Osteoporosis is far more common than many people realise – and because it develops silently, without pain or obvious symptoms, most people don’t know they have it until a fracture occurs. Understanding your risk is the first and most important step towards protecting your bone health before that happens.
Consultant orthopaedic surgeon Mr Nirav Shah treats patients with osteoporosis-related fractures regularly, particularly hip fractures, which can have a significant impact on mobility and independence. Here’s what puts you at greater risk – and what you can do about it.
What is osteoporosis?
Osteoporosis occurs when bones lose density and become thinner and more fragile over time. The internal structure of the bone becomes less able to repair itself, gradually weakening to the point where even a minor fall or accident can result in a fracture. The hips, spine and wrists are the most commonly affected areas.
It can affect people of all ages but becomes significantly more common as we get older – particularly in post-menopausal women, whose declining oestrogen levels accelerate bone loss.
Risk factors you can’t change
Some risk factors for osteoporosis are outside your control – but being aware of them is still important.
Age. Bone density naturally declines as we get older. The risk of osteoporosis increases significantly from the age of 50 onwards.
Sex. Women are at considerably higher risk than men, largely due to the hormonal changes that occur during and after the menopause. Men are not immune, however, and osteoporosis in men is often underdiagnosed.
Early menopause. Women who go through the menopause before the age of 45 – whether naturally or as a result of surgery – are at greater risk, as they spend a longer period with lower oestrogen levels.
Family history. A parent or sibling who has had osteoporosis or a hip fracture increases your own risk. Genetics play a meaningful role in determining bone density.
Previous fracture. Having suffered a low-impact fracture – one caused by a minor fall or everyday activity that wouldn’t normally be expected to break a bone – is one of the strongest indicators that osteoporosis may already be present.
Body weight. Being underweight or having a low body mass index is associated with lower bone density and a higher risk of fracture.
Risk factors you can change
Several risk factors for osteoporosis are linked to lifestyle, which means there are practical steps you can take to reduce your risk regardless of your age or family history.
Smoking. Smoking is directly associated with lower bone density. Stopping smoking at any age has a positive effect on bone health.
Alcohol. Heavy alcohol consumption interferes with the body’s ability to absorb calcium and reduces bone formation. Keeping within recommended limits is beneficial for bone health as well as general health.
Physical inactivity. Weight-bearing exercise – walking, jogging, dancing, resistance training – stimulates bone formation and helps maintain density. A sedentary lifestyle accelerates bone loss over time.
Diet. Calcium and vitamin D are essential for bone health. A diet consistently low in these nutrients increases the risk of osteoporosis. Vitamin D is also produced by the skin in response to sunlight, which means people who spend little time outdoors may be particularly at risk of deficiency.
Long-term medication. Prolonged use of corticosteroids – commonly prescribed for conditions such as asthma, rheumatoid arthritis and inflammatory bowel disease – is one of the most significant medication-related risk factors for osteoporosis. If you have been taking steroids long term, it’s worth discussing bone health with your GP.
Medical conditions that increase risk
Certain health conditions are associated with an increased risk of osteoporosis, including rheumatoid arthritis, coeliac disease, inflammatory bowel conditions, hyperthyroidism and chronic kidney or liver disease. If you have any of these conditions, bone health should be part of your ongoing monitoring and care.
How is risk assessed?
If you have one or more of the risk factors above, your GP or specialist may recommend a DEXA scan – a simple, low-dose X-ray that measures bone mineral density and helps determine your risk of future fracture. The results, combined with your medical history and lifestyle, provide a clear picture of where you stand and what action, if any, is needed.
Managing and preventing osteoporosis
The good news is that osteoporosis is manageable – and in many cases, preventable. Lifestyle changes, dietary improvements and, where appropriate, medication can all help to strengthen bones, slow further loss and reduce the risk of fracture. The earlier the condition is identified, the more effective these measures tend to be.
For patients who have already suffered a fracture, Mr Shah can treat the injury and work with you and your GP to put a plan in place to reduce the risk of it happening again.
Taking the first step
If you recognise yourself in any of the risk factors above – or you’ve had a fracture that seems out of proportion to the cause – it’s worth getting it checked. Osteoporosis doesn’t have to reach the point of a serious fracture before it’s taken seriously.
Mr Nirav Shah is a consultant orthopaedic surgeon based in West Sussex with extensive experience in treating fractures and managing osteoporosis. If you have concerns about your bone health, he’d be delighted to help.
