doctor has prescribed calcium supplements for you, talk to them about any concerns you have. Don’t stop taking any prescribed medicine without discussing it first with your doctor. 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.


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Related information

Related information

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  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, January 2019
    Expert reviewer, Dr Sundeept Bhalara, Consultant Physician and Rheumatologist
    Next review due January 2022



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