Got a question about osteoporosis or bone health? You might find the answer you are looking for in our FAQs section.

Literally put, it means ‘porous bone’.

Porous bone occurs when there is not enough bone formation or there is more bone loss than there is bone formation, causing cavities (like honeycomb) in the bone and making it ‘porous’.

Osteoporosis, sometimes informally referred to as brittle bone disease, is a skeletal disease where the bones of the body lose mineral density to the point where they become weak, brittle and susceptible to fracture. It typically doesn’t manifest until later in life.

It develops when inevitable age-related bone loss, or symptomatic bone loss of an underlying cause, is not mitigated by the formation of new bone and there is inadequate bone mineral density reserve.

Throughout our lives our bodies are constantly breaking down bone and forming new. Bone is a living tissue made up of different components, such as calcium salts and collagen fibres, and this matrix of components is what gives bone its density and stops it from breaking easily.

Osteoporosis occurs when the breakdown of bone tissue is greater/faster than its formation and bone mineral decreases until it is below a healthy density, resulting in an increased risk of fracture.

Fractures that happen with seemingly minor incidents that would not be forceful enough to break healthy bone are known as fragility fractures and are the hallmark of osteoporosis.

Fractures can be in the form of a break (e.g., hip fracture) or a collapse (e.g., compression fracture of the vertebrae).

Get bespoke advice on steps you can take to improve your bone health - Take Our Test

Related FAQs: What are fragility fractures? 

Osteoporosis isn’t usually painful until a bone is broken.

• A broken bone is typically the first clear sign of osteoporosis – especially if it was caused by an ostensibly minor fall or injury –and can cause temporary to chronic pain.
• Fractures or collapse of vertebrae in the spine is a common cause of chronic pain, as are hip fractures. There can also be sciatic pain from nerves being compressed by a collapsed spine.
• Microscopic fractures can lead to deep bone pain that some people with osteoporosis describe as comparable to toothache pain.
• Bone growth is slower in people with osteoporosis, so the average six to eight weeks of healing pain most people with a fracture experience may be prolonged.
• Some people experience pain as a side effect of treatment for osteoporosis.

Related FAQs: What are the side effects of osteoporosis treatment?  What are the signs/symptoms of osteoporosis? 

Genes can play a role.

Genetic variants that increase risk have been identified and each variant causes a small increase in risk. Having more than one variant possibly amplifies risk.

However, taking steps to increase bone health (see our articles Adults and Bone Health and Best Exercises for Strong Bones) can go a long way to mitigating inherited risk.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: How can I prevent my child from developing osteoporosis in later life? 

Osteoporosis is a body-wide weakening of bones, but there are areas of the body that are more prone to breaking.

The most common fracture sites are:

• Hip fractures
• Vertebrae (spinal fractures)
• Wrist fractures
• Forearm fractures
• Shoulder fractures

Wrists are particularly susceptible as they often bear the brunt of a person’s weight when they try to break a fall. However, fractures can occur in many other areas, the arm and pelvis also being vulnerable, especially if a person falls awkwardly.

Hip fractures carry an elevated risk of mortality.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: What are fragility fractures? 

The ‘stages’ of osteoporosis are just the gradual thinning of bone until it becomes so marked as to be considered osteoporotic.

The stage before osteoporosis, where the bone is thinning but not yet clinically considered to be osteoporosis, is called osteopenia.

Clinically, bone mineral density (BMD) – which can be measured by a DEXA scan – carries a score that is the result of comparing a patient’s BMD with that of a young and healthy person’s peak bone density. This is known as a T-score and is used to determine primary osteoporosis (weak bones without an underlying cause).

The T-score result reflects what range a person’s bone density is in:

• Normal range (+1 to -1)
• Osteopenia range (-1 to -2.5)
• Osteoporosis range (-2.5 and below)

For premenopausal women, men younger than 50 and children, the comparison is made against people of the same age and sex to try and identify a secondary cause of bone loss, and this is called a Z-score.

Related FAQs: How does osteoporosis affect the body? 

Osteopenia is the thinning of bones to the point where bone mass is below average for age but not to the point of osteoporosis diagnosis.

Although the precursor to osteoporosis, having osteopenia does not mean it will definitely develop into osteoporosis, and you may be able to prevent osteopenia from worsening.

The same risk factors for osteoporosis apply for osteopenia.

Deterioration of bone is an inevitable part of the aging process; however, for some people it is so gradual that it never becomes osteoporosis. See also A Personal Story of Recovery.

Related FAQs: How can I prevent osteoporosis? 

This is highly dependent on various factors, such as severity of condition and if they are being treated.

A person can live with osteoporosis for a long time, and it is not in itself a terminal disease. However, if a person suffers a hip fracture and they are not treated in a timely manner, then this carries a mortality risk. 20% of people who go into hospital with a hip fracture do not survive the year; most of the deaths are due to associated conditions and are not attributable to the fracture itself, reflecting high levels of comorbidity. The 80% of people that do survive are not independent due to the fracture and the health issues it causes.

Related FAQs: Can osteoporosis be cured/reversed? 

Fragility fractures occur when a person’s bones have become so weak that a low energy trauma that wouldn’t cause injury to healthy bone results in a bone fracture. They are the hallmark of osteoporosis, with increasing incidence with age. Fragility fractures are a growing health issue and are associated with a significant mortality rate.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: Is a fracture the same as a broken bone? 

Primary osteoporosis is when there are no underlying factors responsible for thinning bones and is associated with the process of normal aging.

There are two types of primary osteoporosis:

• Type I, aka post-menopausal osteoporosis (as much more common in women): mainly affects trabecular bone and is characterised by vertebral and wrist fractures
• Type II, aka senile osteoporosis: age-related and typically affects people over 70 years of age. It affects men and women, but is more common in women, and is characterised by fractures of the hip, humerus, and tibia.

Secondary osteoporosis is when weakened bones are a side effect of something such as medications or health conditions (like malabsorption syndrome, which could inhibit the absorption of calcium and lead to osteoporosis).

Related FAQs: How is osteoporosis diagnosed? 

Yes, the words ‘broken bone’ and the words ‘fractured bone’ mean the same thing.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: What are fragility fractures? 

Osteoporosis is where inevitable age-related bone loss or symptomatic bone loss of an underlying cause is not mitigated by the formation of new bone and there is inadequate bone mineral density reserve.

This loss of bone density increases the risk of fractures. Fractures can be in the form of a break (ie. hip fracture) or a collapse (e.g., compression fracture of the vertebrae).

The most common fracture sites are:

• Hip fractures
• Vertebrae (spinal fractures)
• Wrist fractures
• Forearm fractures
• Shoulder fractures

Spinal fractures can cause loss of height due to curvature of the spine. Hip fractures carry an elevated risk of mortality.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: What are fragility fractures? 

Welcome to the beginning of your journey to better bone health. Our short questionnaire will calculate the current condition of your bone health and, based on your answers, predict where your bone health might be in the future. We will then suggest a strategy for you to move forward to a life free from osteoporosis.

Take Our Test

There are lifestyle risk factors you can change, but there are also some risk factors that are not within your control.

Not reaching peak bone mass in early life, 20s for men and 30s for women, is a major contributor for developing osteoporosis in later life. There are many factors that affect someone’s ability to build strong bones.

Lifestyle risk factors:

• Poor diet, especially with low calcium and vitamin D (see Adults and Bone Health for diet advice)
• Sedentary lifestyle
• Smoking
• High alcohol consumption

Non-lifestyle risk factors:

• Aged 65 or over (average age for hip fracture is 83 for women and 84 for men). Studies have found that women over 85 years are nearly eight times more likely than women aged 65-74 years to be hospitalised with a hip fracture
• Being postmenopausal – more pronounced if early menopause
• Certain medication, especially prolonged use.
• Hormone treatment for certain cancers
• Being thin or small-framed
• Being Asian or Caucasian
• Family history
• Having a disease that affects bone health, such as an endocrine disorder

Having a risk factor does not mean you will definitely develop osteoporosis, but it does mean your risk for developing it is increased. The more risk factors you have, the higher your chances of developing the disease.

Deterioration of bone is an inevitable part of the aging process; however, for some people it is so gradual that it never becomes osteoporosis.

Osteopenia is the precursor to osteoporosis.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: Which drugs raise osteoporosis risk?  What is osteopenia?  Can men get osteoporosis? 

There are a few diseases other than osteoporosis that affect bone health, either directly or indirectly.

Diseases that directly affect bones include:

• Osteopenia – low bone mass that could lead to osteoporosis.
• Osteopetrosis – very dense bones. This can, seemingly paradoxically, cause bones to break more easily.
• Osteonecrosis – reduced blood flow to bone.
• Osteogenesis Imperfecta – an inherited disorder also known as brittle bone disease.
• Paget’s disease of the bone – bones grow too large and become weak.
• Fibrous dysplasia – genes instruct the body to replace bone with other types of tissue.
• Osteomalacia – inadequate mineralization of the bone from impaired bone metabolism usually from markedly low vitamin D levels.

Some diseases that can indirectly affect bone health, either through disease pathway or treatment, include:

• Type 1 diabetes
• Hyperthyroidism
• Lupus
• Rheumatoid arthritis
• Celiac disease
• Osteoarthritis

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: What is osteopenia? 

Unfortunately, there are quite a lot of drugs that can interfere with bone health in some way. There are medications called bisphosphonates available to help counteract the bone health issues caused by certain medications. 

If you have any concerns at all, always talk to your GP.

Glucocorticoids

Glucocorticoids are a class of corticosteroids used as anti-inflammatory medicines for conditions such as asthma and auto-immune diseases. They can affect calcium absorption and bone metabolism in various ways, which can lead to bone loss - sometimes rapid loss if the medicine is taken at a high dose. Topical steroids do not present the risks that oral or inhaled steroids do.

Some steroid drugs that can compromise bone health include:

Asthma:

• beclomethasone dipropionate
• budesonide
• fluticasone
• mometasone

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319192/

Rheumatoid arthritis:

• dexamethasone
• dexamethasone
• hydrocortisone
• methylprednisolone
• prednisolone
• prednisone
• triamcinolone

https://pubmed.ncbi.nlm.nih.gov/17192452/

https://pubmed.ncbi.nlm.nih.gov/24925411/

Proton Pump Inhibitors

Proton Pump On Inhibitors are medications to help treat issues caused by stomach acid. They can decrease the absorption of calcium.

Some PPI drugs that can compromise bone health include:

• Aspirin and omeprazole
• dexlansoprazole
• esomeprazole
• esomeprazole magnesium/naproxen
• lansoprazole
• omeprazole/sodium bicarbonate
• pantoprazole
• rabeprazole

Anti-seizure medication

Such as phenytoin (Dilantin) and phenobarbital.

Blood thinner medication

Heparin can activate osteoclasts (the cells that resorb bone).

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: What is the current treatment for osteoporosis?  What is bone infusion therapy?  Do SSRIs negatively affect bone health?  What are the side effects of osteoporosis treatment? 

Pregnancy and breast feeding are demanding on a woman’s body, especially with regards to calcium loss and hormonal disruption, and there is an average bone mass loss of 5%.

However, some studies suggest that this bone loss is transient and subsequently restored after weaning. Pregnancy-associated osteoporosis appears to be uncommon, possibly due to the high levels of oestrogen during pregnancy, which is very good for bone building.

During the beginning stages of pregnancy, a woman’s calcium absorption is doubled and stored in her bones, so it is a critical time for ensuring that this increase in mineral requirement is met. Breastfeeding is also very demanding on a woman’s physical resources, and so it is vital continue to be aware of the extra nutritional needs during this time.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: Does menopause affect bone health? 

Yes – menopause and changes in bone density are closely linked.

During the menopause, the crucial hormone oestrogen, which helps keep bone density in check in women, dramatically declines. This can increase the risk of bone fractures. This is even more pronounced with early (before 45) or premature (before 40) menopause because the longer the body has gone without the bone-protective effects of oestrogen the greater the chance of loss of bone density.

Following good bone health habits can help mitigate some of the issues that can arise from a fall in oestrogen, such as weight-bearing exercise, a healthy diet, drinking alcohol only in moderation, and not smoking.

See also 10 Best Exercises for Bone Health and Adults and Bone Health.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: How can I prevent osteoporosis?  Can Hormone Replacement Therapy (HRT) prevent osteoporosis? 

Yes, even though there is a greater prevalence in post-menopausal women, 20% of men over 50 have osteoporosis. The same risk factors such as certain types of medications or lifestyle choices (smoking, lack of activity) apply to men as well as women in terms of bone health, and there is a link to age-related testosterone deficiency and an increased risk of developing osteoporosis in men.

There is some thinking that osteoporosis is underdiagnosed in men. It’s not clear what causes osteoporosis in men and long-term management of men with osteoporosis is based solely on studies in women, but medicines that work in women should lead to the same outcomes in men with regards to decreased fracture risk.

See also How Does Osteoporosis Affect Men?

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: Can children get osteoporosis?  Why does the body breakdown and regrow bone constantly? 

Yes, women are a greater risk of osteoporosis, specifically post-menopausal women because of the reduction in bone-protective hormone oestrogen; however, men can develop osteoporosis also and the risk increases as they age.

In general, men’s bone health declines more slowly than women’s, with fractures occurring in men about a decade later than women. There is a large increase in fracture risk after the age of 75.

The hormone testosterone seems to have a protective effect, and even though this does decline as men get older, the decline is not as steep as it is with bone-protective oestrogen in women at menopause. Although women tend to have an earlier onset of osteoporosis, men are more likely to die after a hip fracture than women.

The advice is the same for men as it is for women when it comes to prevention. See Adults and Bone Health and 10 Exercises for Bone Health. Lifestyle changes are often particularly helpful for men.

Related FAQs: Can men get osteoporosis? 

Osteoporosis is rare in children and adolescents but not unheard of.

Known as paediatric or juvenile osteoporosis when it does occur, it is usually in the form of secondary osteoporosis which has many potential causes, including inadequate nutrition, certain medications, disorders such as Cushing’s syndrome, etc.

Idiopathic osteoporosis is a primary condition with no known cause and, fortunately, most children recover from this form.

See our related article Children and Bone Health for more information.

Related FAQs: How can I prevent my child from developing osteoporosis in later life?  Which vitamins and minerals are key to bone health? 

Studies have indicated a possible negative association between SSRI use and bone mineral density; however, the results have been inconsistent and more research is needed.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: Which drugs raise osteoporosis risk? 

There are many lifestyle changes that a person can make to dramatically reduce their risk of developing osteoporosis.

Prevention tips:

1. Take regular weight bearing exercise, e.g. running, dancing, aerobics, etc., as this strengthens the bones and surrounding muscles. See also 10 Bone-Healthy Exercises.
2. Get enough calcium. This mineral is important in maintaining bone health. Calcium-rich foods include leafy green vegetables, dried fruit, tofu and yoghurt. See Adults and Bone Health and Children and Bone Health for more nutritional advice.
3. Get enough vitamin D. This helps the body absorb calcium and can be obtained by regular (but safe) exposure to sunlight during the spring and summer months. Additional dietary sources of vitamin D are oily fish, eggs and liver. Supplementation might be necessary during the darker months of autumn and winter. See also Why is Vitamin D So Important?
4. Stop smoking. Smoking slows the cells that build bone in the body. Smokers are found to be at higher risk of breaking a hip as they age. See the NHS’s Stop Smoking page if you need help stopping smoking.
5. Limit alcohol consumption. Studies have shown that heavy alcohol consumption compromises bone health. The NHS recommends no more than 14 units a week. Also, alcohol increases your chances of falling and breaking bones. See the NHS’s Alcohol Support

Avoiding inactivity is extremely important, especially in today’s society where sedentary lifestyles are increasingly becoming the norm. Not only does exercise build muscle and strengthen bone, it also improves balance, which helps to prevent falls.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: Is rebounding good for preventing osteoporosis?  Which vitamins and minerals are key to bone health?  Are ankle weights good for osteoporosis?  Does menopause affect bone health? 

For bone health supplemental calcium, vitamin D and magnesium are recommended. Vitamin D and magnesium help the body absorb calcium.

There is also research being conducted into the usefulness of vitamin K2 for bone health.

How much an adult should be getting:

• The official recommended daily amount of vitamin D for adults is 10µg (micrograms/mcg). This is equivalent to 400 international units (IU) of vitamin D. We recommend 25µg (micrograms) – that is 2000 IU a day – in the darker months, between October and April, when there is not enough sunlight to synthesize enough vitamin D naturally. Do not exceed 100 µg (micrograms) a day (equivalent to 4,000 IU).
• The RDA of calcium for adults is 700mg (milligrams) – possibly more if deficient but usually not more than 1,500mg.
• Recommended daily amounts of magnesium are 270mg for adult females and 300mg for adult males, although there is some thinking that this recommendation should be increased. Having up to 400mg a day is unlikely to cause harm.

Consult your GP for guidance on supplements if you are unsure of your needs.

See our article Adults and Bone Health for more info.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What is the current treatment for osteoporosis? 

Childhood and adolescence set the stage for bone health, so this is an extremely important window of time for maximising bone density with good nutrition and plenty of exercise.

Some tips for helping build healthy bones in children:

1. Make sure they take regular exercise, e.g., running, dancing, and gymnastics, as this strengthens the bones and surrounding muscles. See Best Exercises for Bone Health.
2. Ensure they get enough calcium. This mineral is important in maintaining bone health. Calcium-rich foods include leafy green vegetables, dried fruit, tofu and yoghurt.
3. Ensure they get enough vitamin D. This helps the body absorb calcium and can be obtained by regular (safe and monitored) exposure to sunlight during the spring and summer months. Additional dietary sources of vitamin D are oily fish, eggs and liver. Supplementation might be necessary during the darker months of autumn and winter.
4. Get your child into good eating habits in general. Eat a ‘rainbow’ diet ensuring you include foods from across all the food groups – fruit and vegetables, starchy food, dairy, protein and fat.

If you are unsure about any guidance or if you are worried about your child's health, check with your GP for advice.

See also Children and Bone Health for more information.

Take our test and see which areas you can take action in to improve your bone health.

Moderate to high impact weight-bearing exercise is the best type of exercise to prevent osteoporosis. However, low impact exercise, like rebounding on a mini trampoline, is also good for bone health and especially useful for people with joint issues.

Avoiding inactivity is extremely important, especially today where sedentary lifestyles are increasingly becoming the norm. Not only does exercise build muscle and strengthen bone, it also improves balance, which helps to prevent falls.

Weight-bearing impact exercises and resistance exercises are best for bones:

• Impact: Bones need to be subjected to compressive forces (the weight of the body acts as a compressive force during exercise) to stimulate them to increase or maintain density. Compression activates the osteoblasts (cells that synthesize bone) so that additional new bone is produced. Impact varies depending on whether both feet leave the ground at the same time (like running) or just one foot at a time (walking). Exercise can, in general, be divided into low and high impact:
  • Low impact: generally, when one foot always remains on the ground, or something absorbs the impact like a rebounder or water (swimming is technically a no-impact exercise)
  • High impact: moves that put more stress on the body through speed and height of movement with both feet off the ground simultaneously
• Weight: Weight-bearing exercise – which is any exercise where muscle overcomes a resistant force, including gravity – staves off age-related declining muscle mass and grows new muscle. This is good for bones because denser muscle means a person weighs more as they go about their day-to-day activities, which helps build bones, and the more muscle around joints and bones, the more protected they are from injury.
• Resistance: Resistance training is a weight-bearing exercise that involves using weights or resistance bands to create a strong resistance for muscles to overcome. This is more challenging to perform and results in more muscle gain.

High impact (the faster and higher, the more impact) exercise includes:

• Skipping
• Hopping
• Jumping jacks
• Dance classes (high impact like Jive)
• Resistance exercises such as weights and bands (weight dependent on fitness level)
• Running
• Jogging
• Aerobics
• Tennis
• Football
• Volleyball

Bear in mind, high impact exercise and sports run a higher risk of injury.

When embarking on a new exercise regime:

• Warm up and do gentle stretches before exercising
• Start slowly and move gently, avoiding jerky movements or overextending yourself
• Don’t lift heavy weights until you have built up to it
• Wear appropriate clothes and footwear
• Observe proper exercise technique to avoid injury
• If possible, exercise with the supervision of a certified trainer

If you have any health conditions or have had previous injuries, ask your GP if you need to be aware of any physical limitations based on your bone strength and general health.

See also our article 10 Best Exercises for Bone Health for more info.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: How can I prevent osteoporosis?  What is the current treatment for osteoporosis?  Is swimming a good exercise for people with osteoporosis?  What are the best exercises if you have osteoporosis? 

Yes, HRT can be used to mitigate osteoporosis risk but is not without risks itself.

HRT was once considered a first line defence in preventing osteoporosis in menopausal women because of the role oestrogen plays in bone health, but this thinking was turned on its head as concerns that HRT could increase risks of blood clots, heart disease, stroke and breast cancer came to the fore.

Now the thinking has turned again, with evidence suggesting that, for many women, the benefits of HRT outweigh the risks.

However, there are risks, albeit small, with a person’s age, health profile, and the type and length of HRT treatment – such as tablet or gel, combined or oestrogen-only - factoring into any risk assessment a health practitioner performs when considering whether to prescribe HRT.

Take our test and see which areas you can take action in to improve your bone health

Related FAQs: How can I prevent osteoporosis?  Does osteoporosis affect women worse than men? 

Rebounding means jumping up and down on a mini trampoline and is a great low-impact exercise that, amongst other benefits, is good for bone health. Because it is low impact it can be enjoyed by people who suffer from osteoporosis, as well as those seeking to prevent it. Some trampettes come with a handle for those who would like extra support.

You can go to rebounding aerobics classes or you can purchase your own rebounder and exercise at home. Start off gently and be mindful of the impact that rebounding can have on knees – even low impact exercises can cause injury if proper technique is not observed.

See also Exercises for Bone Health.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: What are the best exercises for preventing osteoporosis?  What are the risk factors for developing osteoporosis? 

Weight bearing exercise is important for helping to build strong bones and ankle weights are a good adjunct to this. As with all exercise, be sure to research the correct techniques for exercises and find out what weight is most appropriate for your needs.

See also Exercises for Bone Health.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are the best exercises for preventing osteoporosis?  What is the current treatment for osteoporosis?  Can osteoporosis be cured/reversed? 

Welcome to the beginning of your journey to better bone health. Our short questionnaire will calculate the current condition of your bone health and, based on your answers, predict where your bone health might be in the future. We will then suggest a strategy for you to move forward to a life free from osteoporosis.

Take Our Test

Osteoporosis, in general, has no symptoms until you break a bone.

Bone loss happens without any symptoms and therefore osteoporosis can progress undetected for years – hence it being known as the ‘silent disease’. Often the first sign is when it has developed to the point where a relatively minor accident causes a bone to fracture.

However, there are some things to look out for that could be hints at loss of bone integrity (although these may have completely unrelated causes):

• A stoop in posture or a curved spin as well as back pain. This can be caused by vertebral crush fractures, and these can occur without injury
• Breathing difficulties that might be caused by a vertebral crush fracture
• Microscopic fractures can lead to deep bone pain that some people with osteoporosis describe as comparable to toothache pain
• Muscle spasms
• Localized bone pain (sometimes mistaken for joint pain)
• Hip, back and knee pain can also be indicators of bone health issues
• Dull bone and muscle pain that may become sharper as the disease progresses

If you are concerned about your bone health speak to your GP. They may recommend you have diagnostic testing, such as a blood test or a bone density (known as a DEXA or densitometry) scan.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are the best exercises for preventing osteoporosis? 

Yes, often osteoporosis has no symptoms until it is quite advanced and a bone fractures in a low impact incident that wouldn’t break a healthy bone, an injury known as a fragility fracture.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are fragility fractures?  Is osteoporosis painful?  What are the stages of osteoporosis? 

A blood test can be a useful diagnostic tool for osteoporosis, but it can’t diagnose osteoporosis categorically.

Usually an array of tests, including a bone densitometry (DEXA) scan, is needed to make a diagnosis.

Blood and urine tests are often used to find out what is happening within the body generally and this can help build a picture of any deficiencies or underlying disorders a person might have that can increase the risk of, or mimic symptoms of, osteoporosis. Levels of certain vitamins and minerals are assessed and bone markers such as bone ALP or BALP levels are measured (high levels of BALP are often found in people with osteoporosis) to build this picture.

A blood test can help you identify issues before osteoporosis develops, such as low vitamin levels.

You can have a routine blood or urine test at your GP’s surgery, but you might be referred for further tests such as a bone scan if your GP suspects osteoporosis.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: Where are the most common areas in the body to get osteoporosis?  What is FRAX®? 

Early-stage osteoporosis does not generally present with symptoms. It is usually not until osteoporosis has advanced to the stage of bones fracturing easily that it is discovered.

Some things to look out for:

• Back or hip pain
• Localized bone pain
• Stooped posture
• Bone fractures, especially from ostensibly minor accidents

The stage before osteoporosis is called osteopenia and this is when bone density is lower than average but not so marked as to be considered osteoporotic. However, osteopenia doesn’t always lead to osteoporosis and there are steps that people can take to strengthen their bones before the condition degenerates into osteoporosis.

If you are concerned about your bone health speak to your GP. They may recommend you have a blood test or a bone density (DEXA or densitometry) scan to look for any irregularities.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What is osteopenia?  Can osteoporosis be without symptoms? 

Clinical risk factors are assessed, but to make an actual diagnosis a bone density scan (very low dose X-ray), also known as a DEXA or DXA scan, is performed to determine the density of bones. It measures how much radiation is absorbed by bones, which in turn indicates how dense they are.

Related FAQs: What is a DEXA scan?  What is FRAX®?  What is a CTX test for osteoporosis? 

FRAX® is a diagnostic tool used to identify people’s risk of developing osteoporosis. Designed by the University of Sheffield, it evaluates the 10-year probability of bone fracture risk using parameters such as height, weight, lifestyle factors and family history.

Related FAQs: How is osteoporosis diagnosed?  How can I prevent osteoporosis? 

A DEXA scan, also known as a bone densitometry scan, is a very low dose X-ray performed to determine a person’s bone mineral density (BMD). It measures how much radiation is absorbed by the bones, which in turn indicates how dense they are.

Clinically, BMD carries a score that is the result of comparing a patient’s BMD with that of a young and healthy person’s peak bone density. This is known as a T-score and is used to determine primary osteoporosis (weak bones without an underlying cause).

The T-score result reflects what range a person’s bone density is in:

• Normal range (+1 to -1)
• Osteopenia range (-1 to -2.5)
• Osteoporosis range (-2.5 and below)

For premenopausal women, men younger than 50 and children, the comparison is made against people of the same age and sex to try and identify a secondary cause of bone loss, and this is called a Z-score.

Related FAQs: Can osteoporosis be without symptoms?  How is osteoporosis diagnosed? 

A CTX test is a blood test that measures serum cross-linked C-telopeptide of type I collagen, which is a marker of osteoclast (cells that break down bone) activity and is used to assess the level of bone resorption.

Related FAQs: What is a DEXA scan?  Can osteoporosis affect your teeth? 

Anecdotally people with osteoporosis might experience fatigue due to comorbid factors such as chronic fatigue syndrome or hormonal issues, but generally osteoporosis does not present with tiredness. Excessive fatigue should be investigated by a GP.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: How is osteoporosis diagnosed? 

Yes, osteoporosis is implicated in hearing loss where the bones in the inner ear – the hammer (malleus), the anvil (incus) and the stirrup (stapes) – are affected by low bone mineral density.

Related FAQs: What are the signs/symptoms of osteoporosis?  What are the risk factors for developing osteoporosis? 

Loss of density in the jawbone can make teeth unstable and more prone to falling out and can also make it easier for bacteria to infiltrate, causing gum (periodontal) disease.

It can limit your dental treatment options, so if you have any concerns see a dentist as soon as possible. Some treatment for osteoporosis, such as zoledronic acid injections, is not recommended if a patient is planning invasive dental work due to the (very rare) possibility of osteonecrosis.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are the signs/symptoms of osteoporosis? 

Treatment for osteoporosis can be lifestyle improvements in the form of an exercise and vitamin regimen, or a GP may prescribe medication, or a combination of both.

Lifestyle changes

Calcium, vitamin D and magnesium supplements

Vitamin D and magnesium help the body absorb calcium.

How much should you be getting:

• The recommended amount of vitamin D a day for adults is 10 micrograms (this is equivalent to 400 international units (IU) of vitamin D) – possibly more is required if deficient, but no more than 100 micrograms a day (µg) equivalent to 4,000 IU.
• Adults should have 700 milligrams of calcium a day – possibly more if deficient but usually not more than 1,500mg.
• Recommended daily amounts of magnesium are 270mg for adult females and 300mg for adult males, although there is some thinking that this recommendation should be increased. Having up to 400mg a day is unlikely to cause harm.

There is also research being conducted into the usefulness of vitamin K2 for bone health.

Consult your GP for guidance on supplements if you are unsure of your needs.

Weight-bearing exercise is important for both preventing and treating osteoporosis.

Don’t smoke

Studies suggest that smoking decreases bone mass and increases the risk of fracture in both women and men. See the NHS’s Stop Smoking page if you need help stopping smoking.

Limit alcohol

Studies have shown that heavy alcohol consumption compromises bone health. The NHS recommends no more than 14 units a week. Also, alcohol increases your chances of falling and breaking bones. See the NHS’s Alcohol Support page.

Medication

All medications can have possible side effects. Always speak to your GP about any drug treatments you plan to take.

Bisphosphonates

Bisphosphonates are inhibitors of bone resorption that are given as tablets and sometimes injections. They inhibit cells (osteoclasts) that break down bone, helping to maintain bone density.

This medication includes:

• Zoledronic acid aka zoledronate
• Ibandronic acid aka ibandronate
• Alendronic acid aka alendronate
• Risedronic acid aka risedronate

RANK ligand inhibitors

The most recently developed injection treatment is Denosumab. It is in a class of medications known as RANK ligand inhibitors and works by inhibiting the cells (osteoclasts) that break down bone. It is an anti-body-based (monoclonal) medication but doesn’t suppress the immune system.

Selective oestrogen receptor modulators (SERMs)

Raloxifene is a drug that delivers a similar effect on bone as the hormone oestrogen. This treatment is mainly given to postmenopausal women and those on glucocorticoids. Bisphosphonates are usually preferred over SERMs for treating osteoporosis.

HRT (hormone replacement therapy)

Postmenopausal women are at a higher risk for developing osteoporosis because female hormones, especially oestrogen, play a large role in maintaining a woman’s bone health and levels drop dramatically at menopause. So, women who take HRT reduce their risk of osteoporosis; however, HRT is usually not specifically recommended as a treatment for osteoporosis.

Testosterone treatment

Where osteoporosis in men is caused by low levels of male sex hormones, testosterone can be used to remediate the problem.

Calcitonin

Salmon calcitonin is a naturally occurring peptide that is an analog of human calcitonin, a hormone responsible for normal calcium homeostasis. First administered as a parenteral injection, it is now most widely administered intranasally and is particularly indicated for postmenopausal osteoporosis.

Parathyroid hormone

Severe osteoporosis can be treated with a form of parathyroid hormone called teriparatide (brand name Forteo), which is administered by injection. Naturally occurring in the body, this hormone helps regulate calcium metabolization. Whilst other treatments can slow down the breakdown of bone, parathyroid hormone stimulates osteoblasts to create new bone. This is not a first-line treatment, however.

Take our test and see which areas you can take action in to improve your bone health

Related FAQs: What are the best exercises if you have osteoporosis?  Is swimming a good exercise for people with osteoporosis? 

Taking steps to improve bone health, and physical health in general, will always be beneficial no matter your age or health status. So, whilst osteoporosis cannot be completely reversed, with lifestyle changes and the right treatment it can be greatly alleviated and the risk of fracture significantly reduced.

See our articles Adults and Bone Health and Best Exercises for Bone Health.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are the best exercises if you have osteoporosis? 

The most recently developed injection used as treatment for osteoporosis is Denosumab. It is in a class of medications known as RANK ligand inhibitors and works by inhibiting the cells (osteoclasts) that break down bone. It is an anti-body-based medication but doesn’t suppress the immune system.

There is also a medicine that is administered by drip called zoledronic acid. It is in a class of drugs called bisphosphonates, which also work by slowing down the cells that break down bone.

Severe osteoporosis can be treated with human parathyroid hormone injection. Whilst other treatments can slow down the breakdown of bone, parathyroid hormone stimulates cells (osteoblasts) to create new bone. This is not a first-line treatment, however.

Related FAQs: What is the current treatment for osteoporosis?  What is bone infusion therapy? 

Bone infusions are drug treatments given to osteoporosis patients via a drip/IV. The most common drugs used for this are bisphosphonates.

Related FAQs: What is the current treatment for osteoporosis?  Are there injections for osteoporosis? 

The benefits of vibration therapy are yet to be firmly established.

Vibration therapy, standing on a vibrating platform, was developed to treat astronauts who lost bone and muscle mass due to spending extended periods of time in zero gravity. The effectiveness of vibration therapy is, as of yet, unclear – some studies found an increase in bone density and others didn’t. Until more conclusive results are achieved, vibration therapy should be viewed as a complementary, but not the go-to, treatment for osteoporosis.

Related FAQs: What is the current treatment for osteoporosis? 

A brace will support the spine and help the vertebrae heal from a spinal (vertebral) compression fracture. A brace’s primary function is to restrict movement while the fracture heals and is usually a short-term measure.

Related FAQs: Is swimming a good exercise for people with osteoporosis?  What is the current treatment for osteoporosis? 

Avoiding inactivity is extremely important, especially today where sedentary lifestyles are increasingly becoming the norm. Not only does exercise build muscle and strengthen bone, it also improves balance, which helps to prevent falls.

Weight-bearing impact exercises and resistance exercises are best for bones:

• Impact: Bones need to be subjected to compressive forces (the weight of the body acts as a compressive force during exercise) to stimulate them to increase or maintain density. Compression activates the osteoblasts (cells that synthesize bone) so that additional new bone is produced. Impact varies depending on whether both feet leave the ground at the same time (like running) or just one foot at a time (walking). Exercise can, in general, be divided into low and high impact:
  • Low impact: generally, when one foot always remains on the ground, or something absorbs the impact like a rebounder or water (swimming is technically a no-impact exercise)
  • High impact: moves that put more stress on the body through speed and height of movement with both feet off the ground simultaneously
• Weight: Weight-bearing exercise – which is any exercise where muscle overcomes a resistant force, including gravity – staves off age-related declining muscle mass and grows new muscle. This is good for bones because denser muscle means a person weighs more as they go about their day-to-day activities, which helps build bones, and the more muscle around joints and bones, the more protected they are from injury.
• Resistance: Resistance training is a weight-bearing exercise that involves using weights or resistance bands to create a strong resistance for muscles to overcome. This is more challenging to perform and results in more muscle gain.

People with osteoporosis should concentrate on low impact exercise, especially when embarking on a new exercise regime. Exercise classes often offer both low and high impact versions, like Zumba or dance aerobics.

Low impact exercises include:

• Walking
• Stair climbing
• Marching on the spot
• Dance classes (low impact like line dancing or ballroom)
• Resistance exercises such as hand-held weights (weight dependent on fitness status)
• Rebounding - see also Is rebounding good for preventing osteoporosis?
• Yoga
• Pilates
• Tai chi
• Low-impact aerobics or dance classes, such as low-impact Zumba

High impact exercise and sports run a higher risk of injury. Low impact exercise can also cause injury if care is not taken. Always follow proper exercise technique and never overexert yourself.

If you have a high risk of fracture you will need to be extra careful when exercising, but with adaptations can exercise safely.

Before embarking on a new exercise regime:

• Warm up and do gentle stretches before exercising
• Start slowly and move gently, avoiding jerky movements or overextending yourself
• Don’t lift heavy weights until you have built up to it
• Wear appropriate clothes and footwear
• Observe proper exercise technique to avoid injury
• If possible, exercise with the supervision of a certified trainer

If you have any health conditions or have had previous injuries, ask your GP if you need to be aware of any physical limitations based on your bone strength and general health.

See our article 10 Best Exercises for Bone Health for more info.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: How can I prevent osteoporosis?  What are the best exercises for preventing osteoporosis? 

Whilst swimming is a great form of exercise for many reasons, it is not weight bearing due to the support of the water and is technically a no-impact exercise, so shouldn’t be relied upon for bone health. However, because of those things, it is very easy on the joints, so is good for people who need to regain their fitness or mobility slowly. Enjoy swim sessions but complement them with other weight-bearing impact exercises for bone health.

See our article 10 Best Exercises for Bone Health.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are the best exercises for preventing osteoporosis? 

Clinical effectiveness of homeopathy has not been established and there are no recommendations.

Related FAQs: Do back braces help with osteoporosis of the spine?  How is osteoporosis diagnosed? 

Bisphosphonate pills are the most common treatment for osteoporosis and their main side effects are stomach upset and heartburn. However, this can be mitigated by avoiding lying down or bending over for 30 to 60 minutes after taking the medication. This helps to avoid it travelling back up into the oesophagus where it can cause irritation. 

Another possible side effect of bisphosphonates is bone, joint or muscle pain.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What is the current treatment for osteoporosis? 

Welcome to the beginning of your journey to better bone health. Our short questionnaire will calculate the current condition of your bone health and, based on your answers, predict where your bone health might be in the future. We will then suggest a strategy for you to move forward to a life free from osteoporosis.

Take Our Test

The body breaks down bone in order to remodel and maintain the skeleton, repair injuries, and also to release calcium into the blood when needed. Osteoblasts are the cells that build bone and osteoclasts are the cells that resorb bone.

Osteopetrosis, a condition where bones become extremely dense and prone to breaking, develops when osteoclasts malfunction and stop doing their job of breaking down bone. Osteoporosis occurs when osteoblasts no longer work efficiently enough to satisfactorily rebuild bone that has been broken down.

See for Aging Bones - What Happens?  and A Brief History of Osteoporosis for further information about bones.

Related FAQs: What is osteoporosis and why does it develop?  What are the risk factors for developing osteoporosis? 

It depends on the severity of the osteoporosis, but hip replacement surgery is often carried out on patients with osteoporosis who have suffered a hip fracture.

Related FAQs: Can osteoporosis affect your teeth?  Can osteoporosis cause hearing loss? 

Cycling is excellent for cardiovascular health, but as it is not a weight-bearing exercise it is not beneficial to bones.

Bones need to be subjected to compressive forces to stimulate them to increase or maintain density. Compression activates the osteoblasts (cells that synthesize bone) so that additional new bone is produced.

Other bone health considerations for keen cyclists include:

• Low body mass (cyclists are generally lighter and this can be a risk factor for osteoporosis)
• Increased fractures from a fall or a crash
• High-intensity cycling releases calcium from bones, which is then excreted in sweat.

Regular cyclists should ensure they include plenty of weight-bearing exercises in their regimen.

See 10 Best Exercises for Bone Health.

Related FAQs: Is swimming a good exercise for people with osteoporosis?  What are the best exercises if you have osteoporosis?  Is rebounding good for preventing osteoporosis?  Are ankle weights good for osteoporosis? 

No, on the contrary, drinking tea has been associated with better bone health.

Although more research is needed into how tea is beneficial for bones, especially as caffeine has been found to have a negative effect on bone health, especially as it reduces calcium absorption, there is no cause for ditching the teapot.

There is some thinking that tea has an oestrogen-mimicking effect that helps protect bones. Another idea is that tea polyphenols have a positive effect on bone volume.

Green tea usually has less caffeine than black tea, but both contain tannins which can reduce mineral absorption, so it’s best to have your cups of tea in between meals and, as with most things, moderation is key.

Related FAQs: How can I prevent osteoporosis?  Which vitamins and minerals are key to bone health? 

Whilst excessive salt consumption may have a variety of negative effects on the body, it does not appear to have much of an impact on bone health and a low salt diet doesn’t seem to benefit bones.

Daily salt recommendation guidelines are maximum of 6g (2.5g of sodium).

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What is osteoporosis and why does it develop?  What are the risk factors for developing osteoporosis? 

This is a rather contentious issue and there is no current consensus; however, eating adequate amounts of protein is undeniably beneficial to bone health. For a relatively active adult a daily protein intake RDA is 10% of total daily calories.

It has been postulated that high protein consumption, especially animal protein, may be bad for bone health because it leads to an increase in calcium excretion via urine. Because this urine has been noted to be of a lower pH (more acidic), it has therefore been theorized that a high protein diet creates an acidic environment in the body, causing the release of calcium from bones in order make the body more alkaline.

However, whilst it is well established that high protein intake does lead to an increase in calcium secretion, there is no evidence to suggest that it is because it changes the pH balance of the body or, indeed, that people who eat a lot of protein have a higher fracture risk. There is some thinking that the body releases a hormone to mitigate the calcium loss, hence why there is no conclusive evidence that high protein intake leads to decreased bone density.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are the risk factors for developing osteoporosis?  How can I prevent osteoporosis? 

In a word: yes. Studies have shown there is a link between high fizzy drink consumption and increased risk of bone fractures. However, there isn’t conclusive evidence as to why this might be.

One theory is that phosphoric acid (phosphate) – added to drinks to enhance flavour and give a refreshing quality, as well as prevent bacteria - interferes with the absorption of calcium within the body. Phosphorous is a mineral that is found naturally in the body, and there is, as of yet, no concrete evidence that too much phosphate is responsible for the elevated fracture risk.

Another theory is that high caffeine consumption is responsible for bone density loss – both caffeine and non-caffeine fizzy drinks have been implicated in higher fracture risk, but caffeinated drinks seem to be associated more strongly.

Another idea is that people who drink a lot of fizzy drinks simply don’t get enough nutrients because they choose fizzy drinks over more healthful ones. Fizzy drinks are devoid of nutrients and are often high in sugar which can play havoc with insulin levels. Even sugar-free drinks using sweeteners have been shown to have a negative effect on insulin. Insulin resistance can lead to diabetes and people with diabetes tend to have a lower bone density.

So, there is an association between fizzy drinks and increased risk of bone fractures, and the advice is to consume fizzy drinks only in moderation - no more than one a day - or not at all.

Why not take our test and see which areas you can take action in to improve your bone health?

Related FAQs: Is drinking tea bad for bones? 

Milk is a nutritious drink, containing calcium, protein, iodine, potassium, phosphorous and vitamins B2 and B12, but should not be relied upon for bone health as it does not contain vitamin D (in the UK, milk is not fortified).

One Swedish study found that there did not appear to be a decrease in fracture risk with a higher intake of milk (drinking three or more glasses of milk per day compared to drinking one glass per day), with high milk consumption being associated with more bone and hip fractures. More research is needed on this.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are the risk factors for developing osteoporosis?  Can children get osteoporosis? 

Yes, too much calcium from supplements could put a strain on kidneys and can cause hypercalcemia (a build-up of calcium in the blood). Hypercalcemia can cause weakened bones (amongst other health problems).

The recommended daily amount of calcium for adults is 700 milligrams – possibly more if deficient but usually not more than 1,500mg.

Take our test and see which areas you can take action in to improve your bone health.

Related FAQs: What are the risk factors for developing osteoporosis?  What is the current treatment for osteoporosis? 

Osteopetrosis – literally meaning ‘stone bone’ – is a rare condition caused by genetic changes where bones harden abnormally.

It is also known as marble bone disease or Albers-Schönberg disease.

Related FAQs: What is osteoporosis and why does it develop?  What is osteopenia? 

The names are very similar, but they are very different conditions.

Whilst it is possible to have both osteoporosis and osteoarthritis, they develop differently and are associated with different symptoms.

Osteoarthritis is a degenerative joint disease and usually develops from repetitive use of joints in hips, hands, knees, neck, and back. Eventually overuse of joints results in a wearing away of the cartilage that cushions the ends of the bones. Without this protection the bones rub together, causing pain and swelling that can lead to decreased mobility in the affected joints.

Pain management strategies are similar for people with osteoporosis and osteoarthritis, although osteoporosis isn’t usually painful until a bone is broken.

Related FAQs: What is osteoporosis and why does it develop? 

Welcome to the beginning of your journey to better bone health. Our short questionnaire will calculate the current condition of your bone health and, based on your answers, predict where your bone health might be in the future. We will then suggest a strategy for you to move forward to a life free from osteoporosis.

Take Our Test