Osteoporosis
Also known as Brittle bone disease, Low bone density
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is osteoporosis?
Osteoporosis is a condition of reduced bone density and disrupted bone architecture that makes fractures far more likely, particularly of the hip, spine and wrist. It is silent until a fracture occurs. Hip fracture in older adults carries substantial mortality, so identifying and treating high risk people before that first fracture is the central goal.
Causes
- Age related imbalance between bone resorption and formation
- Oestrogen loss after menopause
- Long term corticosteroid therapy
- Vitamin D and calcium deficiency
- Overactive thyroid or parathyroid disease
- Malabsorption from coeliac or inflammatory bowel disease
Symptoms
- No symptoms until a fracture occurs
- Fracture from a fall from standing height or less
- Loss of height over time
- Stooped posture from vertebral compression
- Sudden back pain from a vertebral fracture
- Reduced mobility and independence after fracture
Risk factors
- Female sex and postmenopausal status
- Age over 65
- Previous fragility fracture
- Parental hip fracture
- Long term steroid use
- Smoking and excess alcohol
- Low body weight and physical inactivity
Diagnosis
- DXA scan measuring bone mineral density
- T score of minus 2.5 or below defining osteoporosis
- FRAX or similar fracture risk assessment tool
- Blood tests for calcium, vitamin D, thyroid and coeliac disease
- Spinal imaging for suspected vertebral fracture
Treatment
- Weight bearing and resistance exercise
- Adequate calcium and vitamin D intake
- Bisphosphonates such as alendronate as usual first line
- Denosumab as an alternative, with careful planning around stopping
- Anabolic agents such as teriparatide for severe disease
- Falls risk assessment and home safety review
- Smoking cessation and alcohol reduction
Self care
- Do weight bearing and resistance exercise regularly
- Ensure adequate calcium and vitamin D intake
- Stop smoking and limit alcohol
- Remove home trip hazards and improve lighting
- Have eyesight checked and review medicines that cause dizziness
- Take bone medicines exactly as directed, including posture rules
- Include balance work such as tai chi to reduce falls
When to see a doctor
Book an appointment if:
- A fracture from a fall at standing height or less
- Loss of height or a developing stooped posture
- Sudden back pain in an older adult
- Long term steroid treatment, to assess bone risk
- Early menopause before 45
- To review treatment after several years
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Build bone mass through activity and nutrition in youth
- Continue weight bearing exercise through life
- Maintain calcium and vitamin D intake
- Do not smoke and limit alcohol
- Assess bone health at menopause and with steroid use
- Prevent falls through strength, balance and home safety
Outlook
Osteoporosis itself is painless, and treatment substantially reduces fracture risk, typically by 30 to 70 percent depending on the drug and site. Most people who take bone protecting medicine avoid further fractures. Outcome is largely determined by preventing that first hip or spine fracture, since these carry significant loss of independence.
Common questions
Why is a fracture from a small fall significant?
A fracture from a fall at standing height or less is called a fragility fracture and signals underlying bone weakness. It substantially raises the risk of further fractures, so it should prompt assessment and treatment.
Is calcium supplementation enough on its own?
No. Calcium and vitamin D support bone health but do not by themselves reduce fracture risk meaningfully in people with osteoporosis. Specific bone protecting medicines are needed for that.
Do men get osteoporosis?
Yes, and it is underdiagnosed in men. Around one in five men over 50 will have a fragility fracture, and outcomes after hip fracture are generally worse in men than in women.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.