Osteoporosis: symptoms, causes and prevention

Medically reviewed: 8, January 2024

What is osteoporosis?

Osteoporosis is a dangerous disease in the elderly.

Osteoporosis is a disease where the bones lose some of their calcium content and strength, resulting in fractures occurring by themselves or due to small accidents such as falls and strains. It may be found by a measurement of the amount of bone mineral content using a bone scan.

The disease becomes more common with increasing age and is seldom seen before the age of 55. Women are affected more than men. In osteoporosis sufferers, fractures can happen easily, especially in the back, wrist and in the neck of the femur (thigh bone).

It may be prevented by a healthy lifestyle, calcium and vitamin D supplements and, for women, possibly hormone replacement treatment.

As the most dangerous fractures are almost always in connection with a fall, prevention of falls is of paramount importance. Osteoporosis is a chronic disease, but medication is available to increase the calcium content of the bones that reduces the risk of new fractures.

 

Why do people get osteoporosis?

No one knows why the natural loss of bone matter which begins in your 30s, may lead to osteoporosis for some but not others. It may be hereditary, or a result of a small bone mass produced in youth, or caused by too little exercise, or consuming too little calcium (dairy products) in your diet.

An early menopause, smoking, alcohol consumption, chronic diseases (arthritis, bronchitis, some intestinal diseases, and Cushing’s syndrome) are all associated with osteoporosis. Long-term treatment with corticosteroids (eg prednisolone) may increase the risk of osteoporosis – if the dose is above 7.5mg per day. Unfortunately, corticosteroids are unavoidable in the treatment of many diseases.

What does osteoporosis feel like?

Many people have bone pains, often in the back and groin, but symptoms may not necessarily be present throughout the time of a fracture. Reduced bone mass does not cause symptoms in itself. If you have sustained a fractured neck of the thigh bone (femur), you may become dependent on a walking stick or frame.

If you develop a vertebral collapse of your back, a stoop may develop and your ribcage and pelvis may come closer to one another, causing pains when you breathe.

What are the danger signs of osteoporosis?

• Fractures with no external cause, or caused by a small injury such as a light fall.
• A crack in your back (vertebrae) with sudden, heavy pains.
• An early menopause.
• Low bodyweight, smoking, and osteoporosis in the family.
• Long-term treatment with prednisolone or other medicines that may soften your bones.
• Illnesses that may be associated with osteoporosis (for instance rheumatoid arthritis).

What can I do to prevent osteoporosis?

Take plenty of exercise throughout your life.

Have an adequate diet content of calcium and vitamin D.

The table below lists the recommendations for daily calcium intake from the UK National Osteoporosis Society.

Age Recommended calcium (mg/day):

Children 7-12	800
Kids 13-19	1000
Men 20-60	1000
Women 20-45	1000
Pregnant and nursing women	1200
Pregnant and nursing teenagers	1500
Women >45	1500
Women >45 on HRT	1000
Men >60	1500

A good rule-of-thumb for adults is to try to get 1000mg of calcium per day (for instance 800ml of semi-skimmed milk or 140g of cheddar cheese).

After the menopause, experts in osteoporosis recommend a dose of 1200 to 1500mg of calcium per day. The same amount applies if you are treated with corticosteroids. If you do not like, or you are allergic to, dairy products it is necessary to take a calcium supplement.

Excellent calcium supplements with vitamin D can be bought without a prescription. The amount of calcium tablets you need depends on your intake of dairy products. The calcium supplement should be combined with meals, in two or three doses.

The recommended daily intake of vitamin D is 5 micro grams. This increases to 10 micro grams during pregnancy and breastfeeding, and in men and women over 65 years of age.

Vitamin D is found in oily fish, in tinned foods such as marinated herring, sardines, salmon and mackerel, and is also obtained from sunlight. In summertime, the elderly are advised to be out in the sun for at least half an hour to an hour per day, and in the wintertime to eat oily fish regularly. Otherwise a vitamin D supplement of 10micrograms (400 units) per day is required.

Osteoporosis sufferers may require larger doses of vitamin D and calcium. Talk to your doctor about this.

Smoking should be avoided and alcohol consumption minimized. The yearly bone mass loss is doubled for smokers – statistically one hip fracture in six is caused by smoking.

Treatment with the female sex hormone estrogen should be considered, particularly if you have an early menopause (especially before the age of 45). This is known as hormone replacement therapy (HRT).

Exercising for 30 minutes at least three times a week is beneficial and should be encouraged.

It is important that you arrange your home and adjust your daily life to avoid falling. About 1 in 20 falls in the home cause fractures and of these, one in five is a hip fracture.

How does the doctor diagnose osteoporosis?

With a ‘low-energy’ bone fracture the cause is most often osteoporosis, and a bone scan is not necessary. If you haven’t had a bone fracture, a bone scan (BMD examination), is necessary to find out if you suffer from osteoporosis. A scan of your groin and hips may provide more accurate results compared to a forearm scan when looking for osteoporosis.

Even though a bone scan is sometimes unnecessary (with a ‘low-energy’ bone fracture), an ordinary examination by a doctor and blood tests are required to be sure that the problem is osteoporosis.

Bone fractures and calcium deficiency in bones may also be a result of other diseases that need different types of treatment to osteoporosis. For instance, bone fractures may be caused by some types of cancer, lack of vitamins or illnesses in the bone marrow. However, osteoporosis is the most common cause.

The future

When a bone fracture is caused by osteoporosis, the risk of a new bone fracture is more than doubled, but depends on the calcium content of the bones and how often you fall. There is an increased risk of death only if you have a break in the neck of your thigh bone (femur).