What is Osteoporosis?
Osteoporosis is loss of bone strength that makes fractures likely after minor injury. It causes no symptoms until a bone breaks, which is why it is usually diagnosed too late. It is diagnosed by a DEXA bone density scan and is highly treatable — medication reduces the risk of further fracture substantially.
Also called: Brittle bone disease, low bone density
Who gets Osteoporosis?
Postmenopausal women are at highest risk, because oestrogen loss accelerates bone loss sharply in the years after menopause. Men are also affected and are considerably under-diagnosed. Other major risks: long-term corticosteroid use, low body weight, smoking, excess alcohol, early menopause, a parental hip fracture, rheumatoid arthritis and other inflammatory diseases, thyroid and parathyroid disorders, coeliac disease, and vitamin D deficiency — which is widespread in India despite the sunshine, largely because of skin coverage, air pollution and indoor lifestyles.
What are the symptoms of Osteoporosis?
Not everyone has every symptom below, and having one does not confirm the diagnosis. These are the features that most often lead to assessment:
- Usually none at all until a fracture occurs
- A broken bone after a fall from standing height or less — wrist, hip, upper arm or pelvis
- Sudden severe back pain from a spinal compression fracture, sometimes after minimal strain
- Loss of height over the years
- A stooped upper back
- Back pain that develops gradually as multiple vertebrae compress
- A gap between the lowest rib and the pelvis that has narrowed
How is Osteoporosis diagnosed?
A DEXA scan measures bone density at the hip and spine and gives a T-score: at or below -2.5 defines osteoporosis, between -1 and -2.5 is osteopenia.
Fracture risk is calculated with a tool such as FRAX, which combines density with clinical risk factors — because a person with osteopenia and several risk factors may have a higher real fracture risk than someone with a worse score and none.
Blood tests look for treatable secondary causes: vitamin D, calcium, kidney and liver function, thyroid and parathyroid hormone, testosterone in men, coeliac screening and myeloma screening where indicated. Missing a secondary cause is the commonest error in osteoporosis care.
Spine imaging identifies vertebral fractures, many of which have never been recognised.
How is Osteoporosis treated?
Calcium and vitamin D are the foundation but are not treatment on their own — they support the medicines that reduce fracture risk.
Bisphosphonates (alendronate weekly, or zoledronic acid once yearly by infusion) are first-line for most patients. Denosumab is given six-monthly and is useful in kidney impairment, but it must never simply be stopped, since rapid bone loss and spontaneous spinal fractures can follow — a follow-on drug is always planned.
Anabolic agents such as teriparatide build new bone and are used in severe disease or after fracture on treatment.
Weight-bearing and resistance exercise, balance training to prevent falls, stopping smoking, moderating alcohol, and a home safety review complete the plan. Preventing the fall matters as much as strengthening the bone.
Living with Osteoporosis
Treatment is reviewed after three to five years, since some patients can take a break and others should continue. A fracture on treatment is not necessarily treatment failure but does prompt reassessment. Anyone on long-term steroids should have bone protection considered from the start rather than after a fracture. Dental work is best completed before starting bisphosphonates or denosumab where possible.
When should you see a rheumatologist?
Any fracture from a fall at standing height or lower after the age of 50, loss of height, a new stooped posture, or long-term steroid use should prompt bone density assessment.
Common questions about Osteoporosis
Is calcium and vitamin D enough to treat osteoporosis?
No. They are necessary as a foundation, but they do not reduce fracture risk meaningfully on their own once osteoporosis is established. Specific bone-protective medication is what lowers the risk of the next fracture.
Do I have osteoporosis or osteopenia?
Osteopenia is milder bone loss (T-score between -1 and -2.5); osteoporosis is -2.5 or below. But treatment is based on overall fracture risk, not the score alone — someone with osteopenia and several risk factors may need treatment more than someone with a lower score and none.
How long will I need to take these medicines?
Usually three to five years, then a review. Some patients take a treatment break; those at continuing high risk carry on. Denosumab is different — it must never be stopped without a follow-on drug, because rapid bone loss and spinal fractures can follow.
Can men get osteoporosis?
Yes, and it is substantially under-diagnosed in men. Around one in five osteoporotic fractures occurs in men, and outcomes after hip fracture are worse. Low testosterone, steroids, alcohol and smoking are common contributors.
Does osteoporosis cause pain?
Not by itself. Bone loss is painless. Pain comes from fractures — particularly spinal compression fractures, which can occur with minimal strain and are sometimes mistaken for ordinary back pain.
This page is general information to support a consultation. It is not a diagnosis, and it does not replace an assessment by a doctor who has examined you.