Osteoporosis: Symptoms, Causes & Treatment

Written by Dr. Simon Khela MBChB MRCGP, GMC Registered Doctor

Last reviewed: 04-08-2026

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A patient in her early sixties once came to see me after a minor fall in her garden left her with a broken wrist,the sort of fall she’d have shrugged off a decade earlier. It turned out to be the first sign of osteoporosis she’d ever had. There’d been no pain, no warning, nothing she could have noticed sooner. That story is genuinely typical, and it’s exactly why osteoporosis has earned its reputation as “the silent disease.”

This guide explains what osteoporosis actually is, how it differs from the earlier stage called osteopenia, what causes it (including whether it runs in families), the early warning signs worth knowing about, and the realistic range of treatments and medications available today.

What Is Osteoporosis? A Quick Answer

Osteoporosis is a condition that causes bones to become weaker and more fragile, making them more likely to break, often after only a minor fall or bump. It develops gradually over years and typically causes no symptoms until a fracture happens, most commonly in the wrist, hip or spine. Osteoporosis becomes more common with age, particularly in women after the menopause, though it can affect men and younger people too. There’s no cure, but bone-strengthening medication, lifestyle changes and fall-prevention measures can meaningfully reduce the risk of future fractures.

Osteopenia vs Osteoporosis: What's the Difference?

Many patients are surprised to learn that osteoporosis doesn’t appear overnight,there’s usually an earlier stage called osteopenia. Both are measured using a bone density scan (DEXA scan), which compares your bone density to that of a healthy young adult. The difference is expressed as a T-score:

• A T-score above -1 is considered normal bone density
• A T-score between -1 and -2.5 indicates osteopenia,lower bone density than average, but not low enough to be classed as osteoporosis
• A T-score below -2.5 indicates osteoporosis

One of the most common concerns I see in practice is a patient who’s just been told they have osteopenia and assumes it’s only a matter of time before it becomes osteoporosis. That isn’t automatic,osteopenia doesn’t always progress, and it depends on a number of factors, many of which you have some influence over through lifestyle changes and, where appropriate, treatment.

Osteoporosis Symptoms

Osteoporosis itself isn’t usually painful, which is exactly what makes it difficult to catch early. Many patients are surprised to learn that a broken bone, rather than any preceding symptom, is often the first sign anyone has that their bones have weakened at all.

Early Warning Signs of Osteoporosis

That said, a few subtle changes can sometimes appear before a fracture, particularly once some vertebral compression has already occurred:

• Gradual loss of height, sometimes noticed only when clothes stop fitting the way they used to
• A stooped or forward-curving posture, sometimes called kyphosis
• Persistent back pain, particularly if it develops without an obvious injury
• A fracture from a fall or bump that wouldn’t normally be expected to break a bone (a “fragility fracture”)

A question I am frequently asked is whether back pain alone means someone has osteoporosis. Usually not,back pain has many possible causes, and osteoporosis is only one of them. But persistent, unexplained back pain in someone with risk factors for osteoporosis is worth having assessed rather than dismissed as general wear and tear.

What Causes Osteoporosis?

Bone is living tissue that’s constantly being broken down and rebuilt throughout life. Losing some bone density is a normal part of ageing, but osteoporosis develops when this loss happens faster than the body can replace it.

Is Osteoporosis Hereditary?

Genetics play a real role. You’re more likely to develop osteoporosis if you have a family history of it, particularly if a parent broke a hip. Genetics influence the peak bone density you build in early adulthood, which affects how much of a “reserve” you have as natural bone loss continues with age. That said, family history isn’t the whole picture,lifestyle factors and, where relevant, treatment can meaningfully change the outcome even for those with a strong family history.

Beyond genetics, several other factors increase the risk of osteoporosis:

• The menopause,women lose bone rapidly in the first few years afterwards, particularly with early menopause (before 45) or if the ovaries have been removed
• Long-term use of high-dose steroid tablets (more than 3 months)
• Other medical conditions, including inflammatory conditions, hormone-related conditions, and malabsorption problems
• A low body mass index, or a history of an eating disorder such as anorexia or bulimia
• Long-term use of certain other medicines, such as anti-oestrogen tablets used after some breast cancers
• Not exercising regularly
• Heavy drinking and smoking

Many patients are surprised to learn how many everyday conditions can contribute to osteoporosis as a secondary cause. Coeliac disease, for example, can affect how well the gut absorbs calcium and vitamin D, which is one of several reasons it’s worth mentioning any diagnosed conditions to your GP when discussing bone health, even if they seem unrelated at first glance.

How Is Osteoporosis Diagnosed?

If your GP suspects you may be at risk, assessment usually involves:

• A risk assessment using an online tool such as FRAX, which estimates your future fracture risk based on age, sex, weight, family history and other factors
• A bone density scan (DEXA scan),a short, painless scan, usually of the hip and spine, that measures bone density and gives your T-score

Your doctor may also arrange a bone profile blood test to check calcium, phosphate and other markers, partly to look for any secondary, treatable causes of bone loss rather than assuming age or menopause is the only explanation.

One of the most common concerns I see in practice is a patient assuming a DEXA scan is only offered after a fracture has already happened. It isn’t,if you have risk factors for osteoporosis, it’s entirely reasonable to ask about a risk assessment before anything has broken, rather than waiting for a fracture to prompt the conversation.

Osteoporosis Treatment

Treatment focuses on strengthening bone where possible and reducing the risk of fracture, rather than reversing damage that’s already occurred. The right approach depends on your fracture risk, age, and any underlying causes identified.

Lifestyle Measures

• Weight-bearing exercise, such as walking, dancing or resistance training, to help maintain bone strength
• A calcium-rich diet, alongside adequate vitamin D, which the body needs to absorb calcium properly
• Stopping smoking and reducing alcohol intake, both of which are linked to weaker bones

Most adults in the UK are advised to take a daily vitamin D supplement, particularly over autumn and winter months. Understanding why vitamin D matters for bone health is a useful starting point if you’re not sure whether your current diet and sunlight exposure are giving you enough.

Medication for Osteoporosis

If lifestyle measures alone aren’t enough, or your fracture risk is significant, several medications can help:

• Bisphosphonates,the most commonly used first-line treatment, slowing the rate bone is broken down; available as tablets or injections
• Denosumab,a biological medicine given by injection every six months, often used if bisphosphonates aren't suitable
• Romosozumab and teriparatide,medicines that can also stimulate new bone formation, generally reserved for more severe osteoporosis
• Hormone replacement therapy (HRT),can help maintain bone density around the menopause, though it isn’t specifically prescribed for osteoporosis alone in most cases

Some of these treatments require specialist initiation, so a referral to a specialist,typically a rheumatologist or endocrinologist,is a normal part of accessing them rather than a sign that something has gone wrong. For those who can’t tolerate oral supplements well, a vitamin D injection is sometimes used alongside other treatment.

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Treatment decisions are individual, and your GP or specialist will weigh your fracture risk against the benefits and practicalities of each option,there’s rarely a single “right” answer that applies to everyone.

Living With Osteoporosis: Reducing Your Risk of Falls

If you've already been diagnosed with osteoporosis, medication is only part of the picture. Because fractures are usually triggered by a fall, reducing your chances of falling in the first place is just as important as strengthening the bone itself:

• Removing loose rugs, trailing cables and clutter that could cause a trip, particularly on stairs and landings
• Ensuring hallways and stairs are well lit, including at night
• Having regular sight tests, since poor vision is a genuine and often overlooked contributor to falls
• Having your hearing checked too, since balance and hearing are more closely linked than most people expect
• Wearing well-fitting shoes with good grip, rather than loose slippers, especially outdoors

Many patients are surprised to learn that a fall-prevention conversation is just as much a part of osteoporosis care as any prescription. Reviewing this alongside a broader health assessment,covering things like blood pressure and general fitness alongside bone health,often gives a clearer overall picture than looking at fracture risk in isolation.

Common Myths About Osteoporosis

• Myth: Osteoporosis is just a normal, untreatable part of getting older. Fact: While bone loss is a normal part of ageing, osteoporosis itself is both preventable to a degree and treatable once diagnosed.
• Myth: Only elderly women get osteoporosis. Fact: It's more common in older women, but it can affect men, younger women, and even children in rare cases, particularly where there's an underlying cause.
• Myth: You'd know if you had osteoporosis because it hurts. Fact: Osteoporosis is usually painless until a bone breaks, which is exactly why it's called a silent disease.
• Myth: If it runs in your family, there's nothing you can do. Fact: Family history increases risk, but lifestyle changes and treatment can still meaningfully reduce your individual fracture risk.
• Myth: Osteopenia always turns into osteoporosis. Fact: Osteopenia doesn't inevitably progress,it depends on a range of factors, several of which you can influence.

When to See a GP

It's worth speaking to a GP about your bone health if:

• You've broken a bone from a minor fall or bump that wouldn't normally be expected to cause a fracture
• You've noticed a loss of height or a change in your posture
• You have a family history of osteoporosis, particularly a parent with a hip fracture
• You have a medical condition or take a medication known to increase osteoporosis risk
• You're going through, or have been through, an early menopause

A private GP appointment is a reasonable way to discuss your individual risk factors and agree on whether a bone density scan or further assessment makes sense for you.

Frequently Asked Questions about Osteoporosis