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Currently it’s estimated that more than three million people in the UK have osteoporosis. Osteoporosis is a condition that causes your bones to lose strength, which means these can break easily following a simple bump or fall.

This article was included in issue 82 (autumn 2019) of  The Menopause Exchange newsletter.

One in two women and one in five men over 50 are expected to break a bone during their lifetime, usually due to low bone density (bone strength). Your bone density peaks around the age of 30 and remains stable for a few years. But from your mid-30s a gradual and progressive decline in bone density occurs every year.

Fragility fractures
Your wrist, hip and spine are the most common sites for broken bones associated with osteoporosis, also called fragility fractures. These fractures can occur as a result of minimal force, such as a fall from standing height or a minor knock or bump.

Fractures can also be spontaneous and may happen without any trauma at all. For some people with a very high risk of broken bones, simple actions such as coughing, sneezing or even turning over in bed can result in a spinal fracture.

Common risk factors
Various risk factors can reduce bone density and increase the risk of a broken bone. Bone tissue is made up of different types of bone cells, including osteoblasts and osteoclasts. Osteoblasts (bone builders) are involved in the formation of bone, while osteoclasts (bone absorbers) are involved in the break down and resorption of old bone back into the body.

Generally, women are at a greater risk of osteoporosis due to the menopause, as oestrogen slows bone resorption. After the menopause, when the ovaries no longer make oestrogen, low circulating oestrogen levels increase osteoclast formation and bone resorption. This leads to decreased bone mass and reduced bone strength.

Other risk factors for low bone density and osteoporosis include:

  • Low body weight: a body mass index (BMI) of less than 19kg/m2 is associated with a higher risk, especially if low weight causes an absence of periods in pre-menopausal women
  • Premature menopause
  • Genetic factors: there’s an increased risk if either parent broke a hip
  • Coeliac disease, Crohn’s disease and other malabsorption conditions
  • Inflammatory conditions such as rheumatoid arthritis
  • Current glucocorticoid treatment (taken by mouth for three months or more) as well as aromatase inhibitors used to
    treat breast cancer
  • Gender: women have a higher risk as they have smaller bones
  • Conditions that cause low oestrogen in women, but also low testosterone (hypogonadism) in men
  • Excessive alcohol and smoking
  • Type 1 diabetes
  • Overactive thyroid gland
  • Long periods of immobility
  • Previous fragility fractures increasing the likelihood of further fractures

Diagnosing osteoporosis
If osteoporosis is suspected, or you have significant risk factors, you may be advised to have a bone density scan. The gold standard for diagnosing osteoporosis is called the dual energy X-ray absorptiometry (DXA) scan. A DXA scan measures the quantity of bone mineral in certain parts of your skeleton. It usually measures your lumbar spine (the four vertebrae in your lower back), your hip and the very top of your thigh bone (called the neck of the femur).

Your scan results are compared with the bone mineral density of an average young adult (aged around 30). Your need for treatment will depend on your DXA scan results as well as any significant risk factors or previous broken bones. In most cases, a ‘Fracture Risk Assessment’ tool will combine your DXA results with other information (such as your age, weight, height, other medical conditions, risk factors etc). This provides your 10-year risk of having a major broken bone associated with osteoporosis or a hip fracture. If this is significant, you’ll be recommended to have treatment.

A DXA scan can also be used to understand the effects of osteoporosis medicines to decide whether or not your treatment needs to be changed, continued or stopped. A bone density scan doesn’t identify broken bones, unless there’s an existing fracture in one of the sites the DXA scan measures. If you’re likely to have a broken bone, you may need to have an x-ray. Although an ordinary x-ray can’t diagnose osteoporosis, sometimes if bones have lost a lot of density they appear less white on the x-ray. If this is the case, you may need a DXA scan.

Low bone density
If your original DXA scan highlighted that your bone density was low (called osteopenia), you’ll be given advice on your diet and calcium intake, as well as the benefits of taking a daily vitamin D supplement. A combination of calcium and vitamin D is often prescribed if your dietary calcium intake is low. Weightbearing and resistance-form exercise is now widely accepted to help maintain bone density.

It’s likely that you’ll have another DXA scan in a few years’ time to monitor the rate of change. If your bone density continues to fall and moves from the osteopenia to osteoporosis range, then you may need treatment.

Treating osteoporosis
Several medicines can be used to treat osteoporosis. These are highly effective at increasing bone density, reducing the risk of fragility fractures. Many of these medicines are prescribed by a hospital specialist, but all are available on the NHS if you meet specific criteria. If your osteoporosis is diagnosed early on, you should be able to make decisions on the best way to manage your condition.

HRT can be used to treat osteoporosis by increasing your levels of oestrogen and reducing your bone loss. Women aged between 50 and 60 with a high risk of breaking a bone may be prescribed HRT, particularly if they have menopausal symptoms that need treatment.

For more information
The Royal Osteoporosis Society is dedicated to finding a cure for osteoporosis and improving the lives of everyone affected by it. For free osteoporosis advice, call 0808 800 0035. Visit the website ( for information on the condition.

Created Autumn 2019

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