Osteoporosis is a condition that causes your bones to be thinner and weaker than normal. This means, they can break easily, such as after a small bump or fall.
Osteoporosis affects more than half of women and about one-third of men over 60 years, as well as a few younger people.
There are good treatments that can slow the progression of osteoporosis and help to stop you getting broken bones.
Osteoporosis can be prevented by strengthening your bones. This can be achieved by keeping physically active, getting enough vitamin D and calcium in your diet and not smoking.
What are the symptoms of osteoporosis?
One of the challenges with osteoporosis is there are no early warning symptoms or signs. First signs can include:
A fracture of the wrist, hips, spine or other bones that happens more easily than it should
Loss of height – as the vertebrae of the spine weaken they compress and the spine curves.
With more severe osteoporosis, fractures can occur doing routine things like bending, lifting or just getting up from a chair.
This happens because brittle bones have trouble supporting body weight.
How is osteoporosis diagnosed?
Your doctor can assess your risk for osteoporosis from your medical history and by asking you about your lifestyle. Physical signs that you may have weak bones include:
previous fractures (often of the wrist, hip or spine)
a loss of height or stooping
a curved spine.
Your doctor may suggest you have a bone density scan (also called DEXA scan) to check for bone weakness.
How is osteoporosis treated?
Treatment for osteoporosis will depend upon the results of bone density scans, age, gender, medical history and the severity of the condition. Treatment most commonly involves lifestyle changes and medications and aims to increase bone density and reduce the risk of bone fracture.
Treatment options include:
Calcium and vitamin D supplementation
An exercise programme including strength training exercises, weight-bearing aerobic activities and/or flexibility exercises.
Medications such as:
Bisphosphonates such as alendronate (Fosamax) and zoledronic acid (Aclasta).
Some people are more likely to get osteoporosis than others. Some of the risk factors that increase your likelihood of getting osteoporosis can't be changed, such as your sex or age, but many others can (see: risk factors you can change).
Risk factors you cannot change include:
being female – although men can also develop osteoporosis
increasing age - bones get thinner as we age
family history of osteoporosis or fractures
being very thin and unable to put on weight
long-term use of some medications ie, prednisone, depo provera
in women, irregular periods or early menopause (often caused by having your ovaries removed)
being immobilised in bed for long periods.
Risk factors you can change
Being aware of the risk factors you can change means that you can take steps to keep your bones healthy and strong, which will reduce the chance of osteoporosis developing.
Credits: Editorial team. Reviewed By: Dr Ben Darlow, senior lecturer and researcher, Department of Primary Health Care and General Practice, University of Otago, Wellington
Last reviewed: 09 Aug 2018
Treatment for osteoporosis is decided on a case by case basis and depends upon the results of bone density scans and other factors such as your age, gender, medical history and the severity of the condition.
Treatment most commonly involves lifestyle changes and medications and aims to increase bone density and reduce the risk of bone fracture.
Some people may have difficulty getting enough calcium from food sources (approx four serves of dairy per day) and so calcium supplements may be recommended.
However, there is some disagreement over the use of calcium supplements, as some studies have shown an increased risk of heart problems from taking these, particularly in older adults.
Calcium supplementation slows bone loss but does not usually stop it completely (loss of bone calcium is common in older age).
It is best to discuss calcium supplementation with your doctor.
Vitamin D supplements
Likewise, some people, such as those who spend a lot of time indoors, have difficulty producing enough vitamin D. Vitamin D is essential for maintaining healthy bones and muscles so if you are deficient vitamin D supplements (such as colecalciferol) may be recommended.
If you have already been diagnosed with osteoporosis, it is important to include physical activity into your daily living. Apart from strengthening your bones, exercise may relieve pain, make everyday tasks easier to carry out, and help to maintain or improve your posture.
The three types of activities most often are often recommended for people with osteoporosis are:
strength training exercises
weight-bearing aerobic activities
You will need to check with your health provider which of these exercises are suitable for you. The main thing is to find an activity that you enjoy, which works for you given the progress of your medical condition.
Type of exercise
Includes the use of free weights, weight machines, resistance bands or water exercises to strengthen the muscles and bones in your arms and upper spine. Strength training can also work directly on your bones to slow mineral loss.
Weight-bearing aerobic activities
Involve doing aerobic exercise on your feet, with your bones supporting your weight. Examples include walking, dancing, low-impact aerobics and gardening. These types of exercise work directly on the bones in your legs, hips and lower spine to slow mineral loss.
Can help increase the mobility of your joints, another key component of overall fitness. Being able to bend, extend and rotate your joints helps you prevent muscle injury. Increased flexibility can also help improve your posture.
Medicines used for osteoporosis work by slowing or stopping bone loss or rebuilding bone. The main types of medication used for the treatment of osteoporosis are:
Examples of bisphosphonate medications used in the treatment of osteoporosis include alendronate (Fosamax) and zoledronic acid (Aclasta). Bisphosphonates are usually given in conjunction with calcium supplements. They have been shown to reduce the fracture rate in people with osteoporosis. A common side effect of these medications is nausea and indigestion.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) used to be a treatment for osteoporosis in women with low oestrogen levels (usually due t menopause). HRT increases bone density and reduces fracture rates. However, it also increases the risks of blood clots, breast cancer and uterus cancer, heart attacks and strokes (older postmenopausal women are particularly vulnerable to these risks). For these reasons HRT is used less often now, but still has a role in some circumstances. Men with low testosterone levels may also benefit from testosterone replacement.
Selective Oestrogen Receptor Modulators (SERMs)
An example of a SERM is raloxifene. It has been shown to reduce the number of fractures in the spinal column. It works by copying the effects of oestrogen on bone, thus increasing bone density and may be considered for use with post menopausal women who cannot tolerate oestrogen.
Other medications that may be considered in the treatment of osteoporosis include calcitonin, and teriparatide. Their use, however, may be limited by cost and/or side effects.
Decision aids – choosing the right medication
The following decision aids are a helpful tool to use with your doctor to discuss the pros and cons of different treatments.
Taking steps to keep your bones healthy and strong is the best way to prevent osteoporosis from developing.
Eat a diet rich in calcium and vitamin D
With food choices, aim for low-fat dairy options. A 250ml glass of milk contains about 300mg calcium; there are also higher-calcium versions available. In non-dairy options, soy milk is usually fortified with calcium – check the product label. Calcium is also found in other foods, e.g. dark green leafy vegetables, almonds, sardines, salmon with bones, tofu.
While some aerobic exercises, like swimming and cycling, are great for your health, unfortunately they aren’t that beneficial for building bone density. The activities that really help build and strengthen bone are the weight-bearing kind, which force you to put weight on your muscles and bones such as gardening, stair climbing, tennis, walking, weight lifting, aerobics, and dancing. These activities require your muscles to work against gravity.
Quit smoking and limit alcohol intake
Smoking weakens the bones – studies have shown that smoking can prevent your body from absorbing calcium and lower your bone mass. Similarly, drinking much alcohol can cause bone loss and broken bones.
Frequently asked questions about bone health and osteoporosis
How does bone grow?
Bone is a living tissue that grows in a porous mesh-like structure. Throughout life, the body breaks down old bone and rebuilds new bone in a continuous cycle. We gain bone by building more than we lose.
Bones contain the protein collagen and minerals such as calcium and phosphorus, which make the collagen hard and dense.
To maintain bone density, the body needs adequate calcium and other minerals and certain levels of hormones, including oestrogen in women and testosterone in men.
Vitamin D is needed so the body can absorb calcium from food and incorporate it into bones.
Physical activity (especially weight-bearing exercise) also helps bone become dense.
What causes bone to become thinner?
Bones grow more and more dense until around the age of 30. After about 40, bone breaks down slightly faster than it is replaced and bones slowly become less dense.
Cause of thinning bones
Diet low in calcium and vitamin D
Having low intakes of calcium in the diet and not getting enough vitamin D (mainly from sunlight) puts people of all ages at risk of low bone density and poor bone health.
Lack of exercise
People who are inactive are also at risk, as weight bearing physical activity (such as walking, dancing, jogging) helps bone become denser.
Reduced hormones (oestrogen and testosterone)
In women, after menopause, the level of the hormone oestrogen decreases. Over many years, a low oestrogen level causes the inner mesh of bones to become thinner, weaker and more brittle
In men, this can happen if there is too little testosterone
The ongoing use of some medications such as anticonvulsants or steroids such as prednisone
Do men get osteoporosis?
Although osteoporosis is often considered to be a condition that only affects older women, men can get osteoporosis too. Men are most at risk of getting osteoporosis when their levels of testosterone decrease such as with age, removal of the testes, or because of medication.
Can young people get osteoporosis?
Younger people can also be affected by osteoporosis. Younger women with eating disorders such as anorexiaor bulimia are at higher risk of developing osteoporosis, as are those younger women who do too much exercise and stop having periods.
In 2007, the Mayo Clinic developed the Osteoporosis Choicedecision aids. They are a helpful tool to use with your patients to discuss the pros and cons of treatment and are based on using an estimate of the patient’s risk of bone fracture from the World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK.
Osteoporosis update – Ian Reid Goodfellow Unit, 2017 "Distinguished Professor Ian Reid talks about Osteoporosis New Zealand's Guidance on Diagnosing and Managing Osteoporosis in New Zealand. Ian is a Professor of Medicine and Endocrinology at the University of Auckland and an international expert and research award winner in osteoporosis."
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: