How do I know if I am at risk of osteoporosis?
You can get a good sense of your risk based on age, sex, hormonal history, medication use and lifestyle. If you have multiple risk factors, ask your general practitioner for a bone density measurement.
Age, sex and ethnic background are the most well-established risk factors. Women are at greater risk than men, risk increases with age, and people of white (Caucasian) background are more frequently affected. Yet osteoporosis concerns men too: roughly 40% of all osteoporosis-related fractures occur in men, and after a first fracture their chance of a subsequent fracture and of dying is actually greater than in women.
Hormonal changes play a key role. Women who had their ovaries removed at a young age lose the protective effect of oestrogen early and therefore face a clearly higher risk. In men, a deficiency of sex hormones (hypogonadism) is a common cause. Prolonged use of corticosteroids, such as prednisone, damages bone in both women and men.
Lifestyle also counts, albeit somewhat less so than age and hormones. Smoking, excessive alcohol use, too little calcium in your diet and limited physical activity raise the risk, especially after the menopause. A small body frame or low bone density in your younger years gives you less reserve. If you have already broken a bone, or a parent or sibling has, that too is a signal to be alert.
Measuring bone density with a DXA scan is the standard way to find out where you stand. A T-score of -2.5 or lower indicates osteoporosis. Women are advised to have this scan from the age of 65. If as a woman you already have risk factors at an earlier age, or if you are a man with one or more of the risk factors mentioned above, a scan at a younger age is worthwhile. Discuss this with your general practitioner.
Protective factors exist as well. Adequate calcium and vitamin D, and regular exercise, help to build bone in your younger years and to slow bone loss later on. These are the most practically applicable tools.
Based on several large cohort studies and clinical guidelines (PMID 2517695, 16448873, 36382763, 32773051, 34688418, 30888662, 7696835). The associations for age, sex and DXA-based diagnosis are robust; lifestyle factors are well supported but their causal evidence is less strong.
How do I know whether my bones are strong enough (osteoporosis)?
With a bone density scan and, where appropriate, a fracture risk calculation, your GP can check whether your bones are strong enough, especially if you have risk factors or have previously broken a bone from a minor fall.
Do men get osteoporosis too?
Men do indeed get osteoporosis, and the consequences of a fracture are on average more serious for them than for women. Only 1 in 10 men with osteoporosis receives treatment, so if you have risk factors, it is worth discussing them with your doctor.
Does physiotherapy really help if you already have osteoporosis?
Supervised exercise genuinely helps if you have osteoporosis: it slows bone loss, improves your balance and muscle strength, and reduces fear of falling. Consult a physiotherapist for a safe and effective personalised programme.
Does strength training help against osteoporosis just as well as medication?
Strength training demonstrably improves bone density and offers additional benefits that medication does not, but the two are not alternatives to each other: for a seriously elevated fracture risk, medication has stronger evidence and cannot be replaced by exercise.
How do you prevent bone loss when losing weight at an older age?
Strength training while losing weight is the best protection against bone loss, but cannot prevent it entirely. Combine it with adequate protein intake and discuss it with your doctor if you are losing weight quickly or in large amounts.
Do people with darker skin have a higher risk of osteoporosis (bone loss)?
People with darker skin have a greater chance of vitamin D deficiency, but that does not automatically mean greater bone loss. Whether you are actually at risk depends strongly on your age, eating habits, and how often you spend time outdoors.