What osteoporosis is
Bone is living tissue that is built up and broken down all the time. After the age of 35 to 40, breakdown starts to win. In osteoporosis, bone density and bone quality drop so far that a fracture can happen with very little force.
The typical osteoporotic fractures are those of the hip, the spine, the wrist and the shoulder.
Who is at risk
- Women after the menopause, especially if it came early.
- Men and women over 70.
- People who take cortisone for a long time.
- People with a parent who had a hip fracture.
- People with low body weight, smokers and heavy drinkers.
- People with thyroid conditions, rheumatoid arthritis or absorption problems.
How it is diagnosed
The key test is a bone density scan (DXA) of the hip and spine. The result is given as a T-score: from -1 to -2.5 is osteopenia, and below -2.5 is osteoporosis.
The number does not tell the whole story. The overall fracture risk is worked out together with age, previous fractures and risk factors. Blood tests are often requested too, for vitamin D and for other causes of bone loss.
The low-energy fracture
A fracture after a fall from standing height in someone over 50 is in itself a sign of osteoporosis, even without a scan. Anyone who has had one is far more likely to have a second within the next few years. That is why testing and treatment should start after every such fracture.
What you can do
- Weight-bearing exercise: walking, stairs, resistance training.
- Calcium from food: dairy, small fish eaten with the bones, green vegetables, nuts.
- Vitamin D: some sun, and a supplement when levels are low.
- Protein with every meal, especially at an older age.
- Stopping smoking and going easy on alcohol.
Medication
When fracture risk is raised, medication lowers it considerably. Some drugs slow bone loss and others build new bone. The choice, the duration and the follow-up are set by your treating doctor, based on your history and your tests.
Osteoporosis treatment only works when it is taken consistently. Do not stop it without discussing it first.
Preventing falls
Most fractures need two things: a fragile bone and a fall. The second can be prevented.
- Balance exercises and leg strengthening.
- A home with no loose rugs, good lighting and grab rails in the bathroom.
- A check of eyesight and of any medication that causes dizziness.
- Firm shoes, indoors too.
The orthopaedic surgeon’s role
The orthopaedic surgeon is often the first doctor to see the consequences of osteoporosis. He treats the fracture, and makes sure the testing that will prevent the next one gets started. Read about hip fractures , upper and lower limb fractures and periprosthetic fractures too.
Common questions
Does osteoporosis hurt?
No. Pain appears only when a fracture happens. Sudden back pain at an older age can be a spinal fracture.
How often is a bone density scan done?
Usually every one to two years when there is treatment or raised risk. Your doctor sets the interval.
Does it affect men too?
Yes. It is less common, but it often goes undiagnosed, and hip fractures in men tend to have a harder course.
Medically reviewed by Manos Skotidis, MD, MSc. This information is educational and does not replace a medical examination.