Osteoporosis

Osteoporosis is a health 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 fall or sudden impact causes a bone to break (fracture).

The most common injuries in people with osteoporosis are:

• broken wrist
• broken hip (hip fracture)
• broken spinal bones (vertebrae)

However, breaks can also happen in other bones, such as in the arm or pelvis. Sometimes a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine.

Osteoporosis is not usually painful until a bone is broken, but broken bones in the spine are a common cause of long-term pain.

Although a broken bone is often the first sign of osteoporosis, some older people develop the characteristic stooped (bent forward) posture. It happens when the bones in the spine have broken, making it difficult to support the weight of the body.

Osteoporosis can be treated with bone strengthening medicines.

Bone loss before osteoporosis (osteopenia)

The stage before osteoporosis is called osteopenia. This is when a bone density scan shows you have lower bone density than the average for your age, but not low enough to be classed as osteoporosis.

Osteopenia does not always lead to osteoporosis. It depends on many factors.

If you have osteopenia, there are steps you can take to keep your bones healthy and reduce your risk of developing osteoporosis.

Your doctor may also prescribe one of the bone-strengthening treatments that are given to people with osteoporosis, depending on how weak your bones are and your risk of breaking a bone.

Causes of osteoporosis

Losing bone is a normal part of ageing, but some people lose bone much faster than normal. This can lead to osteoporosis and an increased risk of broken bones.

Women also lose bone rapidly in the first few years after the menopause. Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45) or they've had their ovaries removed.

However, osteoporosis can also affect men, younger women and children.

Many other factors can also increase the risk of developing osteoporosis, including:

• taking high-dose steroid tablets for more than 3 months
• other medical conditions – such as inflammatory conditions, hormone-related conditions, or malabsorption problems
• a family history of osteoporosis – particularly a hip fracture in a parent
• long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets that many women take after breast cancer
• having or having had an eating disorder such as anorexia or bulimia
• having a low body mass index (BMI)
• not exercising regularly
• heavy drinking and smoking

Read more about the causes of osteoporosis.

Diagnosing osteoporosis and osteopenia

If your doctor suspects you have osteoporosis, they can work out your future risk of breaking a bone using an online programme, such as FRAX or Q-Fracture.

Bone density scan (DEXA scan)

They may also refer you for a bone density scan to measure your bone strength. It's a short, painless procedure that takes 10 to 20 minutes, depending on the part of the body being scanned.

Your bone density can be compared to that of a healthy young adult. 

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 shows bone loss and is defined as osteopenia
• below -2.5 shows bone loss and is defined as osteoporosis

Treating osteoporosis

Treatment for osteoporosis is based on treating and preventing broken bones, and taking medicine to strengthen your bones.

The decision about whether you need treatment depends on your risk of breaking a bone in the future. This will be based on a number of factors such as your age, sex and the results of your bone density scan.

If you need treatment, your doctor can suggest the safest and most effective treatment plan for you.

Read more about how osteoporosis is treated.

Preventing osteoporosis

If you're at risk of developing osteoporosis, you should take steps to help keep your bones healthy. This may include:

• taking regular exercise to keep your bones as strong as possible
• healthy eating – including foods rich in calcium and vitamin D
• taking a daily supplement containing 10 micrograms of vitamin D
• making lifestyle changes – such as giving up smoking and reducing your alcohol consumption

Read more about preventing osteoporosis.

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:

• painkillers
• hot and cold treatments, such as warm baths and cold packs
• relaxation techniques and other ways to reduce pain

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.

Read more about living with osteoporosis.

Osteoporosis support

It has detailed information about osteoporosis prevention and treatment, and support groups throughout the UK.

The Royal Osteoporosis Society's free telephone helpline may be particularly helpful if you're newly diagnosed with osteoporosis.

The helpline number is 0808 800 0035 and is open Monday to Friday, 9am to 12.30pm and 1.30pm to 5.00pm.

 Causes Osteoporosis 

Osteoporosis causes bones to become weaker and more fragile. Some people are more at risk than others.

Bones are thickest and strongest in your early adult life until your late 20s. You gradually start losing bone from around the age of 35.

This happens to everyone, but some people develop osteoporosis and lose bone much faster than normal. This means they're at greater risk of a fracture.

Who's at risk of osteoporosis

Osteoporosis can affect men and women. It's more common in older people, but it can also affect younger people.

Women

Women are more at risk of developing osteoporosis than men because the hormone changes that happen at the menopause directly affect bone density.

The female hormone oestrogen is essential for healthy bones. After the menopause, oestrogen levels fall. This can lead to a rapid decrease in bone density.

Women are at even greater risk of developing osteoporosis if they have:

• an early menopause (before the age of 45)
• a hysterectomy (removal of the womb) before the age of 45, particularly when the ovaries are also removed
• absent periods for more than 6 months as a result of over-exercising or too much dieting

Men

In most cases, the cause of osteoporosis in men is unknown. However, there's a link to the male hormone testosterone, which helps keep the bones healthy.

Men continue producing testosterone into old age, but the risk of osteoporosis is increased in men with low levels of testosterone.

In around half of men, the exact cause of low testosterone levels is unknown, but known causes include:

• taking certain medicines, such as steroid tablets
• alcohol misuse
• hypogonadism (a condition that causes abnormally low testosterone levels)

Osteoporosis risk factors

Many hormones in the body affect bone turnover. If you have a disorder of the hormone-producing glands, you may have a higher risk of developing osteoporosis.

Hormone-related disorders that can trigger osteoporosis include:

• overactive thyroid gland
• reduced amounts of sex hormones (oestrogen and testosterone)
• disorders of the pituitary gland
• overactivity of the parathyroid glands (hyperparathyroidism)

Other factors thought to increase the risk of osteoporosis and broken bones include:

• a family history of osteoporosis
• a parental history of hip fracture
• a body mass index (BMI) of 19 or less
• long-term use of high-dose steroid tablets (these are widely used for health conditions such as arthritis and asthma)
• having an eating disorder, such as anorexia or bulimia
• heavy drinking and smoking
• rheumatoid arthritis
• malabsorption problems, as in coeliac disease and Crohn's disease
• some medicines used to treat breast cancer and prostate cancer that affect hormone levels
• long periods of inactivity, such as long-term bed rest

 Treatment Osteoporosis 

Treating osteoporosis involves treating and preventing fractures, and using medicines to strengthen bones.

Although a diagnosis of osteoporosis is based on the results of your bone density scan, the decision about what treatment you need, if any, is based on a number of other factors including your:

• age
• sex
• risk of breaking a bone
• previous injury history

If you've been diagnosed with osteoporosis because you've had a broken bone, you should still receive treatment to try to reduce your risk of further broken bones.

You may not need or want to take medicine to treat osteoporosis.

However, make sure you're getting enough calcium and vitamin D.

To achieve this, your healthcare team will ask you about your diet and may recommend that you make changes or take supplements.

Medicines for osteoporosis

A number of different medicines are used to treat osteoporosis (and sometimes osteopenia).

Bisphosphonates

Bisphosphonates slow the rate that bone is broken down in your body. This maintains bone density and reduces your risk of a broken bone.

There are a number of different bisphosphonates, including:

• alendronic acid
• ibandronic acid
• risedronate
• zoledronic acid

They're given as a tablet, a liquid that you swallow, or an injection.

Always take bisphosphonates on an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. You'll also need to wait between 30 minutes and 2 hours before eating food or drinking any other fluids.

Bisphosphonates usually take 6 to 12 months to work, and you may need to take them for 5 years or longer.

You may also be prescribed calcium and vitamin D supplements to take at a different time to the bisphosphonate.

The main side effects associated with bisphosphonates include:

• irritation to the food pipe
• swallowing problems
• stomach pain

Osteonecrosis of the jaw is a rare side effect linked with the use of bisphosphonates, although most frequently with high-dose intravenous bisphosphonate treatment for cancer and not for osteoporosis.

In osteonecrosis, the cells in the jaw bone die, which can lead to problems with healing. If you have a history of dental problems, you may need a check-up before you start treatment with bisphosphonates. Speak to your doctor if you have any concerns.

Selective oestrogen receptor modulators (SERMs)

SERMs are medicines that have a similar effect on bone as the hormone oestrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine.

Raloxifene is the only type of SERM available for treating osteoporosis. It's only recommended for women, after the menopause. It's taken as a daily tablet.

Side effects associated with raloxifene include:

• hot flushes
• leg cramps
• a potential increased risk of blood clots

Parathyroid hormone

Parathyroid hormone is produced naturally in the body. It regulates the amount of calcium in bone.

Parathyroid hormone treatments (such as teriparatide) are used to stimulate cells that create new bone. You take them as an injection once a day.

While other medicines can only slow down the rate of bone thinning, parathyroid hormone can increase bone density. However, it's only used in a small number of people whose bone density is very low and when other treatments are not working.

Nausea, headaches and dizziness are common side effects of the treatment.

Biological medicines

Biological medicines are made from proteins or other substances produced by the body.

Biological medicines that can be used to treat osteoporosis include denosumab and romosozumab. They may be recommended if you cannot take other medicines such as bisphosphonates, or if you have severe osteoporosis.

They work by slowing down the rate at which your bones are broken down and speeding up the rate at which your cells build bone. They're given by injection every month or every few months.

Common side effects include muscle or joint pain, rashes, constipation and cold-like symptoms.

Calcium and vitamin D supplements

Calcium is the main mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones.

For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium.

However, if you have osteoporosis, you may need more calcium, usually as supplements. Ask your GP for advice about taking calcium supplements.

Vitamin D helps the body absorb calcium. All adults should have 10 micrograms of vitamin D a day.

From about late March or early April to the end of September, most people should be able to get all the vitamin D they need from sunlight on their skin.

But since it's difficult to get enough vitamin D from food alone, everyone (including pregnant and breastfeeding women) should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.

HRT (hormone replacement therapy)

HRT can be taken by women who are going through the menopause, to help control symptoms.

HRT has also been shown to keep bones strong and reduce the risk of getting osteoporosis. If you already have osteoporosis it can strengthen your bones and reduce your risk of breaking a bone.

If you have early or premature menopause, where your periods stop before the age of 45, you'll usually be advised to take HRT or a hormonal contraceptive until at least age 51. This increases your level of oestrogen, which helps protect you from osteoporosis and other health conditions.

Some types of HRT slightly increase the risk of breast cancer. The risk increases if you take HRT for a long time. HRT tablets (but not patches, gel or spray) slightly increase the risk of blood clots.

Whether HRT is right for you depends on your age, symptoms and any risk factors you have. If you're aged 60 or under and have menopause symptoms, the benefits of HRT will usually outweigh the risks.

Discuss the benefits and risks of HRT with your GP.

Read more about the benefits and risks of HRT.

Find out how to save money on HRT medicines with a prescription prepayment certificate.

Treating a broken bone caused by osteoporosis

It explains what recovery will be like, and what type of treatment you can expect.

 Living with Osteoporosis 

Having osteoporosis does not mean you'll definitely have a fracture.

There are measures you can take to reduce your risk of a fall or break.

Preventing falls

Making some simple changes at home can help reduce the risk of breaking a bone in a fall. 

Check your home for hazards you may trip over, such as trailing wires. Make sure rugs and carpets are secure, and keep rubber mats by the sink and in the bath to prevent slipping.

Have regular sight tests and hearing tests. Some older people may need to wear special protectors over their hips to cushion a fall. Your GP can offer help and advice about changes to your lifestyle.

Read more about preventing falls.

Healthy eating and exercise

Regular exercise and a healthy diet are important for everyone, not just people with osteoporosis. They can help prevent many serious conditions, including heart disease and many forms of cancer.

Make sure you have a balanced diet that contains all the food groups to give your body the nutrition it needs.

Find out more about food for healthy bones.

Getting support

Your GP or nurse may be able to answer any questions you have about living with osteoporosis and can reassure you if you're worried.

You may also find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information about these.

Some people find it helpful to talk to others with osteoporosis, either at a local support group or online.

Fracture liaison services

If you're over 50 and have broken a bone, a fracture liaison service can help you prevent further broken bones and keep your bones healthy.

Ask your GP surgery if there's a fracture liaison service in your area.

Recovering from a broken bone

Broken bones can take weeks or months to heal. Having osteoporosis does not affect how long this takes. Recovery depends on the type of fracture you have. Some fractures heal easily, while others may need more intervention.

If you have a complicated broken wrist or broken hip, you may need an operation to make sure the bone is set properly.

Hip replacements are often needed after hip fractures, and some people may lose mobility as a result of weakened bones.

Osteoporosis can cause a loss of height due to a broken bone in the spinal column. This means the spine is no longer able to support your body's weight, which causes a hunched posture.

This can be painful when it happens, but it can also lead to long-term pain. Your GP or nurse may be able to help with this.

During the healing process, you may need the help of a physiotherapist or occupational therapist so you can make as full a recovery as possible.

Read more about physiotherapy and occupational therapy.

Coping with pain

Everyone experiences pain differently, so what works for you may differ from what works for someone else.

There are different ways to manage pain, including:

• painkillers
• heat treatment, such as warm baths or hot packs
• cold treatment, such as cold packs
• simple relaxation techniques
• massage

You can use more than one of these techniques at the same time to manage your pain – for example, you could combine medicine, a heat pack and relaxation techniques.

Working and money

You should be able to continue working if you have osteoporosis. It's very important that you remain physically active.

This will help keep your bones healthy.

There are various benefits available to people with an illness or disability. The social care and support guide has more information on:

• benefits if you're under State Pension age
• benefits if you're over State Pension age

Help for carers

You may also be entitled to certain benefits if you care for someone with osteoporosis.

Read more about benefits for carers.

 Prevention Osteoporosis 

Your genes affect your height and the strength of your skeleton, but lifestyle factors such as diet and exercise influence how healthy your bones are.

Regular exercise

Regular exercise is essential. Adults aged 19 to 64 should do at least 2 hours and 30 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week.

Weight-bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis.

As well as aerobic exercise, adults aged 19 to 64 should also do muscle-strengthening activities on 2 or more days a week by working all the major muscle groups, including the legs, hips, back, abdomen, chest, arms and shoulders.

If you've been diagnosed with osteoporosis, it's a good idea to talk to your GP or health specialist before starting a new exercise programme to make sure it's right for you.

Find out more about:

• physical activity guidelines for adults aged 19 to 64
• physical activity guidelines for older adults
• how to keep bones healthy over 65

Weight-bearing exercise

Weight-bearing exercise is exercise where your feet and legs support your weight.

High-impact weight-bearing exercise, such as running, skipping, dancing, aerobics, and even jumping up and down on the spot, are all useful ways to strengthen your muscles, ligaments and joints.

When exercising, wear footwear that provides your ankles and feet with adequate support, such as trainers or walking boots.

People over the age of 60 can also benefit from regular weight-bearing exercise. This can include brisk walking, keep-fit classes or a game of tennis. Swimming and cycling are not weight-bearing exercise, however.

Resistance exercise

Resistance exercise uses muscle strength, where the action of the tendons pulling on the bones boosts bone strength. Examples include press-ups, weightlifting or using weight equipment at a gym.

If you've recently joined a gym or have not been for a while, your gym will probably offer you an induction. This involves being shown how to use the equipment and having exercise techniques recommended to you.

Always ask an instructor for help if you're not sure how to use a piece of gym equipment or how to do a particular exercise.

Healthy eating and vitamin D supplements

Eating a healthy, balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease, diabetes and many forms of cancer, as well as osteoporosis.

Calcium is important for maintaining bone health. Adults need 700mg a day, which you should be able to get from your daily diet.

Calcium-rich foods include:

• leafy green vegetables
• dried fruit
• tofu
• dairy products, such as milk, cheese and yoghurt

Vitamin D is important for healthy bones and teeth because it helps your body absorb calcium. All adults should consume 10 micrograms of vitamin D a day.

Good dietary sources of vitamin D include:

• oily fish, such as salmon, sardines, herring and mackerel
• red meat
• liver
• egg yolks
• fortified foods, such as most fat spreads and some breakfast cereals
• dietary supplements

However, it can be difficult to get enough vitamin D from foods alone. So, consider taking a daily supplement containing 10 micrograms of vitamin D.

Stop smoking and drink less

Other lifestyle factors that can help prevent osteoporosis include:

• quitting smoking – smoking is associated with an increased risk of osteoporosis

Get some sun

From late March or early April to the end of September, sunlight triggers the production of vitamin D, which helps your body absorb calcium.

This process helps strengthen teeth and bones, which in turn helps prevent conditions such as osteoporosis.

It's recommended to spend a short time in the sun each day.

During the autumn and winter, you need to get vitamin D from your diet because the sun is not strong enough for the body to make vitamin D.