Osteoporosis

Osteoporosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Osteoporosis Osteoporosis About osteoporosis Causes of osteoporosis Treating osteoporosis Preventing osteoporosis Living with osteoporosis About osteoporosis Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a minor fall or sudden impact causes a bone fracture. The most common injuriesin people with osteoporosis are: wrist fractures hip fractures fractures of the spinal bones (vertebrae) However, they can also occur in other bones, such as inthe arm or pelvis.Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine. Osteoporosisisnt usually painful until a fracture occurs,but spinal fracturesare a common cause oflong-term (chronic) pain. Although a fracture is the first sign of osteoporosis,some older people developthe characteristic stooped (bent forward) posture. It happens when the bones in the spinehave fractured, making it difficult to support the weight of the body. Whos affected? Osteoporosis affects over three million people in the UK. More than500,000 people receive hospital treatment for fragility fractures (fractures that occur from standing height or less) every year as a result of osteoporosis. Causes of osteoporosis Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures. Women also lose bone rapidly in the first few years after the menopause (whenmonthlyperiodsstop and the ovaries stop producing an egg). Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45). Many other factors can also increase the risk of developing osteoporosis, including: long-term use of high-doseoral corticosteroids other medicalconditions such as inflammatory conditions, hormone-related conditions, or malabsorption problems a family history of osteoporosisparticularly history of a hip fracture in a parent long-term use of certain medications which can affect bone strength or hormone levels having a low body mass index (BMI) heavy drinking and smoking Read more about the causes of osteoporosis . Diagnosing osteoporosis Risk assessment tools If your doctor suspects you have osteoporosis, they can make an assessment using anonline programme, such as FRAX or Q-Fracture. These tools help to predicta persons risk of fracture between the ages of40 and 90.The algorithmsused give a 10-year probability of hip fracture and a 10-year probability of amajor fracture in the spine, hip, shoulder or forearm. DEXA scan They may also refer youfor a DEXA (DXA) scanto measure your bone mineral density. Its a short, painless procedure that takesaboutfive minutes, depending on the part of the body being scanned. Your bone mineral densitycan becomparedto the bone mineral density of a healthy young adult and someone whos the same age and sex as you.The difference iscalculated as a standard deviation (SD) and is calleda T score. Standard deviation is a measure of variability based on an average or expected value. A T score of: above -1 SDisnormal between -1 and -2.5 SDis defined as decreased bone mineral density compared withpeak bone mass below -2.5 isdefined as osteoporosis Osteopenia You may be diagnosed with osteopenia if bone density tests show you have decreasedbone density, but not enough to be classed as osteoporosis. Your doctor may still recommend some of the treatments described below,depending on your results and your risk of fracture. Treating osteoporosis Treatment for osteoporosis is based on treating and preventing fractures, and using medication to strengthen bones. The decision about whether you needtreatment depends on your risk of fracture. This will bebased on a number of factorssuch as your age, sexand the results of your DEXA scan. If you need treatment, your doctor can suggest the safest and most effective treatment plan for you. Read moreabout how osteoporosis is treated . Preventing osteoporosis If youre at risk of developing osteoporosis, you shouldtake steps to help keep your bones healthy. This may include: taking regular exercise healthy eating  includingfoods rich in calcium and vitaminD making lifestyle changessuch as giving up smoking and reducing your alcohol consumption Read more about preventing osteoporosis . Living with osteoporosis If youre diagnosed with osteoporosis, there are steps you can taketo reduce your chances of a fall, such asremoving hazards from your home and having regular sight tests and hearing tests. To help you recover from a fracture, you can try using: hot and coldtreatmentssuch as warm baths and cold packs transcutaneous electrical nerve stimulation (TENS)where a small battery-operated device is used to stimulate the nerves and reduce pain relaxation techniques Speak to your GP or nurse if youre worried about living with a long-term condition. They may be able to answer any questions you have. You may also find it helpful to talk to a trained counsellor or psychologist, or other peoplewith the condition. The Royal Osteoporosis Society can put you in touch with local support groups . Read more about living with osteoporosis . Causes of osteoporosis Osteoporosis causes bones to become less dense and more fragile. Some people are more at risk than others. Bones are at their thickest and strongest in your early adult life and their density increases until your late 20s. You gradually start losing bone densityfrom around the age of35. This happensto everyone, but some peopledevelop osteoporosis and lose bone density much faster than normal. This means theyre at greater risk of a fracture. Risk groups Osteoporosis can affect men and women.Its more common in older people, but it can also affect younger people. Women Women are more at risk of developing osteoporosis than men becausethe hormone changes that occur in the menopause directly affect bone density. The female hormone oestrogen is essential for healthy bones. After the menopause (when monthlyperiods stop), oestrogen levels fall. This canlead to a rapid decrease in bone density. Women are at even greater risk of developing osteoporosis if they have: anearly menopause (before the age of 45) ahysterectomy (removal of the womb) before the age of 45, particularly when the ovaries are also removed absent periodsfor more than six months as a result of overexercising or too much dieting Men In most cases, the cause ofosteoporosis in men is unknown. However, theres a link to the male hormone testosterone, which helps keep the bones healthy. Men continue producingtestosterone into old age, but the risk of osteoporosis is increased inmen with low levels of testosterone. In around half of men, the exact cause of low testosterone levelsis unknown, but known causes include: the use of certain medications, such as oral corticosteroids alcohol misuse hypogonadism(a condition that causes abnormally low testosterone levels) Risk factors Many hormones in the body can affect the process of bone turnover. If you have a conditionof the hormone-producing glands, you may have a higher risk of developing osteoporosis. Hormone-related conditions that can trigger osteoporosis include: hyperthyroidism (overactive thyroid gland) disorders of the adrenal glands, such asCushings syndrome reducedamounts of sex hormones (oestrogen and testosterone) disorders of the pituitary gland hyperparathyroidism (overactivity of the parathyroid glands) Other risk factors Other factors thought toincrease the risk of osteoporosis and broken bones include: a family history of osteoporosis a parental history ofhip fracture a body mass index (BMI) of 19 or less long-term use of high-doseoral corticosteroids (widely used for conditions such as arthritis and asthma ), which can affect bone strength having an eating disorder, such as anorexia or bulimia heavy drinking and smoking rheumatoid arthritis malabsorption problems, as experienced in coeliac disease and Crohns disease some medications used to treat breast cancer and prostate cancer which affect hormone levels long periods of inactivity, such as long-term bed rest You can read more about whos at risk of osteoporosis and broken bones on the Royal Osteoporosis Society website . Treating osteoporosis Treatment overview Although a diagnosis of osteoporosis is based on the results of your bone mineral density scan (DEXA or DXA scan), the decision about what treatment you need if any is also based on a number of other factors. These include your: age sex risk of fracture previous injury history If youve been diagnosed with osteoporosis because youve had a fracture, you should still receive treatment to try to reduce your risk of further fractures. You may not need or want to take medication to treat osteoporosis. However, you should ensure youre maintaining sufficientlevels of calcium andvitamin D. To achieve this, your healthcare team will ask you about your diet and may recommend making changes or taking supplements. NICE recommendations The National Institute for Health and Care Excellence (NICE)has made some recommendations about who should be treated with medication for osteoporosis. Anumber of factors are taken into consideration before deciding which medication to use. These include your: age bone mineral density (measured by your T score) risk factors for fracture NICE has summarised its guidance for two groups of people: postmenopausal women with osteoporosis who havent had a fracture (primary prevention) postmenopausal women with osteoporosis who have had a fracture (secondary prevention) You can read the NICE guidance by clicking on the links below. NICE guidance: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragilityfractures in postmenopausal women NICE guidance: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women Medication for osteoporosis Anumber of different medications are used to treat osteoporosis. Your doctor will discuss the treatments available andmake sure the medicines are right for you. Bisphosphonates Bisphosphonates slow down the rate at which bone is broken down in your body. This maintains bone density and reduces the risk of fracture. There are a number of different bisphosphonates, including alendronate etidronate ibandronate risedronate zolendronic acid Theyre given as a tablet orinjection. You should always take bisphosphonateson an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. Youll also need to wait between 30 minutes and two hours before eating food or drinking any other fluids. Bisphosphonates usually take 6 to 12 months to work and you may need to take themfor five years orlonger. You may also be prescribed calcium and vitamin D supplements to take at a different time to the bisphosphonate. The main side effects associated with bisphosphonates include: irritation to the oesophagus (the tube that food passes through from the mouth to the stomach) swallowing problems (dysphagia) stomach pain Not everyone will experience these side effects. Osteonecrosis of the jaw is arare side effect thats linked with the use of bisphosphonates, althoughmost frequently with high-dose intravenous bisphosphonate treatment for cancer and not for osteoporosis. Inosteonecrosis, the cells in the jaw bone die, which can lead to problems with healing. If you have a history of dental problems, you may need a check-up before you start treatment with bisphosphonates. Speak to your doctor if you have any concerns. Strontium ranelate Strontium ranelate appears to have an effect on both the cellsthat break down bone and the cellsthat create new bone (osteoblasts). It can be used as an alternative treatment if bisphosphonates are unsuitable. Strontium ranelate is taken as a powder dissolved in water. The main side effects of strontium ranelate are nausea and diarrhoea . A few people have reported a rare severe allergic reaction to the treatment. If you develop a skin rash while taking strontium ralenate, stop taking it and speak to your doctor immediately. Selective oestrogen receptor modulators (SERMs) SERMs are medications 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 typeof SERM thats available for treating osteoporosis. Its taken as a tablet every day. Side effects associated with raloxifene include: hot flushes leg cramps a potential increased risk of blood clots Parathyroid hormone (teriparatide) Parathyroid hormone is produced naturally in the body.It regulates the amount of calcium in bone. Parathyroid hormone treatments (human recombinant parathyroid hormone or teriparatide) are used to stimulate cells that create new bone (osteoblasts). Theyre given by injection. Whileother medicationcan only slow down the rate of bone thinning, parathyroid hormone can increase bone density. However, its only used in a small number of people whose bone density is very low and when other treatments arent working. Nausea and vomiting are common side effects of the treatment. Parathyroid hormone treatments should only be prescribed by a specialist. Calcium and vitamin D supplements Calciumis the major mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones. For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium. However, if you have osteoporosis you may need more calcium, which will usually be in the form of supplements. Ask your GP for advice about taking calcium supplements. Vitamin Dis needed to help the body absorb calcium. Its difficult to get enough vitamin D from your diet alone because few foods contain vitamin D. In the UK, most healthy adults obtain vitamin D from exposing the skin to summer sunlight. However, for people at risk of not getting enough vitamin D, supplementation with 10 micrograms of vitamin D a day (400 international units [IU]) isrecommended to prevent deficiency. At-risk groups include people over 65 years of age,and people who arent exposed to much sunlight because they cover their skin for cultural reasons, are housebound, or who stay indoors for long periods. If youre found to lack vitamin D, your GP may prescribe supplements at a higher dose than the above recommendation to correct the deficiency. Hormone replacement therapy (HRT) HRT is sometimes recommended for women who are experiencing the menopause , as it can help control symptoms. HRT has also been shown to maintain bone density and reduce the risk of fracture during treatment. However, HRT isnt specifically recommended for treating osteoporosis and it isnt often used for this purpose. This is because HRT slightly increasesthe riskof developing certain conditions, such as breast cancer , endometrial cancer , ovarian cancer , stroke and venous thromboembolism more than it lowers the risk of osteoporosis. Discuss the benefits and risks of HRT with your GP. Read more about the risks of HRT . Testosterone treatment In men, testosterone treatment can be useful when osteoporosis is caused by insufficient production of male sex hormones (hypogonadism). Preventing osteoporosis Your genes are responsible for determining your height and the strength of your skeleton, but lifestyle factors such as diet and exercise influence how healthy your bones are. Regular exercise Regular exerciseis essential.Adults aged 19 to 64 should doat least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking , every week. Weight-bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis. As well as aerobic exercise, adults aged 19 to 64 should also do muscle-strengthening activities on two or more days a week byworking all the major muscle groups, including the legs, hips, back, abdomen, chest, arms and shoulders. If youve been diagnosed with osteoporosis, its a good idea to talk to your GP or health specialist before starting a new exercise programme to make sure its right for you. Read more about the physical activity guidelines for adults . Weight-bearing exercises Weight-bearing exercises are exercises where your feet and legs support your weight. High-impact weight-bearing exercises, such as running , skipping, dancing, aerobics, and even jumping up and down on the spot, are all useful ways to strengthen your muscles, ligaments and joints. When exercising,wear footwear that provides your ankles and feet with adequate support, such as trainers or walking boots. Peopleover the age of 60 can also benefit from regular weight-bearing exercise. This can include brisk walking, keep-fit classes or a game of tennis. Swimming and cycling arent weight-bearing exercises, however. Read more about physical activity guidelines for older adults . Resistance exercises Resistance exercises use muscle strength, where the action of the tendons pulling on the bones boosts bone strength. Examples include press-ups, weightlifting or using weight equipment at a gym. If youve recently joined a gym orhavent been for a while, your gym will probably offer you an induction. This involves being shown how to use the equipment and having exercise techniques recommended to you. Always ask an instructor for help if youre not sure how to use a piece of gym equipment or how to do a particularexercise. Healthy eating Eating a healthy, balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease , diabetes and many forms of cancer , as well as osteoporosis. Calciumis importantfor maintaining strong bones. Adults need 700mg a day, which youshould be able to get from your daily diet. Calcium-rich foods include: leafy green vegetables dried fruit tofu yoghurt Vitamin Dis also important for healthy bones and teeth becauseit helps your body absorb calcium. Vitamin D can be found in: eggs milk oily fish However, most vitamin D is made in the skin in response to sunlight. Short exposure to sunlight without wearingsunscreen (10 minutes twice a day) throughout the summer should provide you with enough vitamin D for the whole year. Certain groups of people may be at risk of not getting enough vitamin D. These include: people who are housebound or particularly frail people with a poor diet people who keep covered up in sunlight because they wear total sun block or adhere to a certain dress code women who are pregnant or breastfeeding If youre at risk of not getting enough vitamin D through your diet or lifestyle, you can take a vitamin D supplement. For adults, 10 micrograms a day of vitamin D is recommended. The recommended amount for children is 7 micrograms for babies under six months, and 8.5 micrograms for children aged six months to three years.Talk to your GP for more information. Read moreabout healthy eating . Other factors Other lifestyle factors that can help prevent osteoporosis include: quitting smoking smoking is associated with an increased risk of osteoporosis limiting your alcohol intake  the NHS recommends not drinking more than 14 units of alcohol a week; its also important to avoid binge drinking Read more about healthy bones on theNational Osteoporosis Society website. Living with osteoporosis Getting support Your GP or nurse may be able to answerany questions you have about living with osteoporosis andcan reassure you if youre worried. You may also find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information about these. Some people find it helpful to talk to others with osteoporosis, either at a local support group or in an internet chat room. Osteoporosis support The Royal Osteoporosis Society providesa helpline service run by nurses with specialist knowledge of osteoporosis and bone health. Call 0808 800 0035. You can also email them at nurses@theros.org.uk They can provide you with details of local support groups . Recovering from a broken bone Broken bones usually take six to eight weeks to recover. Having osteoporosis doesnt affect how long this takes. Recovery depends on the type of fracture you have. Some fractures heal easily, while others mayneed more intervention. If you have a complicatedwrist fracture or hip fracture, you may need an operation to make sure the bone is set properly. Hip replacements are often neededafter hip fractures, and some people may lose mobility as a result of weakened bones. Osteoporosis can cause a loss of height due to fractures in the spinal column. This means the spine is no longer able to support your bodys weight and causes a hunched posture. This can be painful when it occurs, but it may also lead tolong-term (chronic)pain. Your GP or nurse may be able to help with this. During the healing process, you may need the help of a physiotherapist or occupational therapist so you can make as full a recovery as possible. Read more about occupational therapy . Coping with pain Everyone experiences pain differently, so what works for you may differ from what works for someone else. There are different ways to manage pain, including: medication heat treatment,such aswarm baths or hot packs cold treatment,such ascold packs transcutaneous electrical nerve stimulation (TENS) this is thought to reduce pain by stimulating the nerves simple relaxation techniques ,massage or hypnosis You can use more than one of these techniques at the same timeto manage your pain for example, you could combine medication, a heat pack and relaxation techniques. Working and money You should be able to continue working ifyou have osteoporosis. Its very important that you remain physically active and have a fulfilled lifestyle. This will help keep your bones healthy and stop you focusing too much on your potential health problems. However, if your work involves the risk of falling or breaking a bone, seek advice from your employer,GP and the Royal Osteoporosis Society about how to limit your risk of having an accident or injury that could lead to a bone break. If you cant continue working, you may be eligible for the Personal Independence Payment . People over 65 who are severely disabled may qualify for a disability benefit called Attendance Allowance . Help for carers You may also be entitled to certain benefits if you care for someone with osteoporosis. Read more about benefits for carers . More information Care Information Scotland GOV.UK: Carers and disability benefits Money Advice Service Source: MSK Expert Panel - Opens in new browser window Last updated: 20 November 2023 How can we improve this page? 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