Osteoporosis causes your bones to become weak and brittle, making them prone to fractures even from simple actions like bending or coughing. It most commonly affects your hips, wrists, and spine. A healthy lifestyle, along with medication and exercise, can help prevent bone loss and support stronger bones.
What is osteoporosis?
Osteoporosis is a condition where your bones gradually become thinner, more porous, and fragile, increasing your risk of fractures. Bone is living tissue that constantly regenerates, but after your peak bone mass, usually reached in your early 30s, this balance shifts. Over time, bone loss begins to outpace bone formation, and bones weaken.
This process speeds up with age, and is more pronounced in women after menopause due to a drop in protective hormones like oestrogen.
Most people are unaware they have osteoporosis until they experience a fracture, often in their hips, wrists, or spine, from a minor fall or even a simple movement. Early diagnosis using a bone density scan can help prevent complications and guide effective treatment.
Osteoporosis symptoms
Osteoporosis is often called a “silent disease” because it typically causes no symptoms until a bone breaks. Many people don’t realise they have it until they experience a fracture from a minor fall or a simple movement.
Common early warning signs of osteoporosis to watch for:
-
Sudden fractures from low-impact injuries (especially in your hip, wrist, or spine)
-
Back pain, often from collapsed or fractured spinal bones
-
Loss of height over time
-
Stooped posture or curvature of your spine
-
Bone pain or tenderness, especially in your lower back.
Subtle osteoporosis symptoms signs:
If you notice any of these changes, especially if you’re over 50, have a family history, or you’re postmenopausal, it’s worth speaking to your doctor about a bone density scan. Early testing, like a DEXA scan, can help prevent future fractures.
What causes osteoporosis?
Osteoporosis occurs when your body loses bone faster than it can rebuild it. Bone is living tissue that constantly renews itself, but after your early 30s, this process slows. Over time, bones become thinner, less dense, and more fragile.
Several factors can increase your risk of developing osteoporosis:
-
Ageing – natural bone loss accelerates after age 35
-
Menopause – reduced oestrogen levels speed up bone breakdown
-
Low calcium or vitamin D intake – weakens bone formation
-
Medical conditions – such as rheumatoid arthritis, thyroid disorders, or malabsorption issues
-
Medications – long-term use of steroids, cancer treatments, or seizure medications
-
Lifestyle factors – smoking, heavy alcohol use, poor diet, and lack of weight-bearing exercise
-
Low body weight or BMI – less bone mass to draw from
-
Family history – especially if a parent had a hip fracture.
Understanding these causes can help you to take proactive steps to protect your bone health and reduce your risk of fractures.
Osteoporosis risk factors
Understanding osteoporosis risk factors can help you take proactive steps - some are beyond your control, while others are related to lifestyle, hormones, nutrition, and medical history.
Unchangeable risk factors
These are factors you can’t control but may increase your likelihood of developing osteoporosis:
-
Age - bone density naturally declines after age 35
-
Sex - women, especially postmenopausal, are at higher risk
-
Ethnicity - white and Asian individuals are more commonly affected
-
Family history - a parent or sibling with osteoporosis or hip fracture increases your risk
-
Body frame size - smaller frames mean less bone mass to draw from as you age.
Hormonal factors
Hormone imbalances can accelerate bone loss:
-
Low oestrogen - common after menopause or with breast cancer treatment
-
Low testosterone - can affect men, especially with prostate cancer therapy
-
Thyroid disorders - overactive thyroid or excessive thyroid medication
-
Parathyroid and adrenal gland disorders - can disrupt bone metabolism.
Diet and nutritional factors
Poor nutrition can weaken bones over time:
-
Low calcium or vitamin D intake
-
Eating disorders - such as anorexia or bulimia
-
Malabsorption issues - conditions like coeliac or Crohn’s disease
-
Gastrointestinal surgery - reduces nutrient absorption.
Medical conditions
Certain health issues are linked to increased bone loss:
Medications and treatments
Some drugs can interfere with bone strength:
-
Long-term corticosteroids (e.g. prednisone)
-
Anti-seizure medications
-
Hormone therapies for cancer
-
Proton pump inhibitors - may affect calcium absorption
-
Diuretics and anticoagulants.
Lifestyle factors
Daily habits play a big role in bone health:
-
Sedentary lifestyle - lack of weight-bearing exercise
-
Smoking - linked to reduced bone formation
-
Excessive alcohol - more than two drinks per day can weaken bones
-
Low body weight or BMI.
Osteoporosis diagnosis
Osteoporosis is typically diagnosed through a combination of clinical assessment and imaging tests that measure bone strength and density.
Your doctor will begin with a physical exam and ask about your medical history, including:
-
Any previous fractures
-
Family history of osteoporosis
-
Lifestyle factors like diet, exercise, smoking, and alcohol use
-
Menstrual history (for women).
They may also use tools like FRAX or Q-Fracture to estimate your future risk of breaking a bone.
Bone density scan (DEXA)
The most common and reliable test to get an osteoporosis diagnosis is a bone density scan, also known as a DEXA scan. This quick, painless procedure uses low-dose X-rays to measure how dense your bones are, usually focusing on your hip and spine, where fractures are most likely to occur.
You lie on a padded table while a scanner passes over your body. The scan compares your bone density to that of a healthy young adult. Results are given as a T-score:
Osteoporosis treatment
Osteoporosis treatment focuses on slowing bone loss, strengthening bones, and reducing your risk of fractures. Most patients benefit from a combination of lifestyle changes, medication, and targeted therapies.
Exercises for osteoporosis
Regular exercise helps maintain bone strength and improve balance, reducing your risk of falls and fractures. Recommended activities include:
-
Weight-bearing exercises - walking, stair climbing, dancing
-
Balance and flexibility - yoga, Pilates, tai chi
-
Resistance training - light weights or resistance bands to build muscle.
A physiotherapist can tailor exercises to your needs and ensure movements are safe and effective.
Osteoporosis medication
Medications help slow bone breakdown or stimulate bone formation. Common options include:
-
Bisphosphonates - (e.g. alendronate, risedronate). Oral or injectable; may cause stomach upset, or rarely bone/jaw side effects
-
Denosumab - a twice-yearly injection that boosts bone density and slows bone loss
-
Parathyroid hormone analogs - (teriparatide, abaloparatide). Daily injections that stimulate new bone growth, typically used for severe osteoporosis.
Hormone therapy
Hormone-related treatments may be used depending on your age, sex, and risk factors:
-
Oestrogen therapy - helps maintain bone density in postmenopausal women. It may increase your risk of blood clots or breast cancer
-
Raloxifene (Evista) - mimics oestrogen’s bone-protective effects. It can reduce your spinal fracture risk
-
Testosterone therapy - may help men with low hormone levels. It’s often used alongside other osteoporosis medications.
You should discuss the risks and benefits with your GP to find the right option.
Calcium and vitamin D supplements
These nutrients are essential for bone health:
-
Calcium - most adults need at least 700 mg daily. Supplements may be needed if you have a low dietary intake
-
Vitamin D - helps absorb calcium; 10 micrograms daily is recommended. Sunlight provides natural vitamin D, but supplements are advised in autumn and winter.
Your GP can guide you on safe dosages and whether supplements are necessary.
Osteoporosis prevention
If you’re wondering how to prevent osteoporosis, there are lifestyle changes that can help protect your bones, keep them stronger for longer, and lower your chances of developing the condition:
-
Eat calcium-rich foods - dairy, leafy greens, and fortified products
-
Get enough vitamin D - through sunlight, food, or supplements (10 micrograms/day)
-
Exercise regularly - weight-bearing and resistance activities like walking, yoga, and strength training
-
Avoid smoking and excessive alcohol - both can weaken bone structure
-
Maintain a healthy weight - being underweight or inactive increases your risk.
Osteopenia vs osteoporosis
Osteopenia is the stage of bone loss that comes before osteoporosis. It means your bones have less density than normal but are not yet fragile enough to be considered osteoporosis. The main difference lies in severity. Osteopenia indicates mild bone loss, while osteoporosis reflects significant loss, with bones more likely to break easily.
In osteopenia, you may not have any symptoms, and your fracture risk is only slightly increased. Osteoporosis, on the other hand, can lead to height loss, back pain, posture changes, and a much higher chance of breaking a bone from even minor accidents.
Importantly, osteopenia doesn't always lead to osteoporosis, it depends on factors like age, hormone levels, health conditions, and lifestyle habits. If you're diagnosed with osteopenia, steps like dietary changes, regular exercise, and sometimes medication can help strengthen your bones and prevent further decline.
Osteomalacia vs osteoporosis
Osteoporosis and osteomalacia both weaken your bones, but in different ways. Osteoporosis involves a loss of bone mass, making your bones thin and fragile, while the ratio of bone mineral to structure stays normal. It's caused by a combination of ageing, hormonal changes, and increased bone breakdown. In contrast, osteomalacia is due to poor bone mineralisation, often from severe vitamin D deficiency, which results in soft, poorly hardened bones.
While both conditions can lead to fractures and share similar symptoms like bone pain or weakness, osteomalacia may also cause muscle discomfort and unusual fracture patterns (such as ribs). Diagnosis involves bone density scans and blood tests, and though they can coexist, treatments differ. Osteomalacia requires correcting vitamin D levels, while osteoporosis focuses on preventing further bone loss.
