What is osteoporosis?

Osteoporosis is a condition that affects the bones. It makes them weak and fragile and more likely to break (fracture).

What are the symptoms of osteoporosis?

Osteoporosis develops slowly over several years. There are often no warning signs for osteoporosis until someone experiences a fracture, usually after a minor fall.

Some signs you have osteoporosis can include:

• back pain, caused by a fractured or collapsed vertebra
• gradual loss of height
• being stooped
• a bone fracture that occurs much more easily than expected

Healthy bones should be able to withstand a fall from standing height, so a bone that breaks in these circumstances is known as a 'fragility fracture'.

The most common injuries in people with osteoporosis are:

• wrist fractures
• hip fractures
• fractures of the spinal bones (vertebrae)

If you have osteoporosis, a simple cough or a sneeze may cause the fracture of a rib or the partial collapse of one of the bones of the spine. Osteoporosis usually doesn't cause pain unless a bone is broken as a result of the condition. Although not always painful, spinal fractures are the most common cause of chronic pain associated with osteoporosis.

What causes osteoporosis?

Osteoporosis is caused by bones losing density of calcium and other minerals.

Bone density naturally decreases from about the age of 35. But people with osteoporosis have lost bone density faster than normal, meaning they are then at risk of fracturing their bones.

Some people are more at risk than others. Osteoporosis can affect men and women. It is more common in older people, but it can affect younger people too.

Bone health runs in families. If your parent or sibling has ever had osteoporosis or low bone density, you could be at greater risk.

Women

Women are at greater risk of developing osteoporosis than men. This is because changes in hormone levels can affect bone density. The female hormone oestrogen is essential for healthy bones. After the menopause, the level of oestrogen in the body falls, and this can lead to a rapid decrease in bone density. Women are at an even greater risk of developing osteoporosis when:

• they have an early menopause (before the age of 45)
• they have a hysterectomy before the age of 45, particularly when the ovaries are also removed
• their periods are absent for a long time (more than 6 months) as a result of over-exercising or over-dieting.

Men

For most men who develop osteoporosis, the cause is unknown. However, there is a link to the male hormone testosterone, which helps to keep the bones healthy. Men continue to produce this hormone into old age, but the risk of osteoporosis is increased in men with low levels of testosterone.

Some other causes of osteoporosis include:

• the use of certain medications such as steroids (used for rheumatoid arthritis, asthma and other conditions)
• alcohol misuse
• hypogonadism — a condition that causes abnormally low testosterone levels

Diseases

Your risk of osteoporosis can increase if you have certain medical conditions, including:

• hyperthyroidism (overactive thyroid gland)
• disorders of the adrenal glands, such as Cushing's syndrome
• reduced amounts of sex hormones (oestrogen and testosterone)
• disorders of the pituitary gland (a small hormone producing gland under the brain)
• hyperparathyroidism (overactivity of the parathyroid glands)
• conditions that mean you don't absorb minerals properly, such as coeliac disease and inflammatory bowel disease
• some chronic diseases like rheumatoid arthritis, chronic liver or kidney disease
• if you are taking some medicines, such as medicines for breast cancer, prostate cancer, epilepsy and some antidepressants

Lifestyle causes

Lifestyle factors thought to increase the risk of osteoporosis and broken bones include:

• low levels of physical activity
• smoking
• excessive alcohol intake
• being either underweight or obese

When should I see my doctor?

Anyone over 50 who experiences a broken bone from a minor bump or fall should check with their doctor whether they have osteoporosis.

If you are over 50 and have any of the risk factors for osteoporosis, talk to your doctor about whether you need a bone density scan.

How is osteoporosis diagnosed?

A bone density test can help diagnose osteoporosis. It is a short, painless scan. It will tell you your 'T-score', which compares your bone density to that of a healthy young adult.

A T-score of:

• above -1 is normal
• between -1 and -2.5 is classed as 'osteopenia' (where bone density is lower than average but not low enough to be classed as 'osteoporosis')
• below -2.5 is classed as 'osteoporosis'

A bone density test can help diagnose osteoporosis, but it is not the only factor that determines your risk of fracturing a bone.

Your doctor will also consider your age, sex and any previous fractures before deciding whether you need treatment for osteoporosis.

You can also use Osteoporosis Australia's online Know Your Bones tool for an initial self-assessment. It will help identify potential risk factors for you to discuss with your doctor.

How is osteoporosis managed?

There is no cure for osteoporosis, but lifestyle changes can help slow its progression and falls prevention strategies can also reduce the risk of having a fracture.

What treatment, if any, you have can be based on a number of factors, including your risk of fracture. If you've been diagnosed with osteoporosis because you've had a fracture, you should still be treated to try to reduce the risk of any further fractures.

Your healthcare team may advise a change to your diet or taking supplements to improve your bone health.

Some people need osteoporosis medications to strengthen their bones. These work by preventing the bone from breaking down. This reduces the amount of bone lost, so that a net gain in bone density occurs over time.

You can find more information on living with osteoporosis here.

Can osteoporosis be prevented?

Osteoporosis risk can be reduced by:

• Calcium: You need 3-5 serves of calcium-rich foods every day, including dairy foods, oily fish, nuts and green vegetables. You may also need a supplement.
• Vitamin D: Vitamin D maintains your bones and helps you absorb calcium from your diet. You can get vitamin D from sunlight or a supplement.
• Exercising: Regular physical activity will keep you bones strong. For bone strength, you need to do resistance training and weight bearing exercises.

See our osteoporosis prevention page for more information about preventing osteoporosis.

Complications of osteoporosis

A fractured bone can be serious, especially in an older person. Depending on where it occurs, it can lead to long-term disability. For example, a hip fracture may lead to long-term problems with mobility.

Resources and support

For more information about osteoporosis visit:

• Osteoporosis Australia
• Know Your Bones self-assessment tool
• NPS MedicineWise