Osteoporosis

Osteoporosis is a condition in which bones lose density and strength, becoming thin, fragile and more prone to fracture. It develops when the natural process of bone breakdown and renewal falls out of balance — bone is lost more quickly than the body can replace it, causing bones to become porous and weak from the inside out, even though they may look completely normal from the outside. The hip, spine and wrist are most commonly affected, though osteoporosis can weaken any bone in the body.

Osteoporosis is often called a “silent disease” because bone loss happens gradually and painlessly, with no warning signs at all in the early stages. Many people only discover they have osteoporosis after suffering a fracture from a fall that would not normally break a healthy bone — or sometimes even without any significant fall at all. While osteoporosis can affect men and women of any age, it is especially common in women after menopause, when a natural drop in oestrogen accelerates bone loss.

Types of Osteoporosis

Osteoporosis is generally classified according to its underlying cause, which helps guide both prevention and treatment.

• Postmenopausal Osteoporosis (Primary Type I): The most common form in women, resulting from the sharp drop in oestrogen that occurs at menopause. Oestrogen plays a key protective role in maintaining bone density, and its decline can lead to rapid bone loss in the years immediately following menopause.
• Age-Related Osteoporosis (Primary Type II): Affects both men and women as part of the natural ageing process, as the body's ability to form new bone gradually declines with age, typically becoming significant from the 70s onward.
• Secondary Osteoporosis: Develops as a result of an identifiable underlying cause, such as certain medications (particularly long-term corticosteroid use), hormonal disorders, chronic diseases, or lifestyle factors, and can occur at any age, including in younger adults.
• Osteopenia: A milder stage of reduced bone density that comes before osteoporosis — bone density is lower than normal but not yet low enough to be classified as osteoporosis. Identifying osteopenia early provides an important opportunity to intervene before significant bone loss occurs.

How Osteoporosis Develops: Understanding Bone Remodelling

Bone is living tissue that is constantly being broken down and rebuilt throughout life, in a process called bone remodelling:

• Bone resorption: Specialised cells called osteoclasts continuously break down old or damaged bone tissue, releasing calcium and other minerals into the bloodstream.
• Bone formation: Other specialised cells called osteoblasts rebuild new bone tissue to replace what has been broken down, using calcium and other minerals from the diet.
• Peak bone mass: During childhood, adolescence and early adulthood, bone formation outpaces bone breakdown, allowing bones to grow stronger and denser, typically reaching their peak strength and density by the late 20s to early 30s.
• The shift with age: From around the mid-30s onward, bone breakdown gradually begins to outpace bone formation, leading to a slow, natural decline in bone density with age.
• Accelerated loss with menopause: The decline in oestrogen at menopause removes an important protective effect on bone, causing the rate of bone loss to accelerate significantly, particularly in the first 5 to 10 years after menopause.

Osteoporosis develops when this imbalance between bone breakdown and bone formation becomes pronounced enough that bones lose structural strength, developing a porous, honeycomb-like internal structure that is far more fragile than healthy bone.

Symptoms of Osteoporosis

Osteoporosis typically causes no symptoms in its early stages, which is why it is so often diagnosed only after a fracture occurs. As bone density declines further, some signs may become apparent:

• A bone fracture that occurs from a minor fall, bump, or even a routine movement such as bending or coughing, that would not normally break a healthy bone
• Back pain, which can result from a fractured or collapsed vertebra in the spine (a compression fracture)
• Gradual loss of height over time
• A stooped or hunched posture (kyphosis), sometimes referred to as a “dowager's hump,” resulting from multiple small vertebral fractures
• Reduced grip strength, which may correlate with reduced bone density elsewhere in the body
• Receding gums, which can sometimes be an early indicator of bone loss affecting the jaw

Because osteoporosis is so often silent until a fracture occurs, proactive screening — particularly for those with known risk factors — is one of the most important tools for catching the condition before a serious fracture happens.

Risk Factors for Osteoporosis

A number of factors can increase your risk of developing osteoporosis:

• Sex: Women have a significantly higher risk of osteoporosis than men, partly because women generally have less bone mass to begin with, and partly due to the accelerated bone loss that occurs after menopause.
• Age: Risk increases progressively with age, as the balance between bone formation and breakdown shifts further towards bone loss over time.
• Ethnicity: People of White or Asian descent are at greater risk of developing osteoporosis compared to other ethnic groups.
• Family history: Having a parent or sibling with osteoporosis, or a family history of fragility fractures, increases your own risk of the condition.
• Body frame size: People with a smaller, thinner body frame tend to have less bone mass to draw on as they age, increasing their risk of osteoporosis.
• Hormonal factors: Low oestrogen levels (including after menopause or from early menopause), low testosterone levels in men, and thyroid conditions such as hyperthyroidism can all contribute to bone loss.
• Low calcium and vitamin D intake: A diet consistently low in calcium and vitamin D contributes to reduced bone density and an increased risk of fracture over time.
• Certain medications: Long-term use of corticosteroids and some other medications can interfere with bone rebuilding and accelerate bone loss.
• Sedentary lifestyle: Prolonged inactivity, or extended periods of bed rest, can lead to weakened bones over time, as bone density responds to the mechanical stress of regular movement and exercise.
• Smoking and excessive alcohol consumption: Both are independently associated with reduced bone density and an increased risk of osteoporosis and fracture.
• Certain medical conditions: Conditions such as rheumatoid arthritis, coeliac disease, and other disorders that affect nutrient absorption or hormone levels can increase the risk of secondary osteoporosis.

Possible Complications of Osteoporosis

The most significant risk associated with osteoporosis is fracture, and the consequences of a fracture in someone with weakened bones can be considerably more serious than in someone with healthy bone density:

• Fragility fractures: Fractures that occur from a fall from standing height or less, most commonly affecting the hip, spine and wrist — the hallmark complication of osteoporosis.
• Hip fractures: Among the most serious osteoporotic fractures, often requiring surgery and a prolonged recovery, and associated with a significant risk of reduced mobility, loss of independence, and increased mortality in the following year, particularly in older adults.
• Vertebral (spinal) fractures: Can occur with minimal or no trauma, sometimes going unnoticed at the time, but contributing to chronic back pain, height loss, and progressive spinal curvature over time.
• Chronic pain: Both acute fracture pain and longer-term pain related to changes in posture and spinal alignment can significantly affect quality of life.
• Reduced mobility and independence: Fractures, particularly of the hip, can substantially limit mobility and the ability to carry out everyday activities, sometimes requiring long-term care support.
• Psychological impact: Fear of falling and losing independence after a fracture can lead to reduced activity, social withdrawal, and a higher risk of anxiety or low mood.

How Osteoporosis Is Diagnosed

Osteoporosis is primarily diagnosed through bone density testing, often supported by a broader assessment of individual fracture risk.

• Bone Mineral Densitometry (DEXA Scan): The gold-standard test for measuring bone density, using a low-dose X-ray to scan the hip and spine. Results are expressed as a T-score, comparing your bone density to that of a healthy young adult, and are used to diagnose osteoporosis and osteopenia.
• X-ray: Not used to measure bone density directly, but useful for identifying fractures, including vertebral compression fractures that may not have caused noticeable symptoms.
• Blood Tests: Used to check calcium, vitamin D and thyroid hormone levels, and to help identify underlying causes of secondary osteoporosis.
• Fracture Risk Assessment (FRAX Score): A calculation that combines bone density results with other risk factors, such as age, sex, weight and fracture history, to estimate your individual 10-year risk of a major fracture and help guide treatment decisions.

Living With Osteoporosis

Because fractures are the primary concern with osteoporosis, and most fractures result from falls, reducing your risk of falling is just as important as strengthening your bones.

At home, removing loose rugs and trip hazards, improving lighting (particularly on stairs and in hallways), and installing grab rails in the bathroom can meaningfully reduce fall risk. Regular exercise that includes a balance and strength component — such as tai chi or supervised strength training — has been shown to reduce fall risk in older adults.

Having your vision checked regularly, wearing appropriate, well-fitting footwear, and reviewing your medications with your doctor (as some medications can affect balance or cause dizziness) are all worthwhile additional steps. If you have already been diagnosed with osteoporosis, working with your care team on both bone-strengthening treatment and fall prevention together offers the best protection against future fractures.

How to Reduce Your Risk of Osteoporosis

While some risk factors for osteoporosis, such as age, sex and genetics, cannot be changed, several lifestyle measures can meaningfully support bone health throughout life:

• Exercise regularly: Weight-bearing and resistance exercise are particularly effective for improving and maintaining bone density, and should form a regular part of your routine at every life stage.
• Eat a bone-healthy diet: A well-balanced diet rich in calcium — found in leafy greens, dairy products, dried fruits and tofu — supports long-term bone health and helps prevent osteoporosis.
• Get adequate vitamin D: Sunlight exposure triggers the body's own production of vitamin D, which is essential for calcium absorption; supplementation may be needed for those with limited sun exposure.
• Quit smoking: Smoking is associated with an increased risk of osteoporosis and fracture, and quitting benefits bone health as well as overall health.
• Limit alcohol consumption: Heavy alcohol consumption has been linked to reduced bone density and an increased risk of osteoporosis and falls.
• Build peak bone mass early: Encouraging good nutrition, activity and calcium intake in childhood and adolescence helps maximise peak bone mass, providing a stronger foundation to draw on later in life.
• Get screened if at risk: If you have risk factors for osteoporosis, particularly after menopause or from age 65 onward, discuss bone density screening with your doctor to catch bone loss early.