Osteoporosis

Osteoporosis develops when your bone density decreases. Your body reabsorbs more bone tissue and produces less to replace it. Osteoporosis causes your bones to deteriorate and become porous, which raises the risk of fractures.

Bone that is spongy or porous is referred to as osteoporosis. Minerals, primarily calcium salts, are what make up bone and are held together by robust collagen fibres. Known as cortical or compact bone, this thick, hard outer layer of our bones is clearly seen on X-rays. Trabecular bone, a softer, spongier bone mesh with a honeycomb-like structure, is contained within this.

A healthy bone has tiny openings throughout this honeycomb structure. Osteoporosis causes these holes to get larger, which reduces the bone's density and strength. The outside of the bone also becomes thinner and weaker.

Bone is a dynamic, living tissue that constantly regenerates. Osteoclasts, which break down old bone tissue, are then replaced by osteoblasts, which create new bone tissue.

At various times throughout our lifetimes, the ratio of bone production to bone resorption fluctuates.

• When a person is young and growing, new bone forms quite quickly. Consequently, our bones might enlarge and become more robust (denser). By our mid-to late-20s, bone density peaks
• After that, the production of new bone occurs at roughly the same rate as the decomposition of the existing bone. Therefore, the adult skeleton undergoes a complete renewal process over a period of 7-10 years
• After age 40, the bone starts to break down more quickly than it is rebuilt, which causes our bones to gradually lose density

As we age, we all experience some bone loss, but osteoporosis is only referred to when the bones become brittle in nature. A bone damaged by osteoporosis has greater pores in the honeycomb structure and a lower overall density, which increases the risk of fracture.

Osteoporosis symptoms develop gradually, and you might not be aware that you have the condition until you suffer a fracture or break following a relatively small incident, such as a fall. Severely osteoporotic bones can break even with a cough or sneeze.

People with osteoporosis frequently break their wrists, hips, or spinal vertebrae. A spinal vertebral break may cause a stoop, abnormalities in posture, or a curvature of the spine. A drop in height or a change in how well clothing fits are other potential osteoporosis symptoms.

There typically are no symptoms in the early stages of osteoporosis. But once your bones have been weakened, you might have signs and symptoms of osteoporosis that include:

• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone that breaks much more easily than expected

Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of:

• Minor falls, such as a fall from a standing height that would not normally cause a break in a healthy bone
• Normal stresses such as bending, lifting, or even coughing

If you don't have symptoms of osteoporosis but have a family history of the condition, a private consultation can help you assess your risk.

Osteoporosis and joint pain

In our Joint Pain Matters survey, we asked people with osteoporosis to share their experience of joint pain. We found that:

• 34.89% of our respondents diagnosed with osteoporosis reported they suffered from pain in their hands and wrists
• 39.848% of our respondents diagnosed with osteoporosis reported they suffered from pain in their knees
• 34.47% of our respondents diagnosed with osteoporosis reported they suffered from pain in their back
• 33.27% of our respondents diagnosed with osteoporosis reported they suffered from pain in their necks

Bone deterioration is a typical aspect of ageing, although some people lose bone much more quickly than usual. Osteoporosis and an elevated risk of broken bones can result from this.

Your bone mass from your youth has a bearing on how likely you are to develop osteoporosis. Peak bone mass varies by ethnic group and is partly hereditary. The more bone you have "in the bank" and the higher your peak bone mass, the less likely it is that you will get osteoporosis as you get older.

Additionally, women lose bone quickly in the initial years following menopause. In particular, if menopause starts early (before the age of 45) or a woman has had her ovaries removed, she is more likely to develop osteoporosis than a man.

However, males, younger women and children can also develop osteoporosis. Your age, race, lifestyle choices, existing medical issues, and undergoing certain treatments are just a few of the variables that can make you more likely to develop osteoporosis.

Many people who have osteoporosis have several risk factors, but not everyone who has the disease does. You may be able to change some risk factors, while you cannot change others. You might be able to avoid the disease and fractures, though, by being aware of these factors.

Many other factors can also increase the risk of developing osteoporosis, including:

• Taking high-dose steroid tablets for more than 3 months
• A family history of osteoporosis - particularly a hip fracture in a parent
• Long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets that many women take after breast cancer
• Having or having had an eating disorder such as anorexia or bulimia
• Having a low body mass index (BMI) - classed as being 19 or under
• Not exercising regularly
• Heavy drinking and smoking
• Ethnicity
• Previous fractures
• Rheumatoid arthritis
• Medical conditions such as coeliac disease (or sometimes treatments) that affect the absorption of food

Hormonal conditions that can lead to osteoporosis

The body's hormones have a large impact on bone turnover. You may be more likely to develop osteoporosis if you have a disorder of the hormone-producing glands.

• Overactive thyroid gland (hyperthyroidism)
• Reduced amounts of sex hormones (oestrogen and testosterone)
• Disorders of the pituitary gland
• Overactivity of the parathyroid glands (hyperparathyroidism)

Senile osteoporosis

You might be familiar with the term 'senile osteoporosis'. This is simply osteoporosis that is brought on by ageing when other potential secondary causes are ruled out; it is not a different form.

As already noted, one of the main risk factors for osteoporosis is age. Your body's increasing bone loss may result in osteoporosis and weakening bones if suitable prevention or treatment measures are not taken.

Approximately one-tenth of women in their 60s and two-fifths of those in their 80s worldwide have osteoporosis, according to data from the International Osteoporosis Foundation.

If you are at risk of osteoporosis, your initial consultation will probably be with a consultant rheumatologist, though you might see an orthopaedic specialist instead.

Your consultant will start by taking a detailed medical history and perform a short physical examination to look for osteoporosis. In order to look for disorders that could lead to bone loss, they might also perform blood and urine tests on you. A doctor will also take into account any risk factors and family history.

Your doctor will likely recommend a bone densitometry or DEXA (dual energy x-ray absorptiometry) scan, also known as a bone density test or bone mineral density scan, if they suspect you have osteoporosis or are at risk of developing it.

Dual-energy X-ray absorptiometry, a form of X-ray, is used for bone density scanning (DEXA).. It measures the density of the bones in your wrists, hips, or spine using X-rays. These three regions are particularly prone to osteoporosis.

You lie on a comfortable surface during this painless examination as a scanner moves over your body. Typically, only a few bones - usually the hip and spine - are examined. This painless test can take from 10 to 30 minutes.

Two types of devices can carry out a DEXA scan:

• A central device: You will lie on a table during this hospital-based scan to test the bone mineral density of the hip and spine
• A peripheral device: This portable device analyses bone in the finger, heel, or wrist

Why is bone density checked?

Doctors use bone density testing to:

• Identify decreases in bone density before you break a bone
• Determine your risk of broken bones (fractures)
• Confirm a diagnosis of osteoporosis
• Monitor osteoporosis treatment

Your bones are denser the higher their bone mineral composition. Additionally, bones tend to be stronger and less prone to break the denser they are. The possible results of bone density checks are:

Normal - Your risk of a low-impact fracture is likely to be low.

Osteopenia - Although your bone is weakening, the likelihood of a low-impact fracture is minimal. Depending on your other risk factors, you may or may not need therapy. How you might lower your risk factors should be discussed with your doctor.

Osteoporosis - You have a greater risk of low-impact fractures and you may need treatment. You should discuss this with your doctor.

DEXA test results

Doctors give the results of the test as a DEXA T score or a Z score.

You can compare your bone mineral density to that of a healthy young adult and someone your own age and sex. The difference is measured as a T score, which is a standard deviation (SD) calculation.

Standard deviation is a measure of variability based on an average or expected value. A T score of:

• -1.0 or above is normal or shows good bone strength
• -1.1 to -2.5 suggests mild bone loss (osteopenia), defined as decreased bone mineral density compared with peak bone mass
• -2.5 or below indicates osteoporosis

The Z score compares the bone mass with that of other people of a similar build and age.

A doctor will typically repeat the test every 2 years as this allows them to compare results.

H3: People with certain risk factors for osteoporosis

There isn't enough support to say that it would be beneficial to screen everyone for osteoporosis. However, if any of the following apply to you, you should speak with your doctor about getting a scan:

• You've already had a low-impact fracture
• You need steroid treatments for 3 months or more
• You had early menopause (before the age of 45)
• Either of your parents had a hip fracture
• You have a different medical condition that can impact your bones, such as coeliac disease, diabetes, rheumatoid arthritis, inflammatory bowel disease (Crohn's disease or ulcerative colitis), or hyperthyroidism (overactive thyroid)
• You have a body mass index (BMI) of less than 19

People showing symptoms of osteoporosis

Men can get osteoporosis, despite the fact that women are more prone to the condition. Your doctor might suggest a bone density test, regardless of your gender or age, if you've:

• Lost height - People who have lost at least 1.5 inches (3.8 centimetres) of height are at risk for compression fractures of the spine, one of the main causes of which is osteoporosis
• Fractured a bone - When a bone becomes too brittle, it breaks far more easily than is normal, leading to fragility fractures. An especially vigorous cough or sneeze may occasionally result in fragility fractures
• Taken certain drugs - Long-term use of steroid medications, such as prednisone, interferes with the bone-rebuilding process - which can lead to osteoporosis
• Had a drop in hormone levels - In addition to the normal decline in hormones that follows menopause, several cancer treatments can cause a decrease in oestrogen in women. Male testosterone levels can be decreased by several prostate cancer therapies. Bone is weakened by lower sex hormone levels

CT Scan

Through computer processing, cross-sectional images (slices) of the bones inside your body are produced during a computerised tomography (CT) scan, which combines a number of X-ray images obtained from various angles all over your body. Images from a CT scan offer more information than an X-ray would.

A CT scan can be used for a variety of purposes, but it works especially well for quickly examining patients who might have internal fractures or other sorts of injuries. Nearly all body areas may be seen on a CT scan, which is also used to diagnose osteoporosis and make treatment decisions.

Ultrasound scanning

The imaging technique of diagnostic ultrasound, also known as sonography or diagnostic medical sonography, uses sound waves to create images of the internal organs and other structures in your body. To diagnose and guide treatment for many illnesses and conditions, such as osteoporosis, bone abnormalities, or bone fragility, the images can be a valuable resource.

While certain ultrasound exams require inserting a tiny device into your body, most ultrasound examinations use ultrasound equipment that is outside of your body.

Another technique that clinicians use to evaluate osteoporosis is an ultrasound scan of the heel bone, which can be done in a primary care setting. Since the measurements cannot be compared to DEXA T scores, it is less frequently taken than DEXA.

Osteoporosis treatment typically involves using medications to strengthen your bones, and we also focus on treating and preventing fractures.

Although the findings of your bone density scan are used to get an osteoporosis diagnosis, your consultant will take other factors into account when deciding if you need treatment, and if so which treatment is best for you. For example:

• Your age
• Your sex
• Your risk of breaking a bone
• Your previous injury history

Even if you have osteoporosis and have already broken a bone, you should still seek treatment to lower your chance of doing so again in the future.

If the results of your testing indicate that you have osteoporosis, your consultant will work with you to develop an osteoporosis treatment plan. In addition to prescribing drugs, your doctor may advise lifestyle modifications. Among these lifestyle adjustments are getting enough exercise and increasing your calcium and vitamin D intake.

Osteoporosis cannot be totally cured, but effective osteoporosis treatment can help safeguard and strengthen your bones. Some of these therapies can encourage the growth of new bone while others can assist decrease the loss of bone in your body. Your specific situation will determine your treatment, so talk to your doctor about what's best for you.

The likelihood that you will break a bone during the next 10 years is estimated using data from tests like the bone density test. If your risk is low, treatment may not involve medication and may instead concentrate on reducing fall and bone loss risk factors.

However, a variety of medications are used to treat osteoporosis (and sometimes osteopenia). Your doctor will go over the possible osteoporosis treatments with you and ensure that the medications are appropriate for you.

Bisphosphonates

Bisphosphonates are the most common and widely prescribed medications used to treat osteoporosis or men and women who have an increased risk of fracture. By decreasing the rate at which bone is broken down in your body, bisphosphonates are used to stop the loss of bone mass. You have a lower chance of fractures and broken bones as a result of maintaining bone density.

Bisphosphonates may be taken orally via tablet or liquid, or by injection.

They usually take six to 12 months to work, and you may need to take them for five years or longer. Additionally, you can be given calcium and vitamin D supplements to take separately from the bisphosphonate.

Hormone replacement therapy (HRT)

Women going through menopause might take HRT to help manage symptoms. Oestrogen can support bone density maintenance, particularly when started soon after menopause. HRT has also been shown to maintain bone density and lower the chance of developing osteoporosis. It can strengthen your bones and lower your chance of fracturing a bone if you already have osteoporosis.

You will typically be advised to use HRT or hormonal contraception until at least age 51 if you have early menopause, which is when your periods stop before the age of 45. Oestrogen levels rise as a result, helping to shield you from osteoporosis and other conditions.

Your age, symptoms, and other risk factors you may have will determine whether HRT is the correct choice for you. The advantages of HRT typically outweigh the risks if you're under 60 and experiencing menopause symptoms.

Testosterone treatment

When insufficient production of male sex hormones results in osteoporosis in males, testosterone therapy may be beneficial.

For men, osteoporosis might be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone.

Raloxifene

This medication has been found to offer the benefits of oestrogen without many of the risks, although there is still an increased risk of blood clots.

Raloxifene is a selective oestrogen receptor modulator (SERM). SERMs are medicines 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 available for treating osteoporosis. It's only recommended for women, after menopause. It is taken as a daily tablet.

Biological or 'bone-building' medications

Biological medicines are made from proteins or other substances produced by the body.. If you have severe osteoporosis or if the more common treatments for osteoporosis such as bisphosphonates don't work well enough or you are unable to take them, your doctor might suggest trying biological medicines.

They function by increasing the rate at which your cells make new bone while decreasing the rate at which your bones are broken down. You will typically need to take another osteoporosis medicine to maintain the new bone growth after stopping any of these bone-building medications.

Calcium and vitamin D supplements

The primary mineral present in bones is calcium, so eating a diet high in calcium as part of a healthy, balanced diet is crucial for keeping strong bones.

The recommended daily calcium intake for most healthy adults is 700 milligrams (mg), which most people should be able to get via a varied diet that includes calcium-rich foods. But if you have osteoporosis, you might require additional calcium - typically in the form of supplements.

Your body needs vitamin D in order to properly absorb calcium. A daily dose of 10 micrograms of vitamin D is recommended for adults. The majority of healthy persons in the UK get their vitamin D from getting sun exposure throughout the summer. The majority of people should be able to acquire all the vitamin D they require from sunlight on their skin from late March or early April to the end of September.

In the autumn and winter, however, everyone (including pregnant and breastfeeding women) should think about taking a daily supplement containing 10 micrograms of vitamin D because it might be difficult to receive enough of the vitamin through food or diet alone. Supplementing with 10 micrograms of vitamin D per day (400 international units [IU]) is advised for those who are at risk of not getting enough vitamin D to avoid deficiency.

People over 65, those who cover their skin for cultural reasons, those who are housebound, and those who spend a lot of time indoors are among the at-risk demographics. Your doctor might offer pills with a higher dose than the one above if it turns out you don't get enough vitamin D.

Exercise is very important to support the health of your bones, especially weight-bearing exercises.

Weight-bearing exercises are performed with either your feet or your arms fixed to the ground or another surface. Examples include:

• climbing stairs
• resistance training, such as leg presses, squats or pushups
• weight training, such as working with resistance bands, dumbbells or resistance exercise machines

These workouts are beneficial because they make your muscles contract and relax in opposition to your bones. Your body will be instructed to create new bone tissue as a result, strengthening your bones.

Exercise offers you more advantages than only this, though. Exercise has numerous benefits for your weight, heart health, and balance and coordination, which can help you stay upright and prevent falls.

You should always speak to your consultant or a physiotherapist before starting any new exercise plan, especially if you are living with a condition such as osteoporosis.

We offer private physiotherapy sessions across our 50+ UK hospitals, where a highly trained specialist will work with you to develop a tailored exercise plan that can help you to support your bones, build muscle and improve posture, and much more.

We answer your commonly asked questions about osteoporosis.

Does osteoporosis make you tired?

Usually, when people think about osteoporosis, they picture brittle bones and the risks that come with them. However, osteoporosis can affect many elements of your life and cause a variety of unpleasant symptoms.

Although weariness isn't the most common complaint among those with osteoporosis, it can nevertheless occur as your body works to keep their bones healthy. The source of the weariness, however, is not always obvious; occasionally, another ailment other than osteoporosis is to blame.

Is osteoporosis a terminal illness?

No. Although the likelihood of dying varies depending on the type of fracture, the majority of people with osteoporosis and fractures associated with the disease do not pass away as a direct result of their condition.

Many people with osteoporosis can maintain a healthy lifestyle and prevent accidental bone fractures. If you've had fractures, it's crucial to understand what you can do to keep up a high standard of living. However, the signs of a broken bone and the loss of freedom and function are likely to drastically reduce your quality of life.

Is osteoporosis hereditary?

Osteoporosis runs in families. According to experts, your genes will have an influence on roughly 75% of the maximal bone mass you will reach between the ages of 18 and 25.

Your risk of fracture is likely to be higher than average if a close relative has experienced an osteoporotic fracture. You may need to undergo an osteoporosis screening early if one of your parents has ever broken a bone, particularly a broken hip.

Talk to your consultant about the medical history of your family. They can advise you on steps you can take to strengthen weak bones and avoid breaking them.

If someone in your family suffers from osteoporosis, maintaining a healthy diet and doing weight-bearing exercises regularly is even more crucial for you.

What are osteoporosis symptoms?

Osteoporosis develops gradually, and a person may not be aware of their condition until they suffer a fracture or break following a relatively small incident, such as a fall. Osteoporotic bones can break even with a cough or sneeze.

People with osteoporosis frequently break their wrists, hips, or spinal vertebrae. A spinal vertebral break may cause a stoop, changes in posture, and a curvature of the spine. A drop in height or a change in how well clothing fits are other potential symptoms of osteoporosis that people could experience.

How to prevent osteoporosis

You have no control over many osteoporosis risk factors. Women, older age, and a family history of osteoporosis are a few of these. However, certain lifestyle changes can lower the risk of osteoporosis by looking after the health of your bones. This might involve:

• Taking regular exercise
• Healthy eating - including foods rich in calcium and vitamin D. Calcium is abundant in dairy products, which helps lower your risk of developing osteoporosis. Calcium is essential for bones. People should make sure they consume enough calcium daily
• Making lifestyle changes - such as giving up smoking and reducing your alcohol consumption

Is there an osteoporosis diet?

An appropriate diet, together with your osteoporosis treatment plan, can support the health of your bones. Your daily nutrient intake has a direct impact on the condition of your bones. The two that are most crucial are calcium and vitamin D. To keep your bones strong, your body requires calcium, and it also needs vitamin D to absorb calcium.

Protein, magnesium, vitamin K, and zinc are additional nutrients that support bone health.

Speak with your doctor to discover more about the best eating plan for you. They can provide you with dietary recommendations or suggest a qualified dietician who can design a diet or meal plan tailored for your bone health.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatment for osteoporosis, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in January 2023. Next review due January 2026.

1. Osteoporosis, NHS
2. Osteoporosis overview, NIH
3. What is osteoporosis, Versus Arthritis
4. What to know about osteoporosis, Medical News Today
5. Osteoporosis, Healthline