Osteoporosis is a condition that causes your bones to become thinner and weaker than normal. This means that 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 some younger people.
Some people are more likely to get osteoporosis because they have risk factors, including family history, being very thin and long-term use of certain medicines.
There are treatments that can slow the progression of osteoporosis and to help prevent 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.
Image credit: 123rf
What are the symptoms of osteoporosis?
One of the challenges with osteoporosis is that there are no early warning symptoms or signs. You may not know you have osteoporosis until you have:
a fracture of your wrist, hips, spine or other bones that happens more easily than it should
loss of height – as the vertebrae of your spine weaken they compress and the spine curves
with more severe osteoporosis, fractures that occur doing routine things like bending, lifting or just getting up from a chair – this happens because brittle bones have trouble supporting body weight.
Who is at risk of osteoporosis?
Both men and women may have certain risk factors that can make them more likely to develop osteoporosis. Some of the risk factors that increase your likelihood of getting osteoporosis can't be changed, such as your gender or age, but many others can. See more at Can osteoporosis be prevented?
Risk factors for osteoporosis
Being female – women are at a greater risk of developing osteoporosis because of the rapid decline in oestrogen levels during menopause.
Increasing age – bones get thinner as you age.
A family history of osteoporosis or fractures.
Being very thin and unable to put on weight.
Long-term use of some medicines such as prednisone.
In women, irregular periods or early menopause, often caused by having your ovaries removed.
Being immobilised in bed for long periods.
Some medical condition such as rheumatoid arthritis.
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 your 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 a DEXA scan) to check for bone weakness.
How is osteoporosis treated?
Treatment for osteoporosis will depend on the results of bone density scans, age, gender, medical history and severity of the condition. To help decide which treatment is suitable, you and your doctor may use a FRAX score or a Garvan score. These shows your risk of having a fracture due to osteoporosis in the next 10 years. Read more about osteoporosis tools.
Treatment most commonly involves exercise to strengthen your bones and medicine that aims to increase bone density and reduce the risk of bone fracture.
There are 3 types of exercises that are good for people with osteoporosis:
weight-bearing aerobic exercise, such as dancing
resistance training using free weights, such as elastic band resistance and body-weight resistance
exercises to improve posture, balance and body strength, such as tai chi.
Ideally, you should exercise at least 3–4 times a week and include something from all 3 groups each week.
Dr Helen Kenealy is a geriatrician and general physician working at Counties Manukau DHB. She has a broad range of interests and has worked in a variety of settings including inpatient rehabilitation, orthgeriatrics and community geriatrics.
Credits: Health Navigator Editorial Team . Reviewed By: Dr Helen Kenealy, geriatrician and general physician, CMDHB
Last reviewed: 16 Dec 2019
What is the treatment for osteoporosis?
Treatment for osteoporosis is decided on a case by case basis and depends on the results of bone density scans and other factors such as your age, gender, medical history and severity of the condition.
To help decide which treatment is suitable, you and your doctor may use a FRAX score or a Garvan score. This shows your risk of having a fracture due to osteoporosis in the next 10 years. Read more about osteoporosis tools.
Treatment most commonly involves exercise and medicines that aim to increase bone density and reduce the risk of bone fracture.
Exercise for osteoporosis
If you have already been diagnosed with osteoporosis, you need to include physical activity into your daily life. Apart from strengthening your bones, exercise may relieve pain, make everyday tasks easier to carry out and help maintain or improve your posture. The 3 types of activities most often recommended for people with osteoporosis are:
weight-bearing aerobic activities
You 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 and that works for you given your medical condition.
Type of exercise
This includes the use of free weights, weight machines, resistance bands or water exercises to strengthen your muscles and bones in your arms and upper spine. Strength training can work directly on your bones to slow mineral loss.
Weight-bearing aerobic activities
This involves 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.
These 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 for osteoporosis
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 as follows:
These medicines work on the bone-making cells to slow loss of bone and help restore some bone that has been lost. They have been shown to reduce the fracture rate in people with osteoporosis.
Common examples of bisphosphonates for osteoporosis include alendronate (Fosamax or Fosamax Plus, which includes Vitamin D) and risedronate tablets. These tablets are taken only once a week, you need to follow instructions carefully to avoid side effects and make sure the medicine is absorbed so it is effective.
Bisphosphonates are usually given in conjunction with monthly vitamin D supplements. A funded alternative to tablets is zoledronic acid, which is given as an injection into a vein. It takes around 10–15 minutes to administer and then is usually only needed about once every 18 months. Read more about bisphosphonates.
Hormone replacement therapy
Hormone replacement therapy (HRT) used to be a treatment for osteoporosis in women with low oestrogen levels due to menopause. HRT increases bone density and reduces fracture rates. However, it also increases the risks of blood clots, breast and uterine 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.
Raloxifene tablets work by copying the effects of oestrogen on bone, thus increasing bone density and may be considered for use by post-menopausal women who cannot tolerate oestrogen. Read more about raloxifene.
Denosumab and teriparatide
Other medications that may be considered in the treatment of osteoporosis include denosumab and teriparatide. They are generally only used when other medicines have been unsuccessful. They require special authority forms and you must meet specific criteria for them to be appropriate treatments.
Calcium is an important component of bone. It's therefore important to get enough calcium from your diet to maintain healthy bones, but there is no evidence that taking more than this is helpful. If you have difficulty getting enough calcium from food sources (about 4 serves of dairy per day), calcium supplements may be recommended.
Calcium supplementation slows bone loss but does not usually stop it completely. If you have osteoporosis and have had a fracture, calcium alone is not enough to prevent further fractures – you will also need a specific osteoporosis treatment. However, you need to get adequate calcium and vitamin D to support your bone health while you are on osteoporosis treatment.
The most common calcium supplement is calcium carbonate. Supplements may take the form of oral (swallowed) tablets, chewable tablets, effervescent tablets or soluble powder.
However research from the University of Auckland has shown there may be increased rates of heart attacks and strokes from taking calcium tablets so there is a shift away from this to encouraging adequate daily calcium intake from the food you eat. Read more about calcium supplements.
Vitamin D supplements
Vitamin D is essential for maintaining healthy bones and muscles. Your body makes most of the vitamin D it needs in your skin when exposed to sunlight. Some people, such as those who spend a lot of time indoors and those with dark skin, may have difficulty producing enough vitamin D.
If you have osteoporosis, vitamin D tablets called colecalciferol may be recommended. These tablets are only taken once a month. Read more about colecalciferol.
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
Most of your body’s calcium is found in your bones. Calcium combines with other minerals to form the hard crystals that give your bones their strength and structure. Bones act like a calcium bank. If you do not take in enough calcium from your diet to replace losses and maintain adequate levels in your blood, your body reacts by withdrawing calcium from your bone bank and depositing it into your blood. If your body withdraws more calcium than it deposits over a long period, your bone density (bone strength) gradually declines and you may be at risk of developing osteoporosis.
Vitamin D helps your intestines absorb calcium into your blood, which delivers it to your bones, muscles and other body tissues.
The best way to increase your calcium is by eating a balanced, nutritious diet. This is better than taking supplements. Aim to get your calcium from foods such as low-fat dairy options. A 250ml glass of regular milk contains about 300mg of calcium, and there are also higher calcium versions available.
For non-dairy options, soy milk is usually fortified with calcium – check the product label. Calcium is also found in other foods, eg, dark green leafy vegetables, almonds, sardines, salmon with bones and tofu. Read more about calcium.
Exercise is an important way to protect your bones. It can help preserve the bone strength you have and it improves coordination and balance, which can prevent falls that can lead to fractures. While some aerobic exercises such as swimming and cycling are great for your health, 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. These include gardening, stair climbing, tennis, walking, weight lifting, tai chi, aerobics and dancing. These activities require your muscles to work against gravity. Read more about exercise.
Quit smoking and limit alcohol intake
Smokers tend to lose bone faster than non-smokers. Smoking may both interfere with the absorption of calcium and lower the amount of bone-protective oestrogen your body produces.
Similarly, drinking too much alcohol can cause bone loss and broken bones. Alcohol may interfere with your body’s ability to convert inactive vitamin D into its active form. It also appears to affect bone formation and increase losses of calcium and magnesium from your body. Excessive drinking may be accompanied by poor nutrition and an increased risk of falls. People who have more than 2 drinks per day may be at moderately higher risk of low bone density and fractures than non-drinkers.
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 your life, your body breaks down old bone and rebuilds new bone in a continuous cycle. You gain bone by building more than you lose.
Bones contain the protein collagen and minerals, such as calcium and phosphorus, that make the collagen hard and dense.
To maintain bone density, your 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 your body can absorb calcium from food and incorporate it into your bones.
Physical activity (especially weight-bearing exercise) also helps your bones become dense.
What causes bones to become thinner?
Your bones grow more and more dense until around the age of 30. After about the age of 40, your bone breaks down slightly faster than it is replaced and your bones slowly become less dense.
Cause of thinning bones
Diet low in calcium and vitamin D
Having low intakes of calcium in your 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 or jogging) helps bone become denser.
Reduced hormones (oestrogen and testosterone)
In women, the level of the hormone oestrogen decreases after menopause. 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, including 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 or 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 younger women who do so much exercise they stop having periods.
In 2007, the Mayo Clinic developed the Osteoporosis Choicedecision aids. They are a helpful tool to use with 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. He 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: