Osteoporosis and Preventing Fractures

What osteoporosis is

Throughout life, the body breaks down old bone and builds new bone in a constant cycle. In childhood and early adulthood, more bone is built than lost, and bones reach their peak strength in the late twenties. Later in life the balance tips, and bone is lost faster than it is replaced. In osteoporosis, this loss leaves bones thinner and less able to withstand a knock or fall. The most common fractures are of the wrist, hip and spine. Spine fractures can happen without an obvious fall and may cause height loss, a stooped posture or back pain. Because there are usually no warning signs beforehand, many people only learn they have osteoporosis after breaking a bone.

Who is at risk

Several things raise the risk of osteoporosis and fractures. Age is the biggest factor, and women are more affected than men, particularly after the menopause when levels of the bone-protecting hormone oestrogen fall. A family history of osteoporosis or hip fracture, being underweight, smoking and drinking too much alcohol all increase risk. So do long-term use of certain medicines, especially steroid tablets, and some medical conditions such as an overactive thyroid, rheumatoid arthritis, or problems that reduce how well the body absorbs nutrients. A previous fragility fracture — a break from a minor fall — is an important warning sign. Knowing your risk factors helps you and your GP decide whether you need a bone assessment.

How it is diagnosed

Doctors assess fracture risk using a combination of your risk factors and, where appropriate, a bone scan. UK practice often uses an online risk tool, such as FRAX or QFracture, which estimates your chance of a fracture over the next ten years based on your details. If your risk is raised, a bone density scan called a DEXA (or DXA) scan may be arranged. This is a quick, painless, low-radiation X-ray, usually of the hip and spine, that measures how dense your bones are. The result is given as a score that compares your bone density with a healthy young adult. Together, the risk tool and scan help decide whether treatment is needed and guide follow-up.

Treatments that strengthen bones

If treatment is recommended, the aim is to reduce the chance of a fracture. The most commonly used medicines are bone-strengthening drugs that slow bone loss and help maintain bone density; several types are available, given as tablets or injections, and a specialist may suggest others for higher-risk people. Adequate calcium and vitamin D are important for bones, and supplements may be advised if your intake or levels are low, particularly in older or housebound people. Treatment decisions are individual, balancing your fracture risk against the benefits and any side effects, and plans are reviewed over time. It is important to keep taking prescribed treatment as advised, because the protective effect depends on sticking with it.

Preventing fractures for life

Whether or not you take medicine, lifestyle steps protect your bones and prevent falls. Weight-bearing exercise, such as walking, and muscle-strengthening activity help keep bones and muscles strong; balance exercises like tai chi reduce the risk of falling. A balanced diet with enough calcium — from dairy, green leafy vegetables and fortified foods — supports bone health, and safe sunlight and diet help with vitamin D. Stopping smoking and keeping alcohol within recommended limits both help. Preventing falls is just as important as strengthening bone: good lighting, removing trip hazards, having your eyesight and medicines reviewed, and wearing suitable footwear all reduce the chance of a break. Small, consistent changes add up to stronger bones and fewer fractures.