Quick answer
What is osteoporosis?
Osteoporosis means bones have lost density and strength — fractures occur more easily, often from minor falls. Common in postmenopausal women and older men — often silent until a fracture. Prevention includes weight-bearing exercise, adequate calcium and vitamin D, and not smoking. DEXA scan diagnoses; bisphosphonates and other medicines reduce fracture risk in people at high risk. See a GP after any fracture from standing height or less.
Osteoporosis — weak bones, high fracture risk
Osteoporosis literally porous bones — low bone mineral density (BMD) and disrupted microarchitecture — fractures from low trauma (fall from standing height or less, sometimes spontaneous vertebral collapse).
Affects 3 million+ UK — causes 500+ fractures daily — hip fracture mortality significant in elderly.
Who is at risk
Non-modifiable:
- female sex — especially postmenopausal (oestrogen loss)
- age
- family history — hip fracture in parent
- previous fracture — strongest predictor
- early menopause, ** amenorrhoea**
Modifiable:
- low BMI (<19)
- smoking, ** excess alcohol**
- physical inactivity
- low calcium/vitamin D
- long-term corticosteroids
- ** rheumatoid arthritis**, hyperthyroidism
Men: 20% of hip fractures — underdiagnosed.
Fractures
| Site | Consequence |
|---|---|
| Vertebral | Pain, height loss, kyphosis — may be silent |
| Hip | Surgery, loss independence, mortality |
| Wrist (Colles’) | Common in postmenopausal women falling forward |
Any low-trauma fracture → assess bone health.
Diagnosis
FRAX — 10-year fracture probability — GP online tool.
DEXA scan:
- T-score ≥ -1.0 — normal
- -1.0 to -2.5 — osteopenia
- ≤ -2.5 — osteoporosis
Treat based on FRAX or DEXA plus fracture history — NICE thresholds.
Prevention
- weight-bearing exercise — walking, dancing
- resistance training — muscle pulls on bone
- calcium — diet (dairy, fortified) ~700mg/day — supplement if intake low
- vitamin D — see vitamin D deficiency
- stop smoking, moderate alcohol
- fall prevention — home hazards, vision, balance
Treatment — bisphosphonates first-line
Alendronate 70mg weekly (or daily risedronate):
- empty stomach, plain water, stay upright 30 min
- swallow whole — ** oesophageal irritation** risk
- dental hygiene — rare osteonecrosis of jaw with long use
Alternatives if intolerant:
- IV zoledronic acid — annual
- denosumab — 6-monthly injection — rebound fracture risk if stopped abruptly
- raloxifene — breast cancer risk reduction side benefit
- teriparatide — build bone — severe osteoporosis — limited course
- Romosozumab — specialist
Calcium/vitamin D co-prescribed unless dietary adequate.
Menopause link
Oestrogen decline accelerates bone loss — HRT reduces fracture risk — individual risk-benefit for menopause symptoms and bone.
Steroid-induced osteoporosis
≥7.5mg prednisolone ≥3 months — bisphosphonate prophylaxis per guidelines.
Osteoporosis is preventable and treatable — fracture is often first sign — DEXA and alendronate after low-trauma break saves independence.
Common questions
- What are the symptoms of osteoporosis?
- Usually none until fracture — hence "silent disease." Vertebral crush fractures cause sudden back pain, height loss, stooped posture (kyphosis). Hip fracture after minor fall is classic presentation. Dentists sometimes note bone loss on dental X-rays.
- How is osteoporosis diagnosed?
- DEXA (DXA) scan measures bone mineral density at hip and spine — T-score -2.5 or below defines osteoporosis. FRAX calculator estimates 10-year fracture risk using risk factors — guides who needs scan and treatment without scan in some cases.
- What is the best treatment for osteoporosis?
- First-line alendronate or risedronate bisphosphonates — weekly or monthly tablets — reduce hip and spine fractures. Alternatives — denosumab injections, zoledronic acid infusion, raloxifene, teriparatide for severe cases. Adequate calcium (700mg daily diet + supplement if needed) and vitamin D alongside.
- Can osteoporosis be reversed?
- Medicines increase bone density and more importantly reduce fracture risk — partial reversal possible on DEXA but goal is fracture prevention not perfect scan numbers. Lifestyle — weight-bearing exercise, resistance training, stopping smoking — supports bone health lifelong.
- Who should take vitamin D for bones?
- UK guidance — everyone consider 10 micrograms (400 IU) daily in autumn/winter; year-round if limited sun, housebound, or covered skin. Higher doses if deficiency proven. Vitamin D alone does not treat established osteoporosis without other treatment if high risk.