Osteoporosis

Osteoporosis is a condition where the bones become less dense, or thinner. This makes them fragile and more likely to break. It develops slowly over several years, and it's often only diagnosed when a minor fall or a sudden impact causes a bone to fracture.

The most common fractures in people with osteoporosis are:

• wrist fractures
• hip fractures
• fractures of the spinal bones (vertebrae)

Fractures can also happen in other bones, such as in the arm or pelvis. Rarely, a cough or a sneeze can cause a rib fracture, or a partial collapse or fracture of one of the bones of the spine.

Osteoporosis isn't usually painful until a fracture occurs. Spinal fractures, though, can be a common cause of long-term (chronic) pain.

A fracture is normally the first sign of the condition. Some older people may also develop a stooped (bent forward) posture. This happens when several bones in the spine have fractured, which makes it difficult for your spine to support the weight of your body.

Osteoporosis affects over 3 million people. Half of women over 50 years and 1 third of men over 60 years of age will have a low trauma fracture because of osteoporosis.

A low trauma fracture is a fracture that happens from minimal force, such as:

• falling onto your wrist
• picking up a bag of shopping
• falling from a standing height

Over 500,000 people need hospital treatment every year for fragility fractures, and osteoporosis causes these. Fragility fractures are fractures that occur from standing height or less.

Losing bone density is a normal part of getting older. Some people lose it much faster than normal, though, and that can lead to osteoporosis and a higher risk of fractures.

Women lose bone quickly in the first few years after the menopause. They are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45).

In most cases, nobody knows what causes osteoporosis in men. The risk is higher in men who have low levels of the male hormone testosterone.

Other hormone-related conditions can also trigger osteoporosis. These include:

• hyperthyroidism (overactive thyroid gland)
• disorders of the adrenal glands, such as Cushing's syndrome
• disorders of the pituitary gland
• hyperparathyroidism (overactivity of the parathyroid glands)

Several other things are thought to raise the risk of osteoporosis and broken bones:

• a family history of osteoporosis
• a parent who has had a hip fracture
• a body mass index (BMI) of 19 or less
• long-term use of oral corticosteroids, which can affect bone strength
• an eating disorder, such as anorexia or bulimia
• heavy drinking and smoking
• rheumatoid arthritis
• Coeliac disease and Crohn's disease, where people have difficulty digesting or absorbing nutrients from food
• some medicines used to treat breast cancer and prostate cancer, which affect hormone levels
• long periods of inactivity, such as long-term bed rest

You can read more about who's at risk of osteoporosis and broken bones on the Royal Osteoporosis Society website.

If your doctor suspects you have osteoporosis, they can assess your risk using an online programme such as FRAX or Q-Fracture. If you're between 40 and 90, 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.

Your doctor may also send you for a DXA (DEXA) scan to measure your bone mineral density. It doesn't hurt, and it takes 5 to 10 minutes, depending on which part of the body is being scanned.

Your bone density is then compared with that of a healthy young adult. The difference is worked out as a standard deviation (SD) and is called a T score.

Your score shows whether your bone density is normal, whether you have osteopenia, or whether you have osteoporosis. Your doctor can go through it with you when you get your results.

If your bone density is lower than normal, but not low enough to count as osteoporosis, you might be diagnosed with osteopenia.

Treatment for osteoporosis includes:

• treating and preventing fractures
• taking medicine to strengthen bones

Whether you need treatment depends on your risk of fracture. If you do need it, your doctor can suggest the safest and most effective plan for you.

Several different medicines are used to treat osteoporosis. Your doctor will go through the options with you and make sure the medicines suit you.

Bisphosphonates slow down the rate at which your body breaks down bone. This helps keep bone density up and lowers the risk of fracture.

There are a number of bisphosphonates, including

• alendronate
• ibandronate
• risedronate
• zolendronic acid

They're given as a tablet or an injection. Read the leaflet that comes with your medicine for details about the dose and possible side effects.

Strontium ranelate seems to act on both the cells that break down bone and the cells that create new bone (osteoblasts). Doctors can use it as an alternative if bisphosphonates are unsuitable for you. You take it 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 it. If you get a skin rash while taking strontium ranelate, stop taking it and speak to your doctor immediately.

SERMs are medicines that act on bone in a similar way to the hormone oestrogen. They help keep bone density up and lower the risk of fracture, particularly of the spine. Raloxifene is the only SERM available for treating osteoporosis, and you take it as a tablet every day.

Side effects linked to raloxifene include:

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

Parathyroid hormone is made naturally in your body, and it regulates the amount of calcium in bone. Parathyroid hormone treatments (human recombinant parathyroid hormone or teriparatide) are used to stimulate the cells that create new bone (osteoblasts). You inject it yourself every day.

Other medicines can only slow down bone thinning, but parathyroid hormone can increase bone density. Even so, 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. Parathyroid hormone treatments should only be prescribed by a specialist.

Romosozumab is a type of medicine called a monoclonal antibody. You inject it yourself every month for 12 months. It helps the cells that build bone and slows the cells that break bone down. It's suitable for you if you have severe osteoporosis with a high risk of further fractures.

Calcium is the main mineral in bone. Getting enough of it as part of a healthy, balanced diet helps keep your bones healthy. For most healthy adults, the recommended amount is 700 milligrams (mg) of calcium a day, and most people can get this from a varied diet with good sources of calcium. If you have osteoporosis, though, you may need more calcium, usually in the form of supplements. Ask your doctor for advice about taking calcium supplements.

You need vitamin D to help your body absorb calcium. Not many foods contain vitamin D, so it's hard to get enough from diet alone. One main source of vitamin D is sunlight.

Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause. It can also help keep bone density up and lower the risk of fracture while you're on treatment. However, HRT isn't specifically recommended for treating osteoporosis and it isn't often used for this. When it is prescribed for this purpose, it's 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.

Your genes decide your height and how strong your skeleton is, but lifestyle factors such as diet and exercise affect how healthy your bones are.

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

• taking regular exercise
• healthy eating, including foods rich in calcium and vitamin D
• making lifestyle changes, like stopping smoking and reducing how much alcohol you drink

You can read more about healthy bones on the Royal Osteoporosis Society website.

If you're diagnosed with osteoporosis, there are things you can do to reduce your chances of a fall, like:

• 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 using:

• hot and cold treatments like warm baths and cold packs
• a TENS unit, where a small battery-operated device is used to reduce pain by stimulating the nerves
• relaxation techniques

Speak 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 with the condition. The Royal Osteoporosis Society can put you in touch with local support groups.