Insight and Fact Sheet: Osteoporosis

Osteoporosis is a common health condition which weakens bones, making them fragile and more likely to break.

There are around three million sufferers in the UK, and the condition develops slowly over the course of several years - often only being diagnosed when a fall or impact suddenly causes a bone to break.

It can be treated with bone-strengthening medication and there is also a strong focus on injury prevention.


Condition overview

Losing bone density is a natural part of getting older, but some people lose it much quicker than normal – which can lead to osteoporosis.

Women are particularly susceptible to the condition, and their risk is greater if they begin the menopause early (before 45) or have had their ovaries removed.

Osteoporosis can also affect men, younger women and children.

There is a stage before osteoporosis, called osteopenia – in which lower-than-normal bone density is detected. This does not always lead to osteoporosis.

Sufferers can live normal lives, but prevention and treatment go hand-in-hand to minimise the risk of broken bones.


Symptoms and risk factors

The most-common fractures related to osteoporosis are to the hips, wrists and vertebrae - but breaks can also happen in the arm or pelvis. In some cases, a cough or sneeze can lead to a broken rib or the partial collapse of one of the bones of the spine.

There is not usually any pain until a bone is broken, however spinal fractures are a common cause of longer-term pain for sufferers.

Some older people develop a characteristic stooped posture, which is caused when the bones in the spine have broken – leading to difficulty in supporting the weight of the body.

Risk factors include:

  • Taking high-dose steroid tablets for longer than three months
  • Other medical conditions – including inflammatory conditions, hormone-related conditions, or malabsorption issues
  • Family history of osteoporosis – particularly a hip fracture in a parent
  • Long-term use of medicines affecting bone strength or hormone levels, such as anti-oestrogen tablets after breast cancer
  • Having or having had an eating disorder such as anorexia or bulimia
  • Having a low body mass index (BMI)
  • Lack of exercise
  • Heavy drinking and smoking

Diagnosis and treatment

If someone is suspected to have osteoporosis, their future risk of bone fracture will be calculated using an online tool (such as FRAX Q-Fracture).

They may also be sent for a bone density scan, to measure bone strength. This is a short, quick and painless procedure which compares a patient’s bone density to that of a healthy young adult.

The difference is calculated as a standard deviation (SD) and is called a T score.

  • 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

Treatment for osteoporosis centres on healing and preventing fractures - and the type of treatment offered will depend on age, sex, type of injury and injury history.

The condition can be treated with bone strengthening medicines, while lifestyle measures such as ensuring patients consume enough calcium and vitamin D are also relevant.

Medications used to treat osteoporosis (and sometimes osteopenia) include:

  • Bisphosphonates – which slow the rate that bone is broken down in the body, helping to maintain bone density. These take six-to12 months to work and may need to be taken for five years or more.
  • Selective oestrogen receptor modulators (SERMs) - which have a similar effect on bone as the hormone oestrogen, helping to maintain bone density and reduce the risk of fracture, particularly of the spine.
  • Parathyroid hormone treatments - which are used to stimulate cells that create new bone, these can actually increase bone density. This is generally only used in severe cases and where other treatments are not working.
  • Calcium and vitamin D supplements – which can be taken alone or in conjunction with other treatments. Calcium is important for maintaining healthy bones and vitamin D helps the body absorb it.
  • Hormone replacement therapy (HRT) – which can be prescribed to women going through the menopause – and has been shown to keep bones strong and reduce the risk of fractures.
  • Testosterone treatment – which can be useful in men, where osteoporosis is caused by low levels of male sex hormones.

Prognosis

People with osteoporosis can live their lives as normal, or perhaps with a few adjustments, and some may not even break any bones – and therefore not experience any pain.

Those diagnosed with osteoporosis are advised to take steps to minimise the risk of a fall - and may be subject to more frequent eye and hearing tests.

Exercise and staying active are encouraged – but specifically exercise unlikely to cause a broken bone if performed responsibly.

There are numerous ways to manage pain, including medication and other treatments.

This is an abridged version of an article shared with our clients. The full version of our Insight piece for managers includes also covers the occupational health and legal implications for employers. And our Fact Sheet covers the same topic for employees.