Osteoporosis

Also called Brittle bones, Fragile bones

Bones losing density silently until one breaks. Half of women over 50 will have a fragility fracture.

What it is

Osteoporosis causes no symptoms at all until a bone breaks. Around 3.5 million people in the UK have it, and roughly half of women and one in five men over 50 will break a bone because of it.

Bone is living tissue, constantly broken down and rebuilt. After the menopause, and with age generally, the breaking down outpaces the rebuilding.

The most consequential fracture is the hip. Around a third of people who break a hip die within a year, and many of the survivors never regain their previous independence.

Signs you might notice

Nothing, until a fracture.

A broken bone from a fall from standing height or less. That is the definition of a fragility fracture, and it should trigger assessment every time.

Height loss of more than 4cm, and a stooped upper back, both from spinal compression fractures.

Sudden severe back pain, which may be a vertebral fracture rather than a strain.

How it can affect day-to-day life

The gap in care is specific and well documented: a person breaks a wrist at 62, it is treated as an orthopaedic event, nobody assesses their bones, and they break a hip at 70. Fracture Liaison Services exist to close that gap and coverage is still incomplete.

Long-term steroid use is a major risk factor and is often not accompanied by bone protection.

Fear of falling after a fracture reduces activity, which weakens bone and muscle further. See falls, because the two conditions belong together.

Supporting someone well

Treat any fragility fracture as a red flag. Ask directly for a bone density scan and a fracture risk assessment.

Weight-bearing and resistance exercise. Bone responds to load, and this is the part most often left out of advice.

Calcium and vitamin D, and check vitamin D in anybody housebound or with limited sun exposure.

Take the medication. Bisphosphonates reduce fracture risk substantially, and adherence is poor because, again, the condition has no symptoms.

Reduce falls risk actively: medication review, vision, footwear, lighting, strength and balance.

Ask about bone protection whenever oral steroids are prescribed for more than three months.

Where to get help

A GP can arrange a DEXA scan and a FRAX assessment.

The Royal Osteoporosis Society run a free helpline staffed by nurses on 0808 800 0035.

Ask whether your area has a Fracture Liaison Service, and if a fracture was not followed up, ask why.