Osteoporosis: Who Is at Risk and How to Protect Your Bones

Osteoporosis is a condition where bones become thin and fragile, increasing the risk of fractures from minor falls or even everyday activities. It is often called the 'silent disease' because there are usually no symptoms until a fracture occurs.

Who Is at Risk?

Osteoporosis can affect anyone, but certain factors increase your risk:

**Age and sex** — bone density naturally decreases with age. Women are at higher risk, particularly after menopause when oestrogen levels drop sharply. However, men are also affected, especially after age 70.

**Menopause** — the decline in oestrogen at menopause accelerates bone loss. Early menopause (before age 45) is a particularly important risk factor.

**Family history** — a parent who had a hip fracture doubles your own risk.

**Medications** — long-term corticosteroid use (such as prednisolone for asthma, arthritis, or other conditions) is one of the most common causes of secondary osteoporosis. Other medications that can affect bone health include certain cancer treatments and some epilepsy drugs.

**Medical conditions** — rheumatoid arthritis, coeliac disease, inflammatory bowel disease, thyroid disorders, and type 1 diabetes all increase osteoporosis risk.

**Lifestyle factors** — smoking, excessive alcohol, low body weight, physical inactivity, and low calcium or vitamin D intake all contribute to bone loss.

How Is Osteoporosis Diagnosed?

The standard test is a DEXA scan (dual-energy X-ray absorptiometry), which measures bone mineral density at the hip and spine. The result is given as a T-score: normal is above -1.0, osteopenia (low bone mass) is between -1.0 and -2.5, and osteoporosis is -2.5 or below.

I also assess your overall fracture risk using clinical factors alongside the DEXA result, and may arrange blood tests to check for underlying causes of bone loss such as vitamin D deficiency, thyroid problems, or coeliac disease.

Prevention and Treatment

**Lifestyle measures** form the foundation of bone health. Weight-bearing exercise (walking, dancing, gentle jogging), resistance training, adequate calcium intake (approximately 1,000mg daily, preferably from diet), and vitamin D supplementation (at least 800 IU daily) are recommended for everyone at risk.

**Medications** are recommended for people with osteoporosis or those at high fracture risk. Bisphosphonates (such as alendronate or risedronate taken weekly, or zoledronic acid given as an annual infusion) are the most commonly prescribed. Denosumab is an alternative given as a six-monthly injection. For severe osteoporosis, anabolic agents such as teriparatide can help build new bone.

**Falls prevention** is also important — simple measures such as home safety assessments, vision checks, reviewing medications that cause dizziness, and balance exercises can significantly reduce fracture risk.

When to Seek Specialist Assessment

I would recommend a specialist assessment if you have had a fragility fracture (a break from a standing height or less), if you are taking or about to start long-term corticosteroids, if you have risk factors and want to know your bone health status, or if your osteoporosis is not responding to standard treatment.

Self-referral is accepted at my clinic at The Beaumont Hospital, Bolton. Call 01204 404404 to book.

*Last medically reviewed by Dr Leena Das, February 2026*