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What is Osteoporosis

Osteoporosis is a condition in which bones lose their strength and are more likely to break,
usually following a minor bump or fall. Broken bones are also referred to as fractures (the
words mean the same thing). Fractures that occur because of reduced bone strength are
described as fragility fractures and many of these will be caused by osteoporosis. One in two
women and one in five men over the age of 50 experience fractures, mostly as a result of low
bone strength. Although fragility fractures caused by osteoporosis can happen in various parts
of the body, the wrists, hips and spine are the most commonly affected sites.

Osteoporosis is also a term used to describe low bone density as measured on a bone density
(DXA) scan. This means your bones may have lost strength.

Osteoporosis means "porous bones." Our bones are strongest at about age 30, then begin to lose
density. More than 10 million Americans have osteoporosis, which is significant bone loss that
increases the risk of fracture. About half of women 50 and older will have an osteoporosis-related
fracture in their lifetime.

2. Who is affected by osteoporosis?

Women and osteoporosis

Women are more susceptible to osteoporosis because bone loss becomes more rapid for several
years after the menopause, when sex hormone levels decrease. In addition, women tend to have
smaller bones than men and in general live longer, with loss of bone tissue continuing for longer,
making fragility fractures more likely.

Men and osteoporosis

Osteoporosis is not a condition that just affects women, although this is a common misconception.
If you are a man, you might be thinking osteoporosis cant affect you as its a womens problem,
but, in fact, one in five men break a bone after the age of 50 years because of low bone strength.
Men with osteoporosis tell us that this confusion can sometimes make it more difficult to come to
terms with the condition and to seek help and support.

Younger men and women and osteoporosis

Younger men and women (before the menopause) can also, but more unusually, have
osteoporosis and fractures. Usually an underlying condition or reason is identified but sometimes
no cause is found. The medical word for this is idiopathic. If you are a healthy younger person
who is frequently breaking bones, this can be particularly distressing. Diagnosing and treating
osteoporosis in men and in younger women and children is complex and generally a referral to a
hospital specialist is recommended.

3. Your Bones

Your bones have several functions. They give your body its overall structure and provide support
and protection for your internal organs. They store calcium and other minerals and work with your
muscles to allow your body to move. They also contain bone marrow, which is where your blood
cells are produced.
Although from the outside your bones look like simple, solid structures, they actually have a clever
design that allows your skeleton to be strong without being heavy. Each bone is made up of two
types of bone tissue:

a thick outer shell called cortical bone

a strong mesh or scaffolding (like a honeycomb) inside the shell called trabecular bone.

Both types of bone tissue are fed by a nerve and blood supply while fat and bone marrow (for
blood cell production) fill the spaces. Some bones, such as the ends of the long bones in your arms
and legs, and your spinal bones, have a high proportion of trabecular bone.

Scientic bone imageBone tissue is made up of protein hardened by calcium salts and other
minerals to make it strong. Bone tissue is alive and constantly changes through life to make sure it
remains as healthy as possible. Throughout each bone, older, worn-out bone tissue is broken
down by specialist cells called osteoclasts and rebuilt by bone-building cells called osteoblasts. This
process of renewal is called bone remodelling. In younger adults, up until about the age of 35
years, there is usually a balance between the amount of bone that is removed and the amount of
bone that is laid down; repair and renewal are usually in balance and the total amount of bone
tissue thus stays the same.

In childhood, osteoblasts work faster, enabling the skeleton to increase in size, density and
strength. During this period of rapid bone growth it takes the skeleton just two years to
completely renew itself. In adults, this process takes seven to ten years. Bones stop growing in
length between the ages of 16 and 18 years but the total amount of bone tissue you have (the
thickness of the cortical shell and the trabecular bone inside) continues to increase slowly until
your late twenties.

4. Bones & Osteoporosis

After the age of about 35 years, the difference between the amount of bone that is removed and
the amount of bone that is laid down starts to get slightly out of balance as part of the ageing
process. As a result, the total amount of bone tissue starts to decrease. This is often described as
bone loss or bone thinning. It doesnt mean your bones look any different from the outside.
However, inside, the cortical shell thins and the struts that make up the inner structure become
thinner and sometimes break down. This results in the holes in the honeycomb structure
becoming larger hence the description osteoporosis, literally meaning porous bone. This
change in the quality of your bones is much more likely and more significant as you move into
later life, which explains why bones become more fragile and fractures become more common in
old age.

There are many other factors that can upset this balance of bone remodelling and lead to
osteoporosis, and these are described in our Are you at risk page.

5. Testing: DXA Bone Density Scan

Your doctor may recommend a bone mineral density test if:

You're over 50 and have broken a bone

You are a woman over 65, or a man over 70

You are in menopause or past menopause and have risk factors

You are a man age 50-69 with risk factors

DXA (dual X-ray absorptiometry) uses low-dose X-rays to measure bone density in the hip and
spine. The test takes less than 15 minutes.

6. Testing: What Your T-Score Means

Testing compares your bone mineral density (BMD) with that of a healthy 30-year-old, since that's
when bone mass is at its peak. The results come as a T-score in these ranges:

-1.0 and higher is normal bone density

Between -1.0 and -2.5 shows low bone density (osteopenia) but not osteoporosis

-2.5 or below indicates osteoporosis

As your bone density decreases, your T-score gets lower.

7. Build Strong Bones With Weight

Weight-bearing exercise can help you build bone and maintain it. That includes walking, jogging,
tennis, and other activities where you move the full weight of your body. Using small weights in
many different activities helps bones. Women who walk just a mile a day have four to seven more
years of bone reserve, researchers have found.