What is osteoporosis?

Osteoporosis means bones have lost density and strength — fractures occur more easily, often from minor falls. Common in postmenopausal women and older men — often silent until a fracture. Prevention includes weight-bearing exercise, adequate calcium and vitamin D, and not smoking. DEXA scan diagnoses; bisphosphonates and other medicines reduce fracture risk in people at high risk. See a GP after any fracture from standing height or less.

What are the symptoms of osteoporosis?

Usually none until fracture — hence "silent disease." Vertebral crush fractures cause sudden back pain, height loss, stooped posture (kyphosis). Hip fracture after minor fall is classic presentation. Dentists sometimes note bone loss on dental X-rays.

How is osteoporosis diagnosed?

DEXA (DXA) scan measures bone mineral density at hip and spine — T-score -2.5 or below defines osteoporosis. FRAX calculator estimates 10-year fracture risk using risk factors — guides who needs scan and treatment without scan in some cases.

What is the best treatment for osteoporosis?

First-line alendronate or risedronate bisphosphonates — weekly or monthly tablets — reduce hip and spine fractures. Alternatives — denosumab injections, zoledronic acid infusion, raloxifene, teriparatide for severe cases. Adequate calcium (700mg daily diet + supplement if needed) and vitamin D alongside.

Can osteoporosis be reversed?

Medicines increase bone density and more importantly reduce fracture risk — partial reversal possible on DEXA but goal is fracture prevention not perfect scan numbers. Lifestyle — weight-bearing exercise, resistance training, stopping smoking — supports bone health lifelong.

Who should take vitamin D for bones?

UK guidance — everyone consider 10 micrograms (400 IU) daily in autumn/winter; year-round if limited sun, housebound, or covered skin. Higher doses if deficiency proven. Vitamin D alone does not treat established osteoporosis without other treatment if high risk.

Osteoporosis: Symptoms, Causes & Treatment

Osteoporosis — weak bones, high fracture risk

Osteoporosis literally porous bones — low bone mineral density (BMD) and disrupted microarchitecture — fractures from low trauma (fall from standing height or less, sometimes spontaneous vertebral collapse).

Affects 3 million+ UK — causes 500+ fractures daily — hip fracture mortality significant in elderly.

Who is at risk

Non-modifiable:

female sex — especially postmenopausal (oestrogen loss)
age
family history — hip fracture in parent
previous fracture — strongest predictor
early menopause, ** amenorrhoea**

Modifiable:

low BMI (<19)
smoking, ** excess alcohol**
physical inactivity
low calcium/vitamin D
long-term corticosteroids
** rheumatoid arthritis**, hyperthyroidism

Men: 20% of hip fractures — underdiagnosed.

Fractures

Site	Consequence
Vertebral	Pain, height loss, kyphosis — may be silent
Hip	Surgery, loss independence, mortality
Wrist (Colles’)	Common in postmenopausal women falling forward

Any low-trauma fracture → assess bone health.

Diagnosis

FRAX — 10-year fracture probability — GP online tool.

DEXA scan:

T-score ≥ -1.0 — normal
-1.0 to -2.5 — osteopenia
≤ -2.5 — osteoporosis

Treat based on FRAX or DEXA plus fracture history — NICE thresholds.

Prevention

weight-bearing exercise — walking, dancing
resistance training — muscle pulls on bone
calcium — diet (dairy, fortified) ~700mg/day — supplement if intake low
vitamin D — see vitamin D deficiency
stop smoking, moderate alcohol
fall prevention — home hazards, vision, balance

Treatment — bisphosphonates first-line

Alendronate 70mg weekly (or daily risedronate):

empty stomach, plain water, stay upright 30 min
swallow whole — ** oesophageal irritation** risk
dental hygiene — rare osteonecrosis of jaw with long use

Alternatives if intolerant:

IV zoledronic acid — annual
denosumab — 6-monthly injection — rebound fracture risk if stopped abruptly
raloxifene — breast cancer risk reduction side benefit
teriparatide — build bone — severe osteoporosis — limited course
Romosozumab — specialist

Calcium/vitamin D co-prescribed unless dietary adequate.

Menopause link

Oestrogen decline accelerates bone loss — HRT reduces fracture risk — individual risk-benefit for menopause symptoms and bone.

Steroid-induced osteoporosis

≥7.5mg prednisolone ≥3 months — bisphosphonate prophylaxis per guidelines.

Osteoporosis is preventable and treatable — fracture is often first sign — DEXA and alendronate after low-trauma break saves independence.

Common questions about osteoporosis

What are the symptoms of osteoporosis?: Usually none until fracture — hence "silent disease." Vertebral crush fractures cause sudden back pain, height loss, stooped posture (kyphosis). Hip fracture after minor fall is classic presentation. Dentists sometimes note bone loss on dental X-rays.
How is osteoporosis diagnosed?: DEXA (DXA) scan measures bone mineral density at hip and spine — T-score -2.5 or below defines osteoporosis. FRAX calculator estimates 10-year fracture risk using risk factors — guides who needs scan and treatment without scan in some cases.
What is the best treatment for osteoporosis?: First-line alendronate or risedronate bisphosphonates — weekly or monthly tablets — reduce hip and spine fractures. Alternatives — denosumab injections, zoledronic acid infusion, raloxifene, teriparatide for severe cases. Adequate calcium (700mg daily diet + supplement if needed) and vitamin D alongside.
Can osteoporosis be reversed?: Medicines increase bone density and more importantly reduce fracture risk — partial reversal possible on DEXA but goal is fracture prevention not perfect scan numbers. Lifestyle — weight-bearing exercise, resistance training, stopping smoking — supports bone health lifelong.
Who should take vitamin D for bones?: UK guidance — everyone consider 10 micrograms (400 IU) daily in autumn/winter; year-round if limited sun, housebound, or covered skin. Higher doses if deficiency proven. Vitamin D alone does not treat established osteoporosis without other treatment if high risk.

Sources

How we reviewed this page

Medically reviewed by the HealthAnswers UK doctor review panel

First published: 14 June 2026
Medically reviewed: 3 July 2026
Next review due: 3 July 2029 or sooner if NHS or NICE guidance changes

Written by HealthAnswers editorial team. Published by HealthAnswers (Elite Digital AI Solutions Ltd). How we review content · Report a problem with this page