What is Osteoporosis?

Osteoporosis is known as the Silent disease, even though the effects of it are NOT Silent. Osteoporosis effects the strength/thickness of bones, which makes the bones more fragile and unfortunately the diagnosis rate is only 19%.

Note: It should NOT be considered normal for an adult to break a bone from a trip and fall from a standing position or less, even if on ice or cement.

What is osteopenia?

Osteopenia is the early stage of Osteoporosis. Having osteopenia places a person at risk of developing osteoporosis. A diagnosis of osteopenia is a warning that you must start taking care of your bones and that the causes of your bone loss need to be investigated and addressed. This is to ensure you do not continue to lose bone and end up with fractures (broken bones) that could have been prevented. The risk factors for developing osteopenia are the same as for osteoporosis, however, research shows that most fractures occur in the moderate to marked Osteopenia range.

How does a person know if they have Osteoporosis?
What are the signs or symptoms?

There are NO signs or symptoms to warn a person that they are losing bone or that they are at high risk of breaking bones. A person will not know if they have Osteoporosis unless they have a DXA scan of their spine and hips. A person can look perfectly healthy (exercise daily and eat healthily) but have severe bone loss on the inside of their bones.

The following are signs and symptoms that a person may have UNDIAGNOSED Osteoporosis:

  • A broken bone/s: If you or a loved one has broken a bone from a trip and fall, from a standing position or less, you may have undiagnosed Osteoporosis. A broken bone from a sneeze, cough, turning over in bed or getting out of the chair, should be considered Osteoporosis unless proven otherwise. A broken arm or leg bone from a trip and fall.
  • Postural or body shape changes:
    Your head starting to protrude forward from your body.
    Your shoulders starting to become rounded.
    A hump developing on your upper back, which is usually associated with
    loss of height.
    A change in your body shape and size: A pot belly can occur when the
    stomach contents are pushed outwards due to the collapse/fracture of
    vertebrae (Broken bones in your back). This is usually associated with loss
    of height.
  • Loss of height: It should not be considered “Normal aging” for a person to lose height. It is a red flag that a person may have broken bones in their back, due to bone loss.
  • Upper, middle, or low back pain: Especially if you have intermittent back pain or any of the signs or symptoms listed above.

Diagnosing Osteoporosis by X-ray

I was diagnosed with Osteoporosis from an X-Ray. Do I need a DXA scan?

Yes, unless you are bed-bound or unable to lie still for approximately 15 minutes. If you do not get a DXA scan, your bone health will not be able to be accurately monitored for improvements or declines in your bone health.
We recommend that a person get rescanned, at a minimum, every two years and preferably on the same machine.

Diagnosing Osteoporosis

How is Osteoporosis diagnosed?
  • A bone density scan of the spine and hips is called a DXA /DEXA (Dual Energy X-ray Absorptiometry) scan and it is the recommended gold standard for the diagnosis of Osteoporosis. It is the only test we recommend for screening and diagnosing bone loss.
  • A DXA scan is used to measure the density (Strength/thickness) of bones. It is a painless test, that usually takes 15 minutes and is not claustrophobic.
  • If your results decline it is essential that the cause/s of the decline are investigated and addressed.
My local chemist is advertising that they do “bone density” testing. My friend got one done, they only did her heel and told her that their machine was just as accurate as of the DXA test for the spine and hips, is this true?

The heel is NOT one of the most common areas to be affected by bone loss. The spine, hip, and forearm are the most common areas to fracture first. We DO NOT recommend any type of ultrasound machine scan on the heel, shin, or forearm for the screening or diagnosis of Osteoporosis.

Note: A heel scan is NOT as accurate as a DXA scan. A DXA scan of your spine and hips is the World standard for diagnosing Osteoporosis.

The IOS does not recommend ANY TYPE OF heel, shin, or forearm ultrasound testing for screening or diagnosing of Osteoporosis.

Monitoring of your Osteoporosis by DXA

I had a DXA scan three years ago and was told that I did not ever have to get rescanned. How do I know I am improving if I do not get re-scanned?

We highly recommend that a person gets a DXA scan annually or at a minimum every two years, to monitor your response to treatment and to make sure your results have not declined. If your results decline it is essential that the cause/s of the decline are investigated and addressed.

Genetics – Family history - losing height – developing a hump

My sister and I were both told that getting shorter is normal when you age. Both of us have lost several inches in height and I am developing what appears to be a hump on my upper back. Could I have Osteoporosis?

It is considered normal by many people to lose height, due to wear and tear of the bones and discs in the spine. However, loss in height should be investigated, especially with postural changes. A DXA scan with an LVA would be recommended in your situation.
When a person develops a hump on their back, a DXA with an LVA (Lateral Vertebral Assessment) is recommended. If not available on the DXA machine, a lateral thoracic X-ray of your spine should be done to rule out fractures in your back.

Stress - Males and bone loss

My boyfriend is 34 and is under a huge amount of stress at work, he has been complaining of back pain and appears to be losing height. He has also lost interest in sex. Could this be Osteoporosis? If yes, can he be helped?
  • Psychological stress can affect levels of sex hormones, which can affect a person’s libido and can also affect bone.
  • Constant, or intermittent back pain should be investigated.
  • Loss of height should be investigated by a DXA with an LVA.
  • A DXA scan with an LVA would be recommended, and if the DXA scan results are positive, investigating the causes of why he has lost bone is essential especially his testosterone and cortisol levels.

Body shape changing

I am 54 and I have always lived a healthy lifestyle, however over the last year I have developed a “potbelly” and my clothes do not fit the way they used to. I feel my shape is changing and my trousers seem to be longer, even though I have worn the same length for the last 40 years. I am eating the same amount of food and doing the same amount of exercise. Could I have Osteoporosis?

If you have noticed a change in your body shape and possible loss of height, it would be wise to have this investigated, as there are no signs or symptoms warning a person that they are losing bone.
DXA scan with an LVA (Lateral Vertebral Assessment) is a DXA scan side view of the bones in your back.

Multiple broken bones

My mum has broken five bones from falls over the last two years but has never been tested for Osteoporosis.

She should contact us right away, as she would be at high risk of losing her independence. It should not be considered normal for an adult to break multiple bones from trips and falls from a standing position or less.

Hip replacements

I am scheduled to get a hip replacement. Could this be due to Osteoporosis?

Joint replacements are usually due to arthritis. However, if you also have undiagnosed Osteoporosis, the success rate of this surgery is usually significantly reduced.

A pin in any bone that has untreated or undiagnosed Osteoporosis, usually will not hold long term, as there is very little bone for it to be securely attached to.

Any person who is having elective surgery (surgery is scheduled, not from a car accident) for any type of pinning or joint replacement should contact us about getting a DXA scan done prior to surgery. This way if the person has Osteoporosis, they can build up their bones prior to surgery, which will increase the success rate of the surgery.

Some of the many myths regarding Osteoporosis

Is it true that only old women get Osteoporosis?

No, it is not true. More women are affected than men because their bones are smaller, and they also go through menopause.

Note: 1 in 4 men over 50 will get Osteoporosis and children can also be affected.

Is Osteoporosis not preventable?

Yes, it is preventable in most cases. This is why it should be mandatory for all children, in all schools to have to participate in physical education, and it should also be mandatory in the curriculum for the Leaving Certificate.

Why? Weight-bearing exercise in childhood can help to build up strong healthy bones, which will reduce the person’s risk of developing osteoporosis in later life.
Calcium, Vitamin D, and first-class proteins should be encouraged from childhood throughout life to help protect bones.

My mum is 84 and has just been diagnosed with Osteoporosis, but we have been told that at her age it is not treatable. Is it too late to help her?

It is rarely too late to treat a person. We have 90-year-olds who have improved their bones and reduced their risk of further fractures while regaining their independence. A person is never too young or too old to be diagnosed and treated. An example of this is the letter below we received from a son regarding his mother. His mother had broken multiple bones in her back and become wheelchair-bound.

“I wanted to thank your organisation for the help and guidance I received from you regarding my mum’s Osteoporosis.

The improvement has been substantial, and together with the practical steps, we took to adapt her house, her quality of life has improved substantially to the point that she is mobile and active again.  We recently took her to Bath, U.K. to celebrate her 90th birthday and she will go on a Mediterranean cruise with my sister next month!

My Mum and I are extremely grateful for your guidance that has truly given her a new lease on life.

Well done and keep up the great work”.

Best Regards,
Vincent C

I have heard that there are no treatments for Osteoporosis. Is this true?

No, this is not true. Adults, who have been diagnosed with Osteoporosis, should be put on an Osteoporosis medication, plus ensure to take the daily amounts of calcium, vitamin D3, and protein preferably from food, and be assessed for an appropriate exercise programme.
The cause/s of why the person lost bone, should be investigated and addressed. Treatment plans for children under 21 and women in childbearing years are dealt with differently to those who are in the older age group. Contact us if your child had been diagnosed with bone loss and/or you think they have risk factors.


Is calcium the only treatment for Osteoporosis?

No, calcium is not a treatment for Osteoporosis, and Vitamin D3 is essential in order to absorb calcium. Everybody should be taking both calcium and Vitamin D for their bone health, and overall health, You should try to get your Calcium and Vitamin D, preferably through food.

Young people and bone loss

Prevention of Osteoporosis

What can I do to help prevent Osteoporosis?

Bones require their owner to eat healthy foods containing adequate calories, calcium, vitamin D3 and proteins. Normal levels of sex hormones along with appropriate weight-bearing/strengthening exercise are also important, to help reduce your risk of bone loss.

Decline in my DXA scan results

I was diagnosed with Osteoporosis four years ago and have been taking the recommended treatments, but my last scan showed my bones had declined. What could be wrong?

There could be many reasons why this happened. Two common causes are that you are not absorbing your medication/calcium and Vitamin D and/or your causes of bone loss were not investigated and addressed. If you become a member of the Charity (€50 for one year), you can book an appointment with the Helpline manager to discuss this further.

Not taking the Osteoporosis medication you were prescribed

I was diagnosed with Osteoporosis a year ago and was recommended to take an Osteoporosis medication. I did not take the medicine, as I do not like to take pills. I have increased my calcium and vitamin D intake and I do weight bearing exercise every day. Is this enough to prevent it from getting worse?

No, Osteoporosis is a disease that needs to be treated by a medication that has had extensive research and clinical trials done on it, to prove that it works. Therefore, we only recommend treatments that are on prescription or have been on prescription. The causes of your bone loss need to be investigated and addressed. Do not let anyone convince you to buy products that have NOT had extensive clinical research to prove they work. We would not recommend that anyone increase the amount of exercise they are doing when their bones are not protected by treatment. You did not feel your bones getting thinner, you will not feel them declining further. You need to ensure that you are not taking more than the recommended amount of calcium and Vitamin D, as this can be dangerous.

DXA Scanning

When can you not have a DXA scan?

You should not have a scan:

  • if you are pregnant
  • if you have had a barium meal in the last week, you need to wait one week.
Before you have a DXA scan.
  • If you have metal in an under-wire bra or belt you will be asked to remove it.
  • If you have a replacement hip, your other hip can be scanned. If you have metal in both hips, your lower back and forearm should be scanned, along with an LVA (Lateral Vertebral Assessment). If you have metal in both hips and the spine, your forearm can be scanned, and it is essential that bone markers are done, which are blood tests.
I had a DXA scan of my spine and hips and I was told that I have Osteopenia. However, I have a hump on my upper back, I have broken 5 bones and I am getting shorter.

If you have broken bones, we would consider you to have Osteoporosis, unless proven otherwise. The fact that you have developed a hump, a DXA scan with an LVA (Lateral Vertebral Assessment) is recommended if available. If not available, a lateral thoracic x-ray is advised. This will show if the shape of the bones in this area are compressed due to fractures (broken bones in your back). 75% of people with broken bones in their back have intermittent back pain, only 25% of people have constant pain.

A person may have arthritic osteophytes or extra bony spurs (the excess bone that the body develops to protect an area) of their lumbar spine, which can give a false higher bone density reading, which is why anyone with Osteoarthritis should have a DXA scan with an LVA.

Over Exercising / Anorexia / Bulimia or combination of all 3

I had anorexia in my teens, I am now 29, would I be at risk of Osteoporosis?

Yes, you should get a DXA scan done. Anyone with a past or present history of an eating disorder and/or overexercising should arrange a DXA scan ASAP. This is very important if you have any of the signs or symptoms of undiagnosed Osteoporosis.
We have nineteen-year-olds, with fractured vertebrae (broken bones in the spine), secondary to undiagnosed Osteoporosis which they developed from anorexia/bulimia and/or over-exercising. Osteoporosis is treatable but the earlier you get diagnosed, the better the results as Dowager’s humps are not reversable.

My 17-year-old daughter had a DXA scan and was told her bones were very fragile, how can that be? She looks thin, exercises several times a day but is not bent over or on any medication that affects bone. She did admit to me, but not to her doctor that she has not had a period in 3 years.

A girl or woman whose periods stopped, and it is not due to pregnancy, is at high risk for Osteoporosis. This issue needs to be investigated, as it could also affect her chances of having children.
Over-exercising is a sign that she may have an issue with her weight. It is very common for people with eating disorders (anorexia and/or bulimia) to be very good at hiding this problem. It is also not unusual to be diagnosed with Osteoporosis at a young age when the person has an eating disorder and/or over exercises.
However, if the possible eating issue/missing periods are addressed, as well as the Osteoporosis, the person should be able to significantly improve their bone strength. The fact that she is upright and has not broken any bones, it is essential to have this problem investigated and treated, asap.

Ovary, uterus, or Hysterectomy

I had an ovary removed when I was in my thirties. Am I at risk for Osteoporosis?

Removal of an ovary or ovaries can place a person at a much higher risk of developing Osteoporosis, especially in younger people. In the first few years of a woman going through the menopause, some women can lose up to 30% of their overall bone in their body.


I am 56 going through the menopause and having hot flushes, sweats and I am easily agitated. My doctor has recommended HRT, but I am very anxious as I have heard it causes breast cancer. I am having trouble concentrating in work and my husband says I am becoming unbearable to live with. What can I do?

There has been a lot of controversy over HRT. For many years HRT was the only treatment for Osteoporosis. It is usually not recommended for those who have a family history of breast cancer. However, now it is mainly used for menopausal symptoms to improve a person’s quality of life. It also helps to protect the bone while a person is on it. It is also an option for younger people with bone loss, depending on their medical history.

1 in 12 women will get breast cancer.  However, 1 in 2/3 women over 50 will break bones due to Osteoporosis. More women die from Osteoporosis than the combined deaths of cancer of the ovaries, uterus, and cervix. More men pass away from Osteoporosis than develop prostate cancer. Cancer of the lungs is the only cancer that supersedes Osteoporosis in death rates.

When you are on HRT, regular mammograms are done which many women avoid. Women can lose up to 30% of their overall bone while going through the menopause, which is why it is so important your bones are protected. We would highly advise you to go back and discuss this further with your GP.

My mother was 81 and lived independently until she broke her hip and passed away several months later. I heard that it could be linked to Osteoporosis, is this true?

Approximately 90% of fractured hips in senior citizens are due to Osteoporosis. It is not normal for an adult of any age to break a bone from a trip and fall from a standing position. If a person’s bones were healthy, they would not break so easily, unless they were involved in a car accident or trauma accident. If your mother broke her hip from a trip and fall, she may have had undiagnosed Osteoporosis.

  • 20% of people aged 60+ who fracture a hip, pass away within 6-12 months from the secondary complications of Osteoporosis.
  • 50% of people aged 60+ who fracture a hip become dependent on others. They are unable to dress, bath or walk across a room independently.
  • Only 30% of people aged 60+ who fracture a hip, regain their independence.
  • Some secondary complications include a blood clot, pneumonia, or an infection. These usually develop after a person has been bed-bound, for a considerable time, because of a fracture.

Genetics - Family history – Teenagers - Children

Osteoporosis is in my family, I have it, one of my brothers and one of my sisters. My mum and grandmother had humps on their backs, so we assume they had it but were never diagnosed. My child broke several bones very easily, so we were told due to our family history, he should have a DXA scan done. My son is 14 and his DXA scan was positive for significant bone loss, I thought children could not get Osteoporosis?

The good news is that most children can improve their bone density. However, the cause/s must be investigated and addressed, it should not be assumed that family history is the only cause of their bone loss. Gluten sensitivity should be looked at, testosterone levels, as well as multiple other possible causes, some of which are listed below

Children and adolescents can be affected by a variety of conditions such as:

  • Osteogenesis Imperfecta (Brittle bone disease)
  • Turner’s syndrome in girls and Klinefelter’s in boys.
  • Genetics – Family history, especially with 2nd risk factor.
  • Metabolic disorders require a special diet.
  • Still’s a disease, juvenile rheumatoid arthritis.
  • Collagen disorders.
  • Marfan’s Syndrome etc.
  • Osteogenesis Imperfecta (Brittle bone disease).
  • Idiopathic juvenile osteoporosis (IJO).
  • Eating disorders: anorexia, bulimia and/or binge eating.
  • Malabsorption: Coeliac disease, Crohn’s disease, Ulcerative colitis.
  • Cystic Fibrosis.
  • Kidney disease: nephrotic syndrome etc.
  • Endocrine disorders: Cushing’s disease.
  • Bechet’s Syndrome.
  • Severe eczema.
  • Asthma – oral steroids and some inhalers have steroids in them which cause bone loss.
  • Chemotherapy and radiation for cancer.
  • Organ transplant patients.
  • Mobility impairment (limited walking, being wheelchair or bed-bound for six weeks or longer) especially in pre-puberty and teenage years e.g., Muscular dystrophy, Cerebral palsy.
  • Obesity: if a child eats unhealthy food and does not participate in sports or physical activity, their bones will not develop to be healthy and strong.


I do not eat meat or dairy products, as I am a vegan. How can I prevent myself from getting Osteoporosis?

We recommend vegans to get DXA scans done ASAP, as they are at much higher risk for bone loss. A Vegan diet tends to contain very high fibre content. Excessive fibre in the diet can affect your hormones (low oestrogen levels) and in turn, increase your risk of Osteoporosis. You should consider seeing a dietician to ensure you are getting the correct daily amounts to protect your bones. Please see nutrition section.

Being vegan may result in you having difficulty absorbing adequate protein, calcium, and vitamin D3 which puts you at risk of developing bone loss. Protein can be found in lentils and tofu. Too little protein can affect the collagen content of bone. Calcium, Vitamin D3, and protein supplements are available for those who cannot get the daily recommended amounts from food.


Is calcium the only treatment for Osteoporosis?

No, calcium is not a treatment for Osteoporosis and Vitamin D3 is essential in order to absorb calcium. Everybody should be taking both calcium and Vitamin D for their bone health, and overall health, You should try to get your Calcium and Vitamin D, preferably through food.