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 condition is painless until a fracture occurs.

The most common injuries in people with osteoporosis are:

  • wrist fractures
  • hip fractures
  • fractures of the spinal bones (vertebrae)

However, they can also occur in other bones, such as in the 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. Spine fractures can occur without being noticed but may lead to chronic back pain and the development of a stooped posture and loss of height.

1 in 3 women over 50 and 1 in 5 men will experience osteoporotic fractures.

Osteoporosis causes approximately 70,000 hip fractures in England and Wales each year.

Osteoporosis can be treated with bone strengthening medicines.

Causes

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 (when monthly periods stop). 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-dose oral corticosteroids
  • other medical conditions – such as inflammatory conditions, hormone-related conditions, or malabsorption problems
  • a family history of osteoporosis – particularly 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

Diagnosis

Osteoporosis may only be suspected after you have fractured a bone, but it may be a good idea to see your doctor if you have a family history of osteoporosis, or if you have one of the risk factors mentioned above.

If your doctor suspects you have osteoporosis, they can work out your future risk of breaking a bone using an online programme, such as FRAX or Q-Fracture.

Find out more about Frax, the online tool developed by Sheffield University

They may also refer you for a bone density scan.

A bone density or DEXA scan is a low dose X-ray, usually of your lower spine and hip.

Your bone density can be compared to that of a healthy young adult. The difference is calculated as a standard deviation (SD) and is called a T score.

Standard deviation is a measure of variability based on an average or expected value. A T score of:

  • above -1 SD is normal
  • between -1 and -2.5 SD shows bone loss and is defined as osteopenia
  • below -2.5 shows bone loss and is defined as osteoporosis

Selfcare and more information

If you’re at risk of developing osteoporosis, you should take steps to help keep your bones healthy.

This may include:

Treatment

Osteoporosis drug treatments help strengthen your bones and reduce your risk of breaking a bone. You may be offered medication if your risk of breaking a bone is significantly higher than normal.

‘Bisphosphonates‘ are a group of medications that work by slowing down the cells that break down bone. Bisphosphonates are the most common, and often the first, treatment used by people with osteoporosis.

Hormone replacement therapy may be suggested for some women around the time of the menopause HRT for osteoporosis and bone health (theros.org.uk)

Referral to a specialist

Your doctor may consider referring you to a specialist if they are concerned you are at very high risk of fracture, if you have had a fracture despite being on treatment, or if you have been unable to take the usual drugs prescribed. The hospital specialist may be able to prescribe injectable treatments such as:

Useful information about osteoporosis

Videos about osteoporosis

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.