Osteoporosis: Protecting Your Bones at Every Age
Osteoporosis literally means porous bone. Bone is living tissue that is constantly broken down and rebuilt. Until the late twenties we build more than we lose; after that, and particularly after menopause in women and after the age of 70 in men, loss outpaces formation. When bone becomes thin and fragile, a minor fall or even a cough can cause a fracture. Osteoporosis itself is painless, so the first sign is often a broken bone.
Why fractures matter
Hip fractures are the most serious. Many people never fully regain their independence afterwards, and the risk of death in the following year is substantially increased. Spinal compression fractures can cause back pain, height loss and a stooped posture. Wrist fractures are often the first warning.
Who is at higher risk
- Women after menopause, due to falling oestrogen
- Older age in both sexes
- A previous fragility fracture (a fracture from a standing height fall or less)
- Parental hip fracture
- Low body weight or a small frame
- Long-term oral steroid use
- Smoking and heavy alcohol intake
- Early menopause or low testosterone
- Conditions such as rheumatoid arthritis, coeliac disease, thyroid overactivity, hyperparathyroidism and chronic kidney or liver disease
- Medicines including some anti-seizure drugs, aromatase inhibitors and androgen-deprivation therapy
- Low vitamin D, little sunlight and low calcium intake
How it is diagnosed
A DEXA scan measures bone mineral density at the hip and spine. Results are expressed as a T-score: a value of -2.5 or lower defines osteoporosis, between -1 and -2.5 indicates low bone mass (osteopenia). Doctors often use a risk calculator such as FRAX, which combines age, sex, weight, history and bone density to estimate the 10-year probability of a major fracture. Blood tests check calcium, vitamin D, kidney function and other causes of bone loss.
Building and keeping bone
Calcium. Adults need about 700 to 1,200 mg per day depending on age and sex. Food is the preferred source: dairy, fortified plant milks, tinned fish with bones, tofu set with calcium, leafy greens and almonds. Supplements are only needed when diet falls short.
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Vitamin D. Needed to absorb calcium. Sunlight on the skin is the main source, but many people in northern climates, older adults, people with darker skin and those who cover up need a daily supplement, commonly 800 to 1,000 IU.
Protein. Adequate protein supports bone and muscle.
Exercise. Weight-bearing activities such as walking, jogging, dancing and stair climbing stimulate bone formation. Resistance training builds muscle and strengthens bone. Balance training, such as tai chi, reduces falls.
Lifestyle. Stop smoking and keep alcohol within recommended limits. Avoid being underweight.
Preventing falls
Most fractures follow falls, so reducing them matters as much as strengthening bone. Review medicines that cause dizziness, check vision, wear stable footwear, remove loose rugs, light stairs and fit grab rails. A strength and balance programme can cut falls by about a quarter.
Medicines
For people at higher fracture risk, medicines substantially reduce the chance of fractures.
- Bisphosphonates such as alendronate and zoledronic acid slow bone loss and are the usual first choice.
- Denosumab is a six-monthly injection; stopping it without a follow-on treatment can cause rapid bone loss, so it must be planned carefully.
- Anabolic agents such as teriparatide, abaloparatide and romosozumab build new bone and are used for severe osteoporosis.
- Hormone therapy and raloxifene have specific roles.
Rare side effects, such as jaw problems and unusual thigh fractures, are far outweighed by the fracture protection in those who need treatment. Good dental health and regular review are advised.
Osteoporosis in men and younger people
Men are often under-diagnosed. Secondary causes, such as low testosterone, steroids, alcohol and certain diseases, are more common in men and in premenopausal women who develop osteoporosis.
Take action early
Bone health starts in childhood, but it is never too late to act. If you are over 50 and have broken a bone with little force, or have several risk factors, ask your doctor about bone density testing and fracture risk assessment.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.