Risk factors for osteoporosis

Which risk factors can be changed?

Nutrition, physical activity, smoking and excessive alcohol consumption affect bone health. Reducing the likelihood of falls is a separate goal. These measures complement assessment and treatment when needed.^[1]

Age, heredity, hormonal changes and other medical conditions are discussed separately: biological risk factors for osteoporosis.

Nutrition: calcium, protein and adequate body weight

A balanced diet matters for bones and muscles. Pay attention to weight loss, poor appetite or prolonged restrictive diets. Nutrition may be unbalanced even at your usual weight.

• Calcium sources: milk, yoghurt, cheese or appropriately fortified alternatives. Check the calcium content on plant-based drink labels.
• Protein sources: fish, eggs, dairy, meat, pulses and soya products, according to your nutritional needs.
• Regular meals: adequate food and variety are particularly important after a fracture and in older age.

Calcium should preferably come from food. Supplements are considered if the diet does not meet requirements; their composition and amount are agreed with regard to medical conditions and existing treatment.^[2]

Vitamin D: recognising insufficiency

Vitamin D is needed for normal calcium absorption. Discuss the risk of insufficiency, particularly if you rarely leave home, have malabsorption or are already receiving osteoporosis treatment.

The need for testing and supplements is determined by the clinical situation. Do not independently choose high doses or combine several products with the same ingredients. In established osteoporosis, calcium and vitamin D may form part of a plan that includes specific medication when needed.^[1]

Osteoporosis prevention and treatment: investigations and therapy

Movement that supports bone, strength and balance

Regular activity helps maintain bone and muscle. Programmes usually include weight-bearing activity, strengthening and balance training. They are tailored to your abilities and made more challenging gradually.^[3]

After a vertebral fracture, activity needs to be agreed with a professional. Repeated deep forward bends, twisting and lifting require particular attention. A physiotherapist can help you learn safe movement techniques and return to everyday activities.

New severe back pain after a fall or minor exertion needs assessment before starting exercises.

Vertebral compression fractures: how we choose treatment

Fall prevention is a separate part of fracture protection

If you have fallen, feel unsteady or experience dizziness, mention it at the consultation. Causes need assessment: gait, balance, vision, blood pressure and possible medication effects.

• Remove cables and rugs that could cause trips from walkways.
• Provide lighting, particularly on the route to the bathroom at night.
• Choose footwear that fits securely and does not slip.
• Fit handrails if needed and agree an appropriate walking aid.
• Discuss strength and balance training if your gait is impaired.

Sleeping tablets and other medicines that may affect alertness or balance are reviewed with your doctor. Do not stop them yourself.^[4]

Smoking, alcohol and coffee

Stopping smoking and reducing excessive alcohol consumption are part of osteoporosis prevention. Alcohol can also impair coordination and increase fall risk. Before surgery, tell the surgeon and anaesthetist about these habits.^[1]

Coffee alone does not mean you have osteoporosis. Avoid excessive caffeine and ensure adequate calcium intake. Assess the whole diet: caffeine content depends on the drink and serving size.^[5]

When bone condition should be assessed

Osteoporosis may cause no pain for a long time. Reasons for assessment include a fracture after minor injury, noticeable height loss, a previous vertebral fracture or a combination of clinical risk factors.

The doctor determines the need for DXA densitometry, tests and fracture-risk calculation. If screws and a cage are planned, bone condition is considered during preparation for surgery.^[6]

DXA, FRAX and medical causes of fragile bones · Spinal fixation and cage placement

Where to start and what to prepare for a consultation

1. Gather existing records. DXA and laboratory results, fracture discharge summaries and details of treatment received.
2. Record important changes. Loss of height or weight, back pain, falls, walking limitations and dietary restrictions.
3. Make a list of medicines and supplements. Include names, doses and treatment durations.
4. Add spine images if already available. For MRI/CT, complete DICOM series and the report are needed.

Existing materials are sufficient for initial contact. New investigations are requested according to assessment findings. If surgery has been recommended, include the surgeon's preliminary report.

How to prepare and send CT/MRI scans in DICOM format

Questions about habits and osteoporosis risk

Is taking calcium enough?

The plan depends on fracture risk and investigation results. Nutrition and supplements support bone; osteoporosis also requires specific medicines when indicated.

Should I stop physical activity?

It is usually important to maintain manageable movement. After a fracture or surgery, the programme and permitted exertion are agreed with the treating team.

If nothing hurts, are investigations unnecessary?

Absence of pain does not exclude reduced bone strength. The need for assessment depends on fractures, age, medical conditions and medication.

Can dietary changes prepare me for fixation?

A balanced diet is part of preparation. Suspected osteoporosis requires bone assessment and treatment when indicated; we agree these steps before surgery.