What Is Osteoporosis?
Understating what osteoporosis is and Learning about its causes and risk factors, diagnosis, treatment strategy and ways to prevent it.
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Last updated on 3rd Jul, 2025
Introduction
Osteoporosis is a condition that reduces bone strength, making them more brittle and susceptible to fractures. It occurs when bone density and strength decrease over time. The term "osteoporosis" translates to "porous bone." While it can affect any bone in the body, fractures most commonly occur in the hips, wrists, and spine.
Bone tissue constantly regenerates, but as people age, bone breakdown can outpace new bone formation. According to the International Osteoporosis Foundation (IOF), by age 50, about 1 in 3 women and 1 in 5 men will experience fractures due to osteoporosis.
Causes and Risk Factors of Osteoporosis
Osteoporosis develops due to a mix of genetic, lifestyle, and medical factors. While some risks are unavoidable, others can be managed through diet, exercise, and medical care.
1. Unavoidable Risk Factors
Some factors cannot be changed, including:
Sex – Women are at higher risk due to hormonal changes.
Age – Bone strength naturally declines with age.
Ethnicity – White and Asian individuals are more susceptible.
Family History – A close relative with osteoporosis or fractures increases risk.
Body Size – Smaller frames tend to have lower bone mass.
2. Hormonal Imbalances
Hormones are vital for bone health. Osteoporosis may result from:
Reduced Oestrogen and Testosterone – Lower levels after menopause or due to cancer treatments weaken bones.
Thyroid Disorders – Overactive thyroid or excessive thyroid medication can accelerate bone loss.
Other Hormonal Conditions – Issues with the parathyroid or adrenal glands may contribute to bone weakening.
3. Nutritional Deficiencies
Poor diet can lead to weaker bones:
Low Calcium Intake – A long-term deficiency reduces bone strength.
Eating Disorders & Poor Nutrition – Underweight individuals face a higher risk.
Gastrointestinal Conditions – Certain surgeries or disorders can hinder calcium absorption.
4. Medications That Weaken Bones
Long-term use of some medications can reduce bone density, including:
Corticosteroids (e.g., prednisolone)
Drugs for Seizures, Acid Reflux, Cancer, and Transplant Rejection
Certain Anticoagulants, Antidepressants, and Diabetes Medications
5. Medical Conditions That Increase Risk
Some diseases are linked to weaker bones, including:
Autoimmune Disorders – Rheumatoid arthritis, inflammatory bowel disease
Endocrine Disorders – Thyroid, parathyroid, or adrenal issues
Kidney and Liver Disease – Affect calcium absorption and bone metabolism
Certain Cancers – Multiple myeloma and others
6. Lifestyle Factors
Certain habits can impact bone health:
Lack of Exercise
Excessive Alcohol – Regular heavy drinking weakens bones.
Smoking – Tobacco use is linked to reduced bone density.
Signs and Symptoms of Osteoporosis
Osteoporosis is often called a "silent disease" because it typically doesn't present obvious symptoms. You may not feel any discomfort or notice signs that something is wrong with your bones.
The main sign is usually an unexpected fracture from a minor fall or injury. While osteoporosis doesn't cause direct symptoms, some physical changes may indicate weakening bones, such as:
Height Loss – Losing an inch or more over time.
Posture Changes – Developing a stooped or hunched posture.
Breathing Difficulties – Shortness of breath due to compressed spinal discs.
Back Pain – Pain in the lower back from vertebral fractures.
Diagnosis of Osteoporosis
Osteoporosis is typically diagnosed through a bone density test, which measures the strength and mineral composition of your bones. This test uses low-dose X-rays to evaluate the levels of calcium and other minerals present in your bones. It's commonly referred to as a DEXA scan, DXA scan, or bone density scan—different names for the same procedure.
The test is non-invasive and performed on an outpatient basis, meaning you won't need to stay in hospital. Once the test is complete, you can go home, and no injections or needles are involved.
Routine bone density tests are key to identifying osteoporosis early, particularly if you have a family history of the condition, are over 50, or have osteopenia.
Clinical Impact of Osteoporosis
Osteoporosis can lead to serious complications, primarily fractures in the hip or spine. Hip fractures, commonly caused by a fall, may result in long-term disability and an increased risk of death within the first year after the injury.
In some cases, fractures in the spine can occur without any fall. The vertebrae, the bones that form the spine, may weaken to the point of collapse, leading to back pain, reduced height, and a forward-stooped posture.
Treatment Options of Osteoporosis
The goal of treating osteoporosis is to slow bone loss and strengthen existing bone structure, focusing on preventing fractures. Your healthcare provider will suggest a personalised approach based on your needs.
Common treatments include:
1. Exercise: it is vital for maintaining bone density in older adults. Avoid exercises that increase the risk of falls or high-impact activities that could cause fractures.
Recommended activities include:
Weight-bearing exercises help improve strength and balance without straining the bones. You may also work with a physiotherapist to find exercises that suit your condition. Weight-bearing exercises (e.g., walking, jogging, tennis, dancing) for at least 30 minutes, three times a week.
Strength training with free weights, machines, or resistance bands.
Balance exercises such as tai chi and yoga.
Rowing machines.
2. Supplements: Calcium and vitamin D supplements are often recommended to support bone health. Your healthcare provider will advise on the correct type, dosage, and frequency.
3. Medications: These include:
Hormone therapies (e.g., oestrogen or testosterone replacements).
Bisphosphonates, which help slow bone loss.
Parathyroid hormone (PTH) analogues, denosumab, or romosozumab, used for more severe cases, typically administered by injection.
Treatment may also involve: Lifestyle changes such as improving diet, physical activity, and stopping smoking or alcohol use.
Medications are necessary if:
You have osteoporosis with a high fracture risk, confirmed by a bone density test.
You’ve had a fracture and a bone density test shows weakened bones, but not yet osteoporosis.
Common medications include:
Bisphosphonates: The main treatment for postmenopausal women, available in oral or IV forms.
Denosumab: An injection that reduces bone loss and increases bone density.
Teriparatide or abaloparatide: Synthetic hormones that encourage bone growth.
Romosozumab: A newer treatment for severe bone thinning.
The length of treatment depends on fracture risk:
Low fracture risk: 5 years of oral medication or 3 years of IV therapy.
High fracture risk: 10 years of oral medication or 6 years of IV therapy.
Preventive Measures for Osteoporosis
1. Adopting certain lifestyle changes can help lower the risk of osteoporosis.
2. Calcium and Vitamin D: Calcium is essential for strong bones. Adults aged 19 and over should aim for 1,000 mg of calcium daily, while women over 51 and all adults aged 71 and older should consume 1,200 mg daily. Good sources of calcium include:
Dairy products (milk, cheese, yoghurt)
Leafy green vegetables (such as kale and broccoli)
Fish with soft bones (e.g., tinned salmon and tuna)
Fortified breakfast cereals
If dietary calcium is insufficient, supplements may be necessary.
Vitamin D is key to helping the body absorb calcium. While sunlight is the main source, other options include fortified foods, saltwater fish, and liver.
Lifestyle Factors
To further reduce the risk of osteoporosis, consider these adjustments:
Avoid smoking – Smoking impairs bone development and decreases oestrogen in women.
Limit alcohol consumption – Drinking excessively can affect bone health and increase the risk of falls.
Engage in weight-bearing exercise – Activities like walking can help strengthen bones and the muscles that support them.
Incorporate flexibility and balance exercises – Practices like yoga can enhance balance and reduce the likelihood of falls and fractures.
Proper nutrition, consistent exercise, and fall-prevention techniques are important for reducing bone loss and fracture risk, especially for individuals already diagnosed with osteoporosis.
Conclusion
Osteoporosis results in weakened, thinner bones, increasing the likelihood of fractures. Often, individuals are unaware they have the condition until they experience a bone break.
Early detection is key to preventing fractures. It’s important to have regular check-ups with your healthcare provider and inquire about when to begin bone density tests and how frequently follow-up tests should be carried out to track your bone health.
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