Osteoporosis and Bone Health

Osteoporosis is a condition that weakens bones, making them more fragile and more likely to break. It develops gradually and often causes no obvious symptoms. For many people, the first sign is a broken bone following a fall or an everyday movement that would not normally cause a fracture.

Osteoporosis can affect anyone, although the risk increases with age and is particularly common after the menopause. The wrists, hips and bones of the spine are among the areas most often affected.

This page explains the warning signs, risk factors, tests, treatments and practical steps that can help protect your bones.

Osteoporosis itself usually does not cause symptoms before a fracture happens. Bone loss is not something you can feel.

Possible signs or consequences can include:

• breaking a bone after a minor fall or everyday movement
• sudden or persistent back pain caused by a spinal fracture
• becoming shorter over time
• a curved or stooped posture
• reduced movement or independence following a fracture

Ordinary joint or muscle pain does not automatically mean that someone has osteoporosis. A GP can help work out what is causing it.

• Osteoporosis: bones have lost strength and are more likely to break.
• Osteopenia: bone density is lower than normal but has not reached the level used to diagnose osteoporosis.
• Osteoarthritis: a condition affecting joints. It is not the same as osteoporosis, although a person can have both conditions.

• increasing age
• menopause, especially an early menopause
• low levels of oestrogen or testosterone
• a parent who had osteoporosis or a hip fracture
• a previous fracture after a minor fall
• long-term or repeated use of steroid medicines such as prednisolone
• rheumatoid arthritis and certain hormonal or digestive conditions
• low body weight or poor nutrition
• smoking
• regularly drinking more alcohol than recommended
• limited physical activity
• frequent falls
• low calcium or vitamin D levels
• spending very little time outdoors
• some medicines and medical treatments

Having one or more of these risk factors does not mean someone definitely has osteoporosis. It simply means it may be worth discussing bone health with a GP.

It is worth arranging a GP appointment if someone:

• breaks a bone after a minor fall or ordinary movement
• has unexplained loss of height or a new stooped posture
• develops sudden or persistent back pain
• has taken steroid tablets for a prolonged period or regularly needs them
• had an early menopause
• has a strong family history of osteoporosis or hip fracture
• is concerned about several osteoporosis risk factors
• wants advice before starting supplements or a new exercise programme

Find a GP

A GP or specialist may:

• discuss fractures, medicines, menopause, family history and other risk factors
• use an approved fracture-risk assessment such as FRAX or QFracture
• arrange blood tests to look for contributing health problems
• consider a DEXA or DXA bone-density scan
• assess falls, balance and mobility when appropriate

A DEXA scan:

• is quick and painless
• uses a low dose of X-rays
• measures bone density, commonly at the hip and spine
• can help diagnose osteoporosis and guide treatment decisions

Results are interpreted alongside a person’s age, medical history and other risk factors. A score from a chart or an online calculator is not a diagnosis on its own, so always discuss the result with a healthcare professional.

Treatment depends on the person’s age, fracture history, bone density, overall fracture risk and other health conditions. Not everyone needs medication.

Treatment may include:

• medicines that slow bone loss, including bisphosphonates
• other osteoporosis medicines when clinically appropriate
• calcium or vitamin D supplements if needed
• treatment of an underlying medical cause
• strength, balance or physiotherapy support
• falls assessment and practical changes at home
• pain relief and rehabilitation after a fracture
• periodic reviews to check treatment, side effects and fracture risk

Decisions about medicines are made individually with a GP, pharmacist or specialist team who know the person’s full medical history.

• take regular weight-bearing activity appropriate to your ability
• include muscle-strengthening exercise
• work on balance to help reduce falls
• eat a balanced diet containing suitable sources of calcium
• get enough vitamin D
• avoid smoking
• keep alcohol within recommended limits
• have eyesight, hearing and medicines reviewed when falls are a concern
• keep floors, stairs and walkways clear and well lit
• wear supportive footwear
• seek individual advice if you already have osteoporosis, previous spinal fractures, severe pain or a high risk of falling

Walking is beneficial, but on its own it may not provide enough muscle-strengthening exercise. Adding activities that work the muscles, such as resistance bands, light weights or stair climbing, can help.

Exercise and diet support bone health, but they do not replace prescribed osteoporosis treatment where treatment is needed.

Vitamin D helps the body absorb calcium, and both are important for healthy bones. In the UK, most people should consider taking 10 micrograms of vitamin D each day during autumn and winter. Some people at greater risk of vitamin D deficiency may be advised to take it throughout the year.

Do not take high-dose vitamin D or calcium supplements without checking that they are suitable for you. Excessive vitamin D can be harmful, and supplements can interact with some medicines or be unsuitable for certain health conditions.

• NHS — Vitamin D
• Royal Osteoporosis Society — Calcium

• recovering safely after a fracture, following the advice given by the treating team
• managing pain with professional advice rather than guesswork
• pacing activity without becoming unnecessarily inactive
• asking about physiotherapy or occupational therapy
• reducing falls risks at home, such as loose rugs, trailing cables and poor lighting
• discussing work, driving or daily activities when a fracture affects them
• seeking emotional support if fear of falling is reducing confidence or independence

Many people with osteoporosis continue to live active and independent lives, particularly when treatment, exercise and falls prevention are put in place together.

• Menopause
• Sports, Leisure & Wellbeing Facilities
• Care After Hospital
• Find Local Services

• NHS — Osteoporosis
• NHS — Osteoporosis treatment
• NHS — Living with osteoporosis
• NHS — Preventing osteoporosis
• NHS — Bone-density scan (DEXA)
• NICE — Osteoporosis: risk assessment (NG259)
• Royal Osteoporosis Society — Information and support
• Royal Osteoporosis Society — UK facts and statistics
• NHS — Vitamin D

This information is for general guidance and does not replace advice, diagnosis or treatment from a qualified healthcare professional. If you are worried about your symptoms, fracture risk or medicines, speak to your GP, pharmacist or specialist.