Overview
Bone is living tissue that is constantly broken down and rebuilt. In osteoporosis more bone is lost than is replaced, so bone density and bone mass fall and the bones become fragile.
It develops over years without symptoms, and many people learn they have it only when a bone breaks after a minor fall. The wrist, the hip and the bones of the spine are affected most often.
Symptoms
Osteoporosis itself is not usually painful. A break may be the first sign, and it can happen after a small fall, a bend or even a bout of coughing.
Broken bones in the spine can cause severe or lasting back pain, a loss of height over the years, or a back that becomes stooped. A break at the hip or wrist usually causes sudden pain and difficulty using the limb.
When to see a doctor
See a doctor in the next few days if a bone has broken after a minor fall, if height has been lost or the back has become stooped, or if there are risk factors such as an early menopause, long-term steroid tablets or a parent who broke a hip. Repeated falls are also worth raising.
Causes
Bone is at its strongest in early adult life. After that it is slowly lost, and osteoporosis develops when that loss runs faster than usual, or when peak bone strength was never high.
In women the fall in oestrogen at the menopause speeds up bone loss, and the effect is greater after an early menopause or removal of the ovaries. Long courses of steroid tablets, some other medicines, and conditions of the hormones, gut, kidneys or joints can also thin the bones.
Risk factors
- Being a woman, especially after the menopause
- Rising age, including men over 70
- A parent, brother or sister who broke a hip
- A small or slim body frame
- Long-term steroid tablets, or medicines that block oestrogen
- Rheumatoid arthritis and other inflammatory or hormone conditions
- An eating disorder, or a very low body weight
- Too little calcium and vitamin D
- Too little physical activity
- Smoking, and drinking a lot of alcohol
Complications
The main complication is a broken bone. A broken hip in an older person often means an operation, a long recovery and a lasting loss of independence.
Broken bones in the spine can leave continuing pain, a stooped posture and loss of height. Pain and reduced movement then make it harder to stay active, and inactivity weakens bone further.
Prevention
- Weight-bearing exercise such as brisk walking, with strength and balance work
- A balanced diet with enough calcium, vitamin D and protein
- Vitamin D from sunlight, and a supplement where a doctor advises one
- Not smoking
- Limiting alcohol
- Reducing falls at home, with good lighting, secure floor coverings and footwear that grips
- Having bone health reviewed when a doctor advises it
Diagnosis
A doctor asks about past fractures, family history, medicines and the menopause, and may use a risk tool such as FRAX to estimate the chance of a break over the next ten years. is usually suggested for women from 65, and earlier after the menopause when risk factors are present.
Bone density is measured with a scan of the hip and spine that takes about ten to twenty minutes and is painless. A T score of -2.5 or below means osteoporosis, and a score between -1 and -2.5 means osteopenia, a lesser thinning of bone. Blood tests may be added to look for another cause.
Treatment
The aim is to prevent broken bones. Treatment combines enough calcium, vitamin D and protein in the diet, weight-bearing and strength exercise, and practical steps to reduce falls.
Bone strengthening medicines are added when the risk of fracture is high. Some slow the rate at which bone is broken down and others help build new bone, and calcium and vitamin D are often given alongside. Any condition or medicine that is thinning the bones is reviewed at the same time, and the scan may be repeated later to see how the bones are responding.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Weak bones are just part of getting old, so nothing can be done.”What is true?
Fact
Bone is lost with age, but osteoporosis can be assessed and treated. Exercise, enough calcium and vitamin D, stopping smoking, limiting alcohol and, where the risk is high, medicines that slow bone loss or help build bone all reduce the chance of a fracture.
Myth“Osteoporosis only happens to women.”What is true?
Fact
Women, particularly after the menopause, are at higher risk, but men get osteoporosis too, and risk rises with age in both. Men over 70, and men on long-term steroid tablets, are among those who should discuss bone health with a doctor.
Myth“Drinking more milk, or taking a calcium tablet, is enough on its own.”What is true?
Fact
Calcium and vitamin D matter, but they are one part of the plan. Weight-bearing and strength exercise, not smoking, limiting alcohol, preventing falls and, for people at high risk, prescribed medicines all play a part.
Myth“If my bones were weak, I would feel pain in them.”What is true?
Fact
Osteoporosis is not usually painful until a bone breaks. That is why it is called a silent disease, and why bone density is measured with a scan rather than judged by how the bones feel.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is osteopenia the same as osteoporosis?
No. Osteopenia is a milder thinning of bone, shown by a T score between -1 and -2.5, and it can come before osteoporosis. It does not always need medicine. Diet, exercise, stopping smoking and preventing falls matter at this stage, and a doctor decides whether treatment is needed based on overall fracture risk.
I am over 60 and I have never had a bone density scan. Should I ask for one?
It is worth discussing. Screening is generally suggested for women from 65, and earlier after the menopause if there are risk factors, and for older men and anyone on long-term steroid tablets. A doctor can weigh your history and decide whether a scan would change your care.
Does exercise help or harm weak bones?
Regular weight-bearing exercise, such as walking, along with strength and balance work, helps keep bone and reduces falls. Some movements, such as heavy forward bending or twisting of the spine, may be unwise if spinal bones are already fragile. A doctor or physiotherapist can advise what suits you.
