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Diagnosis and Treatment of Osteoporosis

Learn how to assess your bone health and the steps you can take to treat weaker bones. If you are more at risk of developing Osteoporosis this article tells you about steps you can take to prevent it.

How can we assess our bone health?

Bone strength reduces in both sexes as we age, in particular after menopause in women. Although the typical fractures due to Osteoporosis, including hip fractures and vertebral fractures (backbone fractures), occur at older ages, it is worth trying to keep bone strength as much and as soon possible. Keeping active with weight bearing exercise, and eating a healthy diet really does prevent bone loss.

The following factors increase the risk of Osteoporosis:

  • Being postmenopausal
  • Family history of broken bones and osteoporosis
  • Medical conditions (such as inflammatory bowel disease, rheumatoid arthritis, weight loss surgery, anorexia nervosa, Type 1 diabetes, Thyroid Disease)
  • Lifestyle risk factors: high alcohol intake, low calcium or Vitamin D in diet, physically inactive, smoking
  • Whether you take any medicines that can thin the bones (such as long term steroid use)

Your doctor may suggest assessing your bones for osteopenia (thinning bones), or osteoporosis. This is done by analysing your medical history, and may include screening blood tests to look for possible causes of bone loss. This will allow your doctor to confidently diagnose you and explore all possibilities moving forward. There are full details for you on the Royal Osteoporosis Society Website.

Bone Mineral Density Scan

Osteoporosis often has no defining symptoms making it hard to know if you have it - until you get a fracture. Osteoporotic fractures are just as prevalent as common conditions such as heart attack or stroke. Knowing whether you are at risk early on will help you to take appropriate preventative measures and stop unexpected fractures.

Bone Mineral Density DXA (dual X-ray) is one way to measure your bone density. The DXA scan gives a T score, which compares your bone density to that of a 30 year old, and a Z score which compares your bone density to people the same age as you. These scores are used to guide advice and treatment. The score can be low risk, Osteopenia, or in the Osteoporosis range.

Osteopenia is when you have a lower bone density than average, but not low enough to be diagnosed with Osteoporosis. This does not always lead to Osteoporosis, but if you have this you should discuss it with your doctor and make sure to adopt the appropriate lifestyle changes.

Risk Assessment Score

A fracture risk assessment score called the FRAX score may be calculated to estimate your chance of breaking a hip or other major bone in the next 10 years. This score is used to guide treatment.

Medications and Osteoporosis

There are a range of drug treatments both for the prevention of Osteoporosis in people with thin bones (Osteopenia), and for people with diagnosed Osteoporosis.

Many people are prescribed drugs called bisphosphonates, and these drugs need to be reviewed at least yearly. In some cases an additional DXA scan may be used to guide treatment.

Oestrogen in HRT is helpful in protecting your bones. It's best when supported by lifestyle changes like staying active and having a diet rich in calcium and vitamin D. Our 'Menopause and Osteoporosis' article explains lifestyle changes in more detail.

Specific Dietary and Lifestyle Guidance for Men and Women at Risk of Osteoporosis

Postmenopausal women and older men (>50 years) at increased risk of fractures are recommended higher daily intakes of calcium and vitamin D. A daily dose of 800IU cholecalciferol (Vitamin D) is advised, either through dietary intake or supplements.

A daily calcium intake of 700-1200mg, is advised. If possible, try to get this through food. A good way to sneak extra calcium into your diet is by snacking on calcium-rich foods such as brazil nuts or almonds. You can also try including more fish into your diet as it has higher levels compared to red meat protein.

Regular weight-bearing exercise will help you strengthen bones. These include a wide variety of activities which are discussed in our 'Menopause and Osteoporosis' article.

As an extra precaution, if you feel that you are at higher risks of falls, then efforts should be made to reduce this risk. This could include balance exercises as well as checking the house for trip hazards and referral to a local falls prevention team.


National Osteoporosis Foundation. 2020. What Women Need To Know - National Osteoporosis Foundation. [online]
Available at: https://www.nof.org/preventing-fractures/general-facts/what-women-need-to-know/ [Accessed 4 May 2020].

Guidelines. 2012. NICE Osteoporosis Guideline. [online]
Available at: https://www.guidelines.co.uk/musculoskeletal-and-joints-/nice-osteoporosis-guideline/236056.article [Accessed 5 May 2020].

Theros.org.uk. n.d. Royal Osteoporosis Society | Home. [online]
Available at: https://theros.org.uk [Accessed 7 May 2020].

Sheffield.ac.uk. 2019. Welcome To NOGG. [online]
Available at: https://www.sheffield.ac.uk/NOGG/mainrecommendations.html [Accessed 8 May 2020].