Osteoporosis is a condition in which bones become less dense and more likely to break. It develops over time and is often only recognised after a fragility fracture, meaning a break caused by a fall or impact that would not normally be expected to fracture healthy bone.
The spine, hip, and wrist are common fracture sites. Osteoporosis can affect women and men, but risk rises with age and is higher after menopause.
Bone Strength
Bone is living tissue. It is constantly broken down and rebuilt. Osteoporosis develops when bone loss outpaces bone formation, when bone structure weakens, or both.
Bone mineral density is one part of fracture risk, but it is not the only part. Age, previous fracture, falls risk, medicines, other illnesses, smoking, alcohol intake, and family history can all affect whether a person breaks a bone.
Symptoms
Osteoporosis may not cause symptoms until a fracture occurs. Possible signs include:
- A broken bone after a minor fall or low-impact injury.
- Back pain from vertebral fracture.
- Loss of height.
- Stooped posture.
- Reduced mobility after hip, wrist, or spine fracture.
Pain and disability often come from fractures rather than from low bone density alone.
Risk Factors
Risk factors include:
- Older age.
- Previous fragility fracture.
- Early menopause or low oestrogen.
- Long-term glucocorticoid use.
- Low body weight.
- Smoking.
- Heavy alcohol use.
- Low calcium or vitamin D intake.
- Lack of weight-bearing activity.
- Rheumatoid arthritis and some endocrine, bowel, kidney, or liver conditions.
- Family history of hip fracture or osteoporosis.
Assessment and Diagnosis
Assessment may include fracture history, falls risk, medicines, blood tests, and a bone density scan. A DXA scan is commonly used to measure bone mineral density.
NICE guidance covers fracture risk assessment in adults and supports use of risk assessment tools such as FRAX or QFracture where appropriate. Assessment is especially important after a fragility fracture, because a first fracture can predict future fracture risk.
Management
Management aims to reduce fracture risk and maintain independence. It can include:
- Falls prevention.
- Strength and balance work.
- Weight-bearing and resistance exercise where suitable.
- Adequate calcium and vitamin D.
- Stopping smoking.
- Reducing heavy alcohol intake.
- Reviewing medicines that increase falls or bone loss.
- Bone-protective medicines for people at sufficient fracture risk.
Drug treatment may include bisphosphonates or other bone medicines depending on the person's risk, other conditions, kidney function, and tolerance. Treatment decisions usually depend on overall fracture risk rather than age alone.
See Also
References
Discussion log
Use comments for sourcing notes, corrections, and disputed details.
No comments yet.