Osteoporosis
Osteoporosis
Osteoporosis is a condition in which the bones lose density and become thinner over time. This makes them fragile and much more prone to breaking. The condition develops slowly, over several years, and it is often only discovered when a minor fall or a sudden knock causes a bone to fracture.
The bones most commonly affected by fractures in osteoporosis are the wrist, the hip, and the small bones of the spine (vertebrae). Fractures can also happen in other bones, such as the arm or the pelvis. In rare cases, even something as ordinary as a cough or a sneeze can crack a rib, or cause one of the spinal bones to collapse or fracture.
Osteoporosis itself does not usually cause pain until a fracture happens. However, fractures in the spine can become a frequent cause of long-term, chronic pain. A fracture is usually the first sign that osteoporosis is present. In some older people, a stooped or bent-forward posture develops instead. This happens when several bones in the spine have fractured, making it hard for the spine to hold up the weight of the body.
Who osteoporosis affects
Osteoporosis affects over 3 million people in the UK. Half of women over 50 years of age, and 1 third of men over 60 years of age, will experience a low trauma fracture caused by osteoporosis at some point.
A low trauma fracture is one that happens from only a small amount of force, such as falling onto your wrist, lifting a bag of shopping, or falling from standing height.
Every year, more than 500,000 people need hospital treatment for fragility fractures, which are caused by osteoporosis. Fragility fractures are fractures that result from a fall from standing height or less.
Common Symptoms
Symptom information is not available for this condition yet.
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
Losing some bone density is a normal part of getting older. In some people, though, bone density drops much faster than usual, and this can lead to osteoporosis and a higher chance of fractures.
Women lose bone quickly during the first few years after menopause, which is why women face a higher risk of osteoporosis than men, especially if menopause starts early (before age 45).
For most men, doctors cannot pinpoint an exact cause of osteoporosis. However, men with low levels of the male hormone testosterone do face a higher risk.
Other hormone related conditions that can trigger osteoporosis include:
- hyperthyroidism (an overactive thyroid gland)
- disorders of the adrenal glands, such as Cushing's syndrome
- disorders of the pituitary gland
- hyperparathyroidism (overactivity of the parathyroid glands)
Other risk factors
Several other factors are thought to raise the risk of osteoporosis and broken bones:
- a family history of osteoporosis
- a parent who had a hip fracture
- a body mass index (BMI) of 19 or less
- long term use of oral corticosteroid medicines, which can weaken bone strength
- having an eating disorder, such as anorexia or bulimia
- heavy drinking and smoking
- rheumatoid arthritis
- coeliac disease and Crohn's disease, both of which make it harder for the body to digest or absorb nutrients from food
- certain medicines used to treat breast cancer and prostate cancer, since these affect hormone levels
- long periods of inactivity, such as extended bed rest
You can read more about who is at risk of osteoporosis and broken bones on the Royal Osteoporosis Society website.
Diagnosis
If your doctor suspects you have osteoporosis, they can assess your risk using an online tool such as FRAX or Q-Fracture.
If you are between 40 and 90 years old, these tools help predict your risk of a fracture in the hip, spine, shoulder or forearm.
Both the public and healthcare professionals can use the FRAX tool.
DXA scan
Your doctor may also refer you for a DXA (DEXA) scan to measure your bone mineral density. It is a painless procedure that takes 5 to 10 minutes, depending on the part of the body being scanned.
Your bone density is compared with that of a healthy young adult. The difference is calculated as a standard deviation (SD) and is called a T score.
Your score will tell you whether your bone density is normal, whether you have osteopenia, or whether you have osteoporosis. Your doctor can explain this to you along with your results.
If your bone density is lower than normal, but not low enough to be classed as osteoporosis, you might be diagnosed with osteopenia.
Treatment
Treating osteoporosis
Treatment for osteoporosis includes:
- treating and preventing fractures
- taking medication to strengthen bones
The decision about whether you need treatment depends on your risk of fracture.
If you need treatment, your doctor can suggest the safest and most effective treatment plan for you.
Medication for osteoporosis
A number of different medications are used to treat osteoporosis. Your doctor will discuss the treatments available and make sure the medicines are right for you.
Bisphosphonates slow down the rate at which bone is broken down in your body. This maintains bone density and reduces the risk of fracture.
There are a number of different bisphosphonates, including
- alendronate
- ibandronate
- risedronate
- zolendronic acid
They’re given as a tablet or injection.
Read the leaflet that comes with your medicine for information about dosage and possible side effects.
Strontium ranelate appears to have an effect on both the cells that break down bone and the cells that create new bone (osteoblasts).
It can be used as an alternative treatment if bisphosphonates are unsuitable. Strontium ranelate is taken as a powder dissolved in water.
The main side effects of strontium ranelate are nausea and diarrhoea. A few people have reported a rare severe allergic reaction to the treatment. If you develop a skin rash while taking strontium ralenate, stop taking it and speak to your doctor immediately.
SERMs are medications 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 that’s available for treating osteoporosis. It’s taken as a tablet every day.
Side effects associated with raloxifene include:
- hot flushes
- leg cramps
- a potential increased risk of blood clots
Parathyroid hormone is produced naturally in the body. It regulates the amount of calcium in bone.
Parathyroid hormone treatments (human recombinant parathyroid hormone or teriparatide) are used to stimulate cells that create new bone (osteoblasts). You inject it yourself daily.
While other medication 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 aren’t working.
Nausea and vomiting are common side effects of the treatment. Parathyroid hormone treatments should only be prescribed by a specialist.
Romosozumab is a type of medication called a monoclonal antibody. You inject it yourself every month for 12 months. It helps the cells that build bone whilst slowing the cells that breakdown bone.
It’s suitable for you if you have severe osteoporosis with a high risk of further fractures.
Calcium is the main mineral found in bone. Having enough calcium as part of a healthy, balanced diet helps keep bones healthy.
For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day. Most people should be able to get this from a varied diet that contains good sources of calcium.
However, if you have osteoporosis you may need more calcium, which will usually be in the form of supplements. Ask your GP for advice about taking calcium supplements.
You need vitamin D to help your body absorb calcium. There aren’t many foods that contain vitamin D, so it’s difficult to get enough from diet alone. A main source of vitamin D is sunlight.
More information on Vitamin D
Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause.
HRT can also help to maintain bone density and reduce the risk of fracture during treatment.
However, HRT isn’t specifically recommended for treating osteoporosis and it isn’t often used for this purpose. When prescribed for this purpose, it is used around the time of the menopause for up to 5 years.
Read the leaflet that comes with your medicine for information about dosage and possible side effects.
In men, testosterone treatment can be useful when osteoporosis is caused by low levels of testosterone.
Prevention
Your genes play a big role in deciding how tall you are and how strong your skeleton is, but everyday habits like diet and exercise matter too, and they shape how healthy your bones stay over the years.
If you're at risk of developing osteoporosis, it's worth taking a few simple steps to look after your bones. This includes:
- getting regular exercise
- eating well, with plenty of foods rich in calcium and vitamin D
- making lifestyle changes, such as quitting smoking and cutting down on alcohol
Read more about healthy bones on the Royal Osteoporosis Society website.
Complications
If you're diagnosed with osteoporosis, there are steps you can take to lower your chances of a fall, such as:
- removing hazards from your home
- having regular eye examinations and hearing tests
More information on preventing falls
To help you recover from a fracture, you can try:
- hot and cold treatments like warm baths and cold packs
- a TENS unit, a small battery operated device that eases pain by stimulating the nerves
- relaxation techniques
Talk to your doctor or nurse if you're worried about living with a long term condition. They can help answer any questions you have.
You may also find it helpful to talk to a trained counsellor or psychologist, or to other people living with the condition.
The Royal Osteoporosis Society can put you in touch with local support groups.
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