Osteoporosis is a medical condition causing bones to become weak and brittle. Over time, bones naturally lose their density, increasing their fragility and risk of fracture. However, in some people, this occurs faster than normal. Low bone density primarily affects older people and postmenopausal women.

In this guide:

What is osteoporosis?

Osteoporosis refers to a condition characterised by low bone density. The term means “porous bones.” It develops over several years as the bones become lighter and more brittle. Most people don’t notice any symptoms until they suffer a fracture – usually after a fall. The most common locations of fractures are the wrist, hip, and spinal bones (vertebrae).

Bone is a living tissue. It’s constantly being broken down and replaced. If the loss of old bone is higher than the creation of new bone, then your bone density begins to fall. Initially, this isn’t a problem. However, if left untreated, the risk of fractures continues to rise.

In the UK, osteoporosis affects approximately 2% of people over 50 and almost 50% of people over 80. Women are at greater risk of osteoporosis, especially after the decrease in oestrogen production following menopause.

Osteoporosis symptoms

Osteoporosis itself is asymptomatic. Most patients never notice any symptoms until after a fall. The most common symptoms include:

  • Bone fractures (common, even from minor falls)
  • Back pain (due to fractured or collapsed vertebrae)
  • Loss of height over time
  • Stooped posture
  • Weakened grip strength

In severe osteoporosis, the bones are so brittle that even a cough or sneeze can cause a broken rib. A stooped posture (bent forward) is also noticeable in older people when the bones of the spine are no longer able to support the weight of the body.

Causes of osteoporosis

Bone breakdown is a normal part of ageing. Everyone will undergo some bone density loss as they get old – men and women. Osteoporosis occurs when there is a severe imbalance between bone growth and breakdown for several years.

In women, oestrogen has a protective effect on bone density. However, during and after menopause, oestrogen levels begin to fall, accelerating the loss of bone density. Women with relatively low bone density for their age are at greater risk of developing osteoporosis after this point. Decreased testosterone in older men is another potential factor.

Risk factors for osteoporosis

Certain factors can increase your risk of developing osteoporosis. While some of these factors can’t be changed, others can be modified to lower your risk.

Non-modifiable Risk Factors:

  • Ageing (50+)
  • Female gender
  • Menopause
  • Family history of osteoporosis
  • Medical conditions (e.g., rheumatoid arthritis, thyroid issues)

Modifiable Risk Factors:

  • Low calcium/vitamin D intake
  • Sedentary lifestyle
  • Smoking
  • Excessive alcohol consumption
  • Low body weight or being underweight
  • Certain medications (e.g., corticosteroids)
  • Hormonal imbalances (e.g., low oestrogen/testosterone)

How is osteoporosis diagnosed?

People who are considered at high risk of osteoporosis should undergo a routine bone density assessment. Unfortunately, osteoporosis symptoms usually mean it’s impossible to catch early.

Your bone density is measured by a DEXA scan. It stands for dual-energy X-ray absorptiometry. This special X-ray machine determines your bone density, confirming if you have osteoporosis. During the test, you lie on your back as the scanner analyses specific areas – usually the hip and spine.

After the scan, you receive a T-score. It compares your bone density to the normal level for a healthy young adult of your sex.

If your score is:

  • -1 and above. Your bone density is normal
  • Between -1 and 2.5. Your bone density is below normal and may lead to osteoporosis – known as osteopenia.
  • -2.5 and below. Your bone density indicates you have osteoporosis.

You may also receive a Z-score. This score compares your bone density to the normal level for someone of your age, sex, weight, and ethnic or racial origin. It helps your doctor evaluate your T-score.

Osteoporosis treatment

The standard osteoporosis treatment is medication. These medications help prevent bone loss or activate your bone-making cells to restore some lost bone.

Bisphosphonates

According to NICE, the first-line treatments are bisphosphonates (alendronate and risedronate are the most commonly prescribed). Bisphosphonates help slow bone loss and reduce fracture risk. Zoledronic acid is the preferred option if the initial bisphosphonates aren’t tolerated.

You should take bisphosphonates on an empty stomach with a full glass of water. This medication takes 6 to 12 months to work.

Other Medications

If bisphosphonates aren’t well tolerated, you may be prescribed either:

  • Teriparetide. Usually prescribed if a woman has already had a fracture, it mimics the effect of oestrogen, gradually reversing the effects of bone breakdown.
  • Denosumab. Given as an injection twice a year, it is an alternative for postmenopausal women.
  • Romozumab. NICE recommends this as a treatment for women who’ve been through menopause and are at severe risk of fracture.

In addition to these medications, calcium and vitamin D tablets are prescribed, especially for those with limited sunlight exposure.

Hormone Replacement Therapy

Hormone replacement therapy, or HRT, is another option for younger postmenopausal women. It mitigates the drop in oestrogen levels, reduces the risk of fragility fractures and provides relief of menopausal symptoms.

Preventing osteoporosis

Osteoporosis is a preventable condition. The NHS advises several preventative activities:

  • Regular exercise. Do at least 2.5 hours of moderate-intensity aerobic activity per week (e.g., cycling, brisk walking). That can include weight-bearing activities like running, aerobics, and dancing to help strengthen bones, muscles, and joints, or resistance exercises like strength training (e.g., weightlifting or press-ups) to improve bone density.
  • Vitamin D and Calcium: Get 10 micrograms daily from oily fish, fortified foods, or supplements to aid calcium absorption. Ensure 700mg of calcium per day from sources like dairy, leafy greens, or tofu.
  • Quit smoking
  • Limit alcohol: Stay within 14 units per week.
  • Sun exposure: Spend a short time in sunlight daily to boost vitamin D levels (especially in summer).

Further reading and resources

Get Faster Osteoporosis Care with Medefer

When your GP refers you to a specialist for osteoporosis, you can choose Medefer. Instead of waiting weeks, a consultant will review your case within 48 hours. If further tests are needed, Medefer will handle everything, from organising the tests to providing timely follow-up care.

Next time you need a non-urgent referral, ask for Medefer. Contact us at patients@medefer.com or call 08000 112 113.

Written by
Medefer team
Published On
November 1, 2024