Osteoporosis
Bones become thin and fragile, so they break easily — typically the wrist, spine and hip — often after only a minor fall. It causes no symptoms until a fracture occurs.
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About 1 in 3 women and 1 in 5 men over 50 will have an osteoporotic fracture.
What happens in the body
Bone resorption outpaces formation, reducing bone mass and weakening its microarchitecture; oestrogen loss at menopause accelerates this.
Causes
- Age-related bone loss
- Oestrogen deficiency after menopause
Risk factors
- Female sex and early menopause
- Age
- Low body weight
- Smoking and excess alcohol
- Long-term steroids
- Rheumatoid arthritis
- Family history of hip fracture
- Low calcium and vitamin D
- Inactivity
Symptoms
- None until a fracture
- Loss of height and stooped posture from spinal fractures
- Sudden back pain
Diagnosis — tests and examinations
- DXA bone density scan (T-score ≤ −2.5)
- Fracture risk tools (FRAX)
- Blood tests to exclude secondary causes
Treatment
Medicines and medical treatment
- Bisphosphonates (alendronate, zoledronic acid)
- Denosumab
- Anabolic agents for very high risk: teriparatide, abaloparatide, romosozumab
- Calcium and vitamin D
- HRT in some younger post-menopausal women
Operations and procedures
- Fracture fixation or hip replacement
- Vertebroplasty for selected painful spinal fractures
Self-care, home remedies and lifestyle
- Weight-bearing and muscle-strengthening exercise
- Stop smoking, limit alcohol
- Fall prevention at home
- Diet rich in calcium and protein
Possible complications
- Hip fracture (high mortality in older people)
- Vertebral fractures and chronic pain
Prevention
- Exercise and good nutrition throughout life
- Not smoking
Outlook
Treatment reduces fracture risk by 30–70%.
When to see a doctor
Ask about bone density testing if you have risk factors or have broken a bone from a minor fall.
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
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