Osteoporosis in women: prevention, tests and treatment

Reviewed by Emma Carter, Senior Health & Nutrition Editor

Osteoporosis is a disease of weak, fragile bones, and it is far more common in women than men. It works quietly for years, then announces itself with a broken bone. The good news is that a lot of it is preventable, and the steps that protect your bones support the rest of your health too. The catch is that they work best when started early, well before menopause.

What osteoporosis is

Bone is living tissue that is constantly broken down and rebuilt. Osteoporosis develops when this balance tips and you lose bone faster than you replace it, so bones become less dense and their internal structure weakens. The result is bones that break more easily, sometimes from a minor fall or even everyday movements like bending or coughing.

The difficult part is that it is a silent disease. There are usually no symptoms until a fracture happens, by which time a good deal of bone strength may already be lost.

Why women are more at risk

Several things stack the odds against women's bones:

• They reach a lower peak bone mass than men to start with
• The fall in estrogen at menopause speeds up bone loss sharply for several years
• They live longer on average, giving more time for bone to thin

The scale is real: about half of all women over 50 will break a bone because of osteoporosis. Extra risk factors include a family history, early menopause, a small frame, smoking, heavy drinking, long-term steroid medication and some conditions and eating disorders.

How it is diagnosed

Osteoporosis is diagnosed with a bone density scan, usually a DEXA (or DXA) scan. It is a quick, painless, low-dose X-ray, most often of the hip and spine, that measures how much mineral your bones contain. The result compares you with a healthy young adult and grades your bone as normal, low (osteopenia) or osteoporotic. Your doctor decides whether you need a scan based on your age and risk factors.

Protecting your bones

Prevention rests on a handful of well-evidenced habits, best built in through your earlier decades:

• Calcium: aim for your age-appropriate target, mostly from food such as dairy, fortified alternatives, canned fish with bones and leafy greens
• Vitamin D: needed to absorb calcium, and commonly low, so a supplement is often sensible
• Weight-bearing and strength exercise: walking, jogging, dancing and resistance training all signal bone to stay strong. Protein supports the muscle that protects bone too
• Stop smoking and limit alcohol, both of which weaken bone
• Keep a healthy body weight, since being underweight raises risk

None of these is dramatic, but done consistently they make a real difference to the bone you carry into later life. One expectation worth setting: reviews of calcium plus vitamin D supplements in postmenopausal women find the effect on bone density and fracture risk is small and varies between groups (Indian J Endocrinol Metab, 2013), so supplements support the habits above rather than replacing them.

Treatment

If you are diagnosed with osteoporosis, the lifestyle steps above still apply, and doctors add medication to slow bone loss or help build bone. Several effective options exist, chosen based on your fracture risk and health. Around menopause, HRT can also help protect bone in the right candidates, and menopausal hormone therapy is endorsed for preventing osteoporosis in appropriately selected women (North American Menopause Society), as part of a wider decision about menopause symptoms. Preventing falls, through good vision, safe footwear and balance work, is an underrated part of treatment.

When to see a doctor

See your doctor if you have risk factors such as early menopause, a family history of osteoporosis, long-term steroid use or a previous fragility fracture, or if you have lost height or noticed a stooping posture. Ask whether a bone density scan is appropriate. Acting before a first fracture is where the biggest gains are.

Frequently asked questions

Why are women at higher risk of osteoporosis?

Women build less bone mass than men to begin with, and the drop in estrogen at menopause speeds up bone loss for several years. About half of women over 50 will break a bone because of osteoporosis, which is why prevention matters through the earlier decades.

What are the symptoms of osteoporosis?

Osteoporosis is often called a silent disease because there are usually no symptoms until a bone breaks. The first sign is frequently a fracture from a minor fall, or gradual height loss and a stooped posture from small fractures in the spine.

How is osteoporosis diagnosed?

It is diagnosed with a bone density scan, usually a DEXA (or DXA) scan, a quick, painless X-ray that measures the mineral content of your bones. The result is compared with a healthy young adult reference to grade your bone strength.

How can women prevent osteoporosis?

The core steps are enough calcium and vitamin D, regular weight-bearing and strength exercise, not smoking, limiting alcohol, and keeping a healthy body weight. These matter most when done consistently through your 30s, 40s and beyond, before major bone loss happens.

References

1. Calcium and vitamin D in post menopausal women · Indian Journal of Endocrinology and Metabolism, 2013
2. The 2017 hormone therapy position statement of The North American Menopause Society · The North American Menopause Society
3. Osteoporosis: symptoms, causes and treatment · Cleveland Clinic
4. Osteoporosis: causes, risk factors and symptoms · NIH / NIAMS