What is Osteoporosis?
Osteoporosis is a condition in which bones become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. The word osteoporosis means "porous bone." In someone with osteoporosis, the holes and spaces inside the bone are much larger than in healthy bone.
Osteoporosis affects over 3 million people in the UK. It is more common in women — especially after the menopause — but men can also develop it. Fractures from osteoporosis most commonly occur in the hip, wrist, and spine.
Who is at Risk?
- Women after the menopause (oestrogen helps maintain bone density)
- Older adults
- People with a family history of osteoporosis or hip fractures
- Those who smoke or drink heavily
- People with low body weight
- Those with conditions such as rheumatoid arthritis, coeliac disease, or Crohn's disease
- Long-term use of corticosteroid medications
- People with low vitamin D or calcium levels
Symptoms
Osteoporosis is often called a "silent disease" because there are no symptoms until a fracture occurs. Signs that may suggest you have osteoporosis include a loss of height over time, a stooped posture, and back pain caused by fractured vertebrae.
Diagnosis
A DEXA (dual-energy X-ray absorptiometry) scan is used to measure bone density and diagnose osteoporosis. A score below -2.5 indicates osteoporosis.
Treatment and Prevention
- Calcium and vitamin D supplements
- Bisphosphonate medications (e.g. alendronic acid) — the most commonly prescribed drugs for osteoporosis
- Weight-bearing and resistance exercise — strengthens bones
- Quit smoking and reduce alcohol intake
- Fall prevention — home safety modifications, balance exercises
- Hormone replacement therapy (HRT) — for some postmenopausal women
Osteoporosis and arthritis: why they are linked
Osteoporosis and osteoarthritis are different conditions, but people with arthritis can be at higher risk of osteoporosis. Inflammatory conditions such as rheumatoid arthritis, lupus and ankylosing spondylitis can weaken bones through ongoing inflammation. Steroid tablets, often used to control flares, are one of the most important medicine-related causes of bone loss. Pain and reduced mobility can also mean less weight-bearing activity, which bones need to stay strong.
Assessing your fracture risk
Osteoporosis usually has no symptoms until a bone breaks, so assessment focuses on your risk. Your GP may use a risk calculator such as FRAX or QFracture, which takes into account your age, sex, weight, previous fractures, family history, smoking, alcohol, steroid use and conditions such as rheumatoid arthritis. Depending on the result, you may be offered a DEXA scan, a quick, painless scan that measures bone density, usually at the hip and spine. Ask your GP about a bone health check if you have had a fracture from a minor fall, take long-term steroids, or have inflammatory arthritis.
Bone-protecting medicines
If your fracture risk is high, your GP or specialist may recommend a medicine to strengthen bones. The most common are bisphosphonates, such as alendronic acid, taken as a weekly tablet on an empty stomach with specific instructions, or given yearly as an infusion. Other options include denosumab injections and, for people at very high risk, medicines that help build new bone. Calcium and vitamin D supplements are often given alongside. Your team will explain the benefits and possible side effects, including rare jaw and thigh bone problems, and how long treatment should last. Always take these medicines exactly as advised, and do not stop denosumab without a plan, as bone loss can rebound quickly.
Exercise for stronger bones
Bones respond to load. A mix of weight-bearing exercise, muscle strengthening and balance training helps keep bones strong and reduces falls.
- Weight-bearing activity such as brisk walking, dancing or stair climbing, adapted to your joints.
- Strength exercises at least twice a week, using body weight, resistance bands or weights.
- Balance exercises such as tai chi or standing on one leg near support, to lower the risk of falls.
- If you have had spinal fractures, ask a physiotherapist which movements to avoid, such as heavy forward bending with twisting.
Food, vitamin D and lifestyle
Everyday habits make a real difference to bone strength over time.
- Eat calcium-rich foods such as dairy products, calcium-fortified plant milks, tinned fish with bones, tofu and green leafy vegetables.
- Consider a daily vitamin D supplement in autumn and winter, as recommended for everyone in the UK, or all year if you rarely go outdoors.
- Get enough protein to support muscles and bones.
- Stop smoking and keep alcohol within UK low-risk guidelines.
- Keep to a healthy weight; being underweight increases fracture risk.
Preventing falls
Most fractures happen after a fall, so reducing falls matters as much as bone strength. Remove trip hazards, improve lighting, use grab rails, wear well-fitting shoes, have your eyesight checked, and ask for a medicines review if any make you dizzy. Your GP can refer you to a falls prevention service if you have fallen or feel unsteady.
About this page
Written by Louis Maxwell, First Contact Practitioner (HCPC PH128483), and pending clinical review. This is general information, not a diagnosis. Always follow the advice of your own GP, physiotherapist or rheumatology team. For emergencies call 999; for urgent advice use NHS 111.