A three-minute test to reveal a silent disease that affects more than three million people

A three-minute test can detect a hidden disease that affects more than three million people. People with osteoporosis have fragile bones that can easily fracture if they fall or are simply knocked.

Each year, approximately 50,000 people require treatment for bone fractures due to this disease. Although the disease can affect men, women and even children, the risk increases with age.

And for women over 50, the risk is so great that half of them will break a bone because of the disease. Yet many women don’t realize they have it until they fall and break a bone.

It often takes several fractures for a diagnosis to be made. However, according to the Royal Osteoporosis Society, the condition is “not inevitable”.

They said: “Osteoporosis, a disease that makes bones weak and break more easily, is not an inevitable consequence of ageing. Poor bone health can affect anyone: one in two women over 50 are at risk of breaking a bone because of the condition, and one in five men.

“These fractures are not just a painful inconvenience, as many people die from fracture-related causes, such as diabetes or lung cancer.” Despite this, figures show that two thirds of UK adults have never considered they might be at risk of poor bone health and more than half have never thought about their bone health.

Kirsty Carne, Osteoporosis Specialist Nurse at ROS, said: “Bone fractures caused by osteoporosis can be painful, impact daily life and sometimes lead to life-changing disability, but few of us are aware that we may be at risk. It’s never too early or too late to take action for your bone health.

“There are many changes we can all make in our daily lives to protect our bones and prevent fractures, but only if we know our risks and take steps.”

In 2022, the Royal Osteoporosis Society launched the UK’s first Bone Health Risk Check tool, to provide people with free, personalised advice on their osteoporosis risk, with the support of Her Majesty The Queen. Since launch, over 330,000 people have used the tool and received practical advice on how to take action for their bone health.

As a result, an estimated 41,000 patients have been diagnosed. Jamie Grier, director of revenue and engagement at ROS, said: “In the UK, we spend £4.5 billion on managing osteoporotic fractures, rather than preventing them, which is a huge burden on our NHS.”

Jamie added: “The risk checker allows people at high risk of bone fractures to access a vital diagnosis and the treatment they need more quickly. A fifth of women who break a bone break three or more before being diagnosed. So, as well as saving many patients the pain of avoidable fractures, it will also save the country a fortune.”

What is osteoporosis?

According to the ROS, osteoporosis is a disease in which bones become weak and break easily, even after a minor impact or fall. These fractures can be described as fragility fractures. The terms “fracture” and “broken bone” have the same meaning.

Fractures can affect almost any bone, but they are most common in the wrists, hips, and spine. It is these broken bones that can cause pain, rather than osteoporosis itself. Spinal fractures can also cause height loss and curvature of the spine.

Signs and symptoms

Symptoms of osteoporosis are few and the first sign is often a bone that breaks easily. Strong bones must be able to withstand a blow or the impact of a fall from a height. If you have broken a bone easily, talk to your doctor. The most common fractures are those of the wrist or hip.

According to the ROS, spinal bones are also commonly broken when the bones lose strength. A spinal fracture occurs when the bones of the spine crush on themselves, instead of breaking.

You may not always be aware of a spinal fracture. Sometimes, spinal fractures don’t cause the pain you’d expect from a broken bone. And, in other cases, the pain may be mistaken for another condition, such as arthritis.

Symptoms of spinal fractures

One or more of the following may be a sign of spinal fractures:

• Unexplained back pain and muscle spasms
• Loss of height
• A curved spine or change in posture

Symptoms of spinal fractures become more noticeable as the number of broken bones increases. If you think you have any of the symptoms listed above, talk to your doctor. He or she can evaluate your case to determine if your symptoms are caused by spinal fractures or another condition.

What is the cause ?

Osteoporosis and bone fractures have a number of known risk factors that cause your bones to lose strength. Some of these cause a decrease in the amount of bone tissue your body produces and repairs, called bone density. Others affect the strength of your bones or their risk of fracture in other ways.

Understanding your risk factors for osteoporosis and bone fractures can help you determine if there are things you can do to change. Remember, it’s never too late to start taking action for your bones, even after a diagnosis.

Your doctor will often use your risk factors to build a picture of your overall bone health and fracture risk. To do this, he or she will perform a fracture risk assessment. The results will help him or her decide whether you need osteoporosis medication.

Risk factors you can change

• Low body weight – if you have a low body weight, you are more likely to have less bone tissue. If you are older, having a low body weight also means you have less fatty padding around your hips, to cushion the impact of a fall. This makes broken bones more likely if you trip and fall
• Smoking – Smoking slows the growth of bone-building cells in your body. If you are a woman, smoking also increases your risk of early menopause. Postmenopausal women have an increased risk of osteoporosis and bone fractures.
• Drinking too much alcohol – Alcohol affects the cells that build and break down bones. It also makes you unsteady on your feet, increasing the risk of tripping, falling and breaking a bone.
• Slips, trips and falls – if you have poor balance, coordination and reflexes, you are more likely to trip or stumble, and potentially break a bone if you fall.

Risk Factors You Can’t Change

• Your genes – Your genes determine the potential size and strength of your skeleton. Research shows that if one of your parents broke a hip, you are more likely to break a bone yourself.
• Aging: Starting in your late 30s, the amount of bone tissue begins to naturally decrease. This happens at different rates for different people. The amount of bone tissue you have is known as your bone density, which is measured during a bone densitometry scan. As you age, your bone tissue loses strength and becomes more likely to break in general, regardless of your bone density. You may also become less stable on your feet as you age. This increases your risk of slipping or tripping, and breaking a bone if you fall.
• Being a woman – osteoporosis and bone fractures are more common in women than men. Your bones lose strength more quickly after menopause. This is due to decreased levels of oestrogen (the female sex hormone that helps keep bones strong). Women tend to live longer, on average, and are therefore more likely to live with the reduced bone strength that comes with age. Women tend to have smaller bones than men. Larger bones have been found to reduce the risk of fractures.
• History of bone fractures – if you have had a bone fracture in the past, especially in your spine, you are much more likely to break one in the future. Research shows that after a bone fracture, you are two to three times more likely to have another one.

Medical and health conditions

Certain medical and health conditions increase your risk. Here are some of them:

• rheumatoid arthritis
• low levels of estrogen, a sex hormone, in women, due to: early menopause; hysterectomy with removal of the ovaries, before age 45; anorexia nervosa; Turner syndrome; excessive physical exercise
• low levels of the sex hormone testosterone in men, following: surgery for certain cancers; Klinefelter syndrome; Kallmann syndrome; naturally lower testosterone levels
• hyperthyroidism, in which thyroid hormone levels are abnormally high
• parathyroid disease, in which parathyroid hormone levels are abnormally high
• conditions that affect the absorption of food, such as: Crohn’s disease; celiac disease
• conditions that cause long periods of immobility, such as a stroke

Certain medications may also increase the risk, including:

Three-minute risk check

The ROS Risk Test takes three minutes and will provide you with a personalized report on your bone health. To take the test, go here.

Where can I get help?

The Royal Osteoporosis Society is the UK’s national osteoporosis charity. It provides detailed information on the prevention and treatment of osteoporosis, as well as support groups across the UK.

Its president is the Queen, who has supported the charity for decades after her mother died of the disease in 1994. She became president in 2001 when she was Camilla, Duchess of Cornwall.

Find an osteoporosis support group near you on the Royal Osteoporosis Society website. The Royal Osteoporosis Society’s free helpline can be particularly helpful if you’ve just been diagnosed with osteoporosis.

The helpline number is 0808 800 0035. It is open Monday to Friday, 9am to 12:30pm and 1:30pm to 5pm.