Osteoporosis is a loss of bone density and internal structure that makes bones fragile. It causes no pain or other symptoms until a bone breaks, typically from a minor fall or even a cough or lift. The wrist, spine and hip are the usual sites. About one in three women and one in five men over 50 will have a fragility fracture.
It is defined on a DXA scan by a T-score of minus 2.5 or lower, but the decision to treat is based on your overall fracture risk, which also reflects age, previous fractures, family history, steroids and other factors. Treatment lowers the risk of spinal fractures by roughly half to two thirds and hip fractures by around a third to a half.
Symptoms
- No symptoms until a fracture occurs
- A broken wrist, hip, upper arm or pelvis after a fall from standing height
- Sudden mid or lower back pain from a vertebral compression fracture
- Loss of 4 cm or more in height
- A forward curve of the upper back
- Many spinal fractures are silent and found only on imaging
Causes and risk factors
Bone is constantly broken down and rebuilt. After the mid-thirties breakdown slowly overtakes rebuilding, and in women the fall in oestrogen at the menopause accelerates loss for several years. Risk factors include age, female sex, early menopause, low body weight, a parent who broke a hip, smoking, more than 2 to 3 units of alcohol daily, low calcium and vitamin D, and inactivity. Secondary causes matter, especially in men and younger women: oral steroids for over 3 months, aromatase inhibitors, androgen deprivation therapy, some anti-epileptics, overactive thyroid or parathyroid, coeliac disease, rheumatoid arthritis, low testosterone, anorexia, chronic kidney disease and myeloma.
How it is diagnosed
- DXA scan: A low dose X-ray of the hip and lumbar spine taking about 10 minutes. It gives the T-score and is repeated every 2 to 5 years to monitor.
- Fracture risk calculation: FRAX or similar tools estimate your 10 year probability of major fracture and guide who needs treatment.
- Vertebral fracture assessment: A side view of the spine by DXA or X-ray, since a silent vertebral fracture changes management.
- Blood tests: Calcium, vitamin D, kidney and thyroid function, parathyroid hormone, blood count, coeliac screen, testosterone in men, and protein electrophoresis to exclude myeloma.
Treatment options
- Exercise and falls prevention: Weight-bearing and resistance exercise, balance training such as tai chi, a medication review, vision check and home safety.
- Calcium, vitamin D and protein: Aim for about 1000 mg of calcium daily, mainly from food, with vitamin D supplements where levels are low.
- Bisphosphonates: Weekly alendronate or risedronate tablets, or a yearly zoledronate infusion. Usually given for 3 to 5 years, then reviewed.
- Denosumab: An injection every 6 months. Doses must not be delayed or stopped without a follow-on treatment, because bone loss and spinal fractures can rebound.
- Bone-building medicines: Teriparatide daily injections or romosozumab monthly injections for very high risk, followed by a bisphosphonate to keep the gain.
- Hormone therapy: HRT protects bone in women with early menopause or menopausal symptoms under 60; raloxifene is an alternative for spine protection.
- Treating vertebral fractures: Pain control and physiotherapy. Vertebroplasty or kyphoplasty is considered for severe pain that persists.
When it is urgent
Go to a local emergency department after a fall if you cannot bear weight, the leg looks shortened or turned out, or there is severe pain in the hip or groin. A hip fracture needs surgery within about 36 hours. Sudden severe back pain with leg weakness, numbness or loss of bladder control also needs emergency assessment.
Travelling to Türkiye for treatment
Osteoporosis treatment runs for years through repeat prescriptions and scheduled injections, which belongs with your home doctor. What can be done well during a visit is the evaluation: DXA, spine imaging, a full screen for secondary causes and a treatment recommendation in 1 or 2 days, often as part of a check-up. If you start denosumab abroad, make certain the next dose in 6 months is arranged at home. Kyphoplasty for a painful vertebral fracture is a planned short-stay procedure.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Should I worry about jaw problems and unusual thigh fractures?
Both are rare with osteoporosis doses: jaw osteonecrosis affects roughly 1 in 10,000 to 100,000 a year. For people at high fracture risk the benefit far outweighs this. Have a dental check before starting.
Do calcium tablets harm the heart?
Evidence is mixed. Getting calcium from food first and supplementing only the shortfall is the usual advice.
Can bone density be regained?
Yes, particularly with bone-building drugs, which can raise spine density by around 10 percent or more.
Do men get osteoporosis?
Yes, and they are underdiagnosed. A secondary cause is found in about half of affected men.