Osteoporosis: symptoms, treatment, causes and how it is diagnosed

The NHS says that treating osteoporosis involves treating and preventing fractures and using medicines to strengthen bones. A diagnosis is based on the bone density scan, but the decision about what treatment you need, if any, depends on other factors including your age, sex, risk of breaking a bone and previous injury history. If you were diagnosed because you have had a broken bone, the NHS says you should still receive treatment to try to reduce the risk of further broken bones.

Whether or not you take medicine, the NHS says to make sure you are getting enough calcium and vitamin D. Your healthcare team will ask about your diet and may recommend changes or supplements.

The NHS describes osteoporosis as a health condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break. It can be treated with bone-strengthening medicines.

The stage before osteoporosis is called osteopenia. The NHS says this is when a bone density scan shows lower bone density than the average for your age, but not low enough to be classed as osteoporosis. Osteopenia does not always lead to osteoporosis. If you have it there are steps you can take to keep your bones healthy.

There are usually no symptoms until a bone breaks. The NHS says osteoporosis is not usually painful until a bone is broken, though broken bones in the spine are a common cause of long-term pain. The Royal Osteoporosis Society (ROS) says that although osteoporosis does not have early warning signs, an easily broken bone is often the first sign that bones have lost strength.

The NHS lists the most common injuries as a broken wrist, a broken hip and broken spinal bones (vertebrae), though breaks can happen in other bones such as the arm or pelvis, and sometimes a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine.

ROS explains that spinal fractures happen when the bones in the spine squash down on themselves, and that you may not always be aware that one has occurred. Signs can include unexplained back pain and muscle spasms, height loss, and a curved spine or change in posture. The NHS adds that some older people develop a stooped (bent forward) posture when the bones in the spine have broken.

The NHS says losing bone is a normal part of ageing, but some people lose bone much faster than normal, which can lead to osteoporosis. Women lose bone rapidly in the first few years after the menopause and are more at risk than men, particularly if the menopause begins early (before the age of 45) or they have had their ovaries removed. It can also affect men, younger women and children.

• Taking high-dose steroid tablets for more than 3 months.

• Other medical conditions, such as inflammatory conditions, hormone-related conditions or malabsorption problems.

• A family history of osteoporosis, particularly a hip fracture in a parent.

• Long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets taken after breast cancer.

• Having or having had an eating disorder such as anorexia or bulimia.

• Having a low body mass index (BMI).

• Not exercising regularly.

• Heavy drinking and smoking.

If your doctor suspects osteoporosis, the NHS says they can work out your future risk of breaking a bone using an online programme such as FRAX or Q-Fracture. They may also refer you for a bone density scan (DEXA scan), which measures bone strength. The NHS says it is a short, painless procedure that takes 10 to 20 minutes depending on the part of the body scanned.

Your bone density is compared with that of a healthy young adult, and the difference is expressed as a T score. ROS says that if you have broken a bone easily and are 50 or over, or have been through the menopause, or have other risk factors such as taking steroid medicines, you should talk to your doctor about your chance of osteoporosis and breaking more bones, and they may suggest a fracture risk assessment or a bone density scan.

The NHS says calcium is the main mineral found in bone and that for most healthy adults the recommended amount is 700mg a day, which most people can get from a varied diet. If you have osteoporosis you may need more calcium, usually as supplements, so ask your GP.

Vitamin D helps the body absorb calcium. The NHS says all adults should have 10 micrograms of vitamin D a day. From about late March or early April to the end of September most people can get all the vitamin D they need from sunlight, but because it is difficult to get enough from food alone, everyone should consider a daily 10 microgram supplement in autumn and winter.

ROS says eating a healthy, balanced diet can help you get the nutrients you need to keep bones strong, and that there are no specific foods that are bad for bones, though cutting down on caffeine and cola drinks may benefit your bones.

The NHS says that if you are at risk you should take steps to keep your bones healthy. If you have been diagnosed, there are also steps to reduce your chance of a fall.

• Take regular exercise to keep your bones as strong as possible.

• Eat foods rich in calcium and vitamin D.

• Take a daily supplement containing 10 micrograms of vitamin D.

• Give up smoking and reduce alcohol consumption.

• Reduce your chances of a fall: remove hazards from your home and have regular sight and hearing tests.

• To help recovery from a fracture, the NHS suggests painkillers, hot and cold treatments such as warm baths and cold packs, and relaxation techniques.

Osteoporosis is more common in women, but the NHS says it can also affect men, younger women and children. ROS publishes separate information for men, children, transgender people and people with pregnancy-associated osteoporosis. If you are a man or a younger adult with a broken bone from a minor fall, or have risk factors such as long-term steroid use, ask your GP about assessment.

ROS says to talk to your doctor if you have broken a bone easily, especially if you are 50 or over, have been through the menopause or have other risk factors such as taking steroid medicines. See a GP for unexplained back pain, loss of height or a change in posture. If you have broken a bone after a fall, seek urgent care for the injury in the usual way: 999 or A&E for a suspected hip or other serious fracture.

The NHS says to speak to your GP or nurse if you are worried about living with a long-term condition. The Royal Osteoporosis Society is the UK's national charity for osteoporosis and has a helpline and support groups throughout the UK.

On the NHS, a GP can assess fracture risk using FRAX or Q-Fracture, refer you for a DEXA scan, prescribe bone-strengthening medicines and arrange follow-up. ROS also has information on Fracture Liaison Services, which look after people who have had a broken bone.

Bone density scans and specialist bone-health consultations are also available privately. The treatments are the same, so ask how results will be shared with your GP, who will usually continue to prescribe and review your medicine.