Osteoporosis is a condition that weakens bones, making them fragile and more likely to break.
It's a fairly common condition that affects around three million people in the UK. More than 300,000 people receive hospital treatment for fragility fractures (fractures that occur from standing height or less) every year as a result of osteoporosis.
Wrist fractures, hip fractures and fractures of the vertebrae (bones in the spine) are the most common type of breaks that affect people with osteoporosis. However, they can also occur in other bones, such as in the arm, ribs or pelvis.
There are usually no warnings you've developed osteoporosis and it's often only diagnosed when a bone is fractured after even minor falls.
What causes osteoporosis?
During childhood, bones grow and repair very quickly, but this process slows as you get older.
Bones stop growing in length between the ages of 16 and 18, but continue to increase in density until you're in your late 20s.
You gradually start to lose bone density from about 35 years of age. Women lose bone rapidly in the first few years after themenopause (when monthly periods stop and the ovaries stop producing an egg).
Losing bone is a normal part of the ageing process, but for some people it can lead to osteoporosis and an increased risk of fractures.
Other factors that increase your risk of developing osteoporosis include:
inflammatory conditions, such as rheumatoid arthritis, Crohn's disease and chronic obstructive pulmonary disorder (COPD)
conditions that affect the hormone-producing glands, such as an overactive thyroid gland (hyperthyroidism) or an overactive parathyroid gland (hyperparathyroidism)
a family history of osteoporosis, particularly history of a hip fracture in a parent
long-term use of certain medications that affect bone strength or hormone levels, such as oral prednisolone
heavy drinking and smoking
If your doctor suspects you have osteoporosis, they can make an assessment using an online programme, such as FRAX or Q-Fracture. They may also refer you for a scan to measure your bone mineral density.
This type of scan is known as a DEXA (DXA) scan. It's a short, painless procedure and your bone mineral density can then be used to assess your fracture risk.
Treatment for osteoporosis is based on treating and preventing fractures and using medication to strengthen bones.
The decision about what treatment you have – if any – will depend on your risk of fracture. This will be based on a number of factors, such as your age and the results of your DXA scan.
If you're at risk of developing osteoporosis, you should take steps to help keep your bones healthy. This may include:
taking regular exercise
healthy eating, including foods rich in calcium and vitamin D
making lifestyle changes, such as giving up smoking and reducing your alcohol consumption.
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:
hot and cold treatments such as warm baths and cold packs
transcutaneous electrical nerve stimulation (TENS) – where a small battery-operated device is used to stimulate the nerves and 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.
The National Osteoporosis Society can put you in touch with local support groups, and they also have an online discussion forum.
Symptoms of osteoporosis
Osteoporosis develops slowly over several years.
There are often no warning signs or symptoms until a minor fall or a sudden impact causes a bone fracture.
Healthy bones should be able to withstand a fall from standing height, so a bone that breaks in these circumstances is known as a fragility fracture.
The most common injuries in people with osteoporosis are:
fractures of the spinal bones (vertebrae)
Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine.
In older people, a fractured bone can be serious and result in long-term disability. For example, a hip fracture may lead to long-term mobility problems.
Although a fracture is the first sign of osteoporosis, some older people develop the characteristic stooping (bent forward). It happens when the bones in the spine have fractured, making it difficult to support the weight of the body.
Is osteoporosis painful?
Osteoporosis isn't usually painful until it causes a fracture.
Although not always painful, spinal fractures are the most common cause of long-term (chronic) pain associated with osteoporosis.
Causes of osteoporosis
Osteoporosis causes bones to become less dense and more fragile. Some people are more at risk than others.
Bones are at their thickest and strongest in your early adult life and their density increases until your late 20s. But you gradually start losing bone density from around the age of 35.
This happens to everyone, but some people develop osteoporosis and lose bone density much faster than normal. This means they are at greater risk of a fracture.
Osteoporosis can affect men and women. It's more common in older people, but it can also affect younger people.
Women are more at risk of developing osteoporosis than men because the hormone changes that occur in the menopause directly affect bone density.
The female hormone oestrogen is essential for healthy bones. After themenopause (when monthly periods stop), 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 45 years of age)
a hysterectomy (removal of the womb) before the age of 45, particularly when the ovaries are also removed
absent periods for more than six months as a result of overexercising or too much dieting
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:
the use of certain medications, such as oral glucocorticoids
hypogonadism (a condition that causes abnormally low testosterone levels)
Many hormones in the body can affect the process of bone turnover. If you have a condition of the hormone-producing glands, you may have a higher risk of developing osteoporosis.
Hormone-related conditions that can trigger osteoporosis include:
hyperthyroidism (overactive thyroid gland)
disorders of the adrenal glands, such as Cushing's syndrome
reduced amounts of sex hormones (oestrogen and testosterone)
disorders of the pituitary gland
hyperparathyroidism (overactivity of the parathyroid glands)
Other risk factors
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 oral corticosteroids (widely used for conditions such as arthritis and asthma), which can affect bone strength
having an eating disorder, such as anorexia or bulimia
heavy drinking and smoking
malabsorption problems, as experienced in coeliac diseaseand Crohn's disease
some medications used to treat breast cancer and prostate cancer which affect hormone levels
long periods of inactivity, such as long-term bed rest
Osteoporosis is often diagnosed after weakened bones have led to a fracture.
If you're at risk of developing osteoporosis, your GP may refer you for a bone mineral density scan, known as a dual energy X-ray absorptiometry (DEXA, or DXA) scan.
Normal X-rays are a useful way of identifying fractures, but they aren't a reliable method of measuring bone density.
DEXA (DXA) scan
A DEXA scan can be used to help diagnose osteoporosis. It's a quick, safe and painless procedure that usually takes about five minutes, depending on the part of the body being scanned.
The scan measures your bone mineral density and compares it to the bone mineral density of a healthy young adult and someone who's the same age and sex as you.
The difference between the density of your bones and that of a healthy young adult 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 is defined as decreased bone mineral density compared with peak bone mass
below -2.5 is defined as osteoporosis
Although a bone density scan can help diagnose osteoporosis, your bone mineral density result isn't the only factor that determines your risk of fracturing a bone.
Your age, sex and any previous injuries will need to be taken into consideration before deciding whether you need treatment for osteoporosis.
Your doctor can help you take positive steps to improve your bone health. If you need treatment, they can also suggest the safest and most effective treatment plan for you.