What is osteoporosis, and could it affect you?

Bone feels solid and permanent, but it's actually living tissue. Your body is constantly breaking down old bone and building new bone to replace it. In childhood and early adulthood, new bone is made faster than old bone is removed, and your skeleton gets stronger. By around age 30, you've reached what's called peak bone mass. After that, the balance slowly shifts. Bone is still being rebuilt, but the breakdown starts to outpace the rebuilding.

In osteoporosis, that imbalance becomes significant. The internal structure of bone becomes more porous and fragile, and the overall density drops. The bones look the same size from the outside, but they're thinner and weaker on the inside. That means they're more likely to fracture, sometimes from something as minor as a stumble, a bump, or even bending forward.

Osteoporosis is sometimes confused with osteoarthritis, but they're quite different. Osteoarthritis affects the cartilage in your joints. Osteoporosis affects the density and strength of the bones themselves.

The silent condition most people miss

Osteoporosis is often called a "silent condition" because there are usually no symptoms at all until a fracture happens. You can't feel your bones getting thinner. There's no pain, no warning sign. In fact, around two-thirds of spinal fractures happen without the person even realising. They might notice they're losing height or their posture is changing, but they don't connect it to their bones.

Over 1.2 million Australians are estimated to have osteoporosis, and a further 6.3 million have low bone density. By 2033, 7.7 million Australians over 50 are projected to have either osteoporosis or osteopenia. These are not small numbers. And yet, fewer than 20% of people who have a fracture related to osteoporosis are investigated or treated appropriately afterwards. That's a gap I'd like to help close.

What does your T-score actually mean?

If your GP suspects you might be at risk, they'll refer you for a bone density scan, called a DXA scan. It's a quick, painless test that measures the mineral density of your bones, usually at the hip and spine. The result is reported as a T-score.

Your T-score compares your bone density to that of a healthy 30-year-old, when bones are typically at their strongest.

Osteopenia is a risk category, not a disease in itself. Having osteopenia doesn't mean you will definitely develop osteoporosis. It means your bone density is worth monitoring, and there are things you can do now to protect it.

If you've already had a DXA scan and your repeat result comes back "stable," that's actually a good outcome. The measurement error on a DXA scan is around 3-5% at the spine and 5-6% at the hip. A stable reading means your treatment is working and bone loss has been slowed or stopped. Stability is success.

DXA scans are widely available through private radiology clinics in Adelaide. Your GP can refer you and advise whether Medicare covers your scan based on your individual risk factors.

Who is at risk?

Some risk factors for osteoporosis are things you can't change. Others are within your control.

Risk factors you can't change

• Age (bone loss accelerates as you get older)
• Sex (women are at higher risk, particularly after menopause)
• Family history of osteoporosis or hip fracture
• Early menopause (before age 45)
• Certain ethnic backgrounds

In the years around menopause, women can lose bone at a rate of 2-3% per year for five to ten years, due to the rapid drop in oestrogen. After that, the rate of loss slows, but the cumulative effect is significant. Men lose bone more gradually, around 0.5-1% per year from age 50, but the consequences can be just as serious.

Risk factors you can influence

• Calcium and vitamin D intake
• Physical activity (and what kind you do)
• Smoking
• Alcohol intake
• Body weight
• Long-term use of certain medications, particularly corticosteroids

There are also medical conditions that can contribute to bone loss, sometimes called secondary causes of osteoporosis. In many cases, treating the underlying condition can improve bone health. Your GP can screen for these with a combination of blood tests and clinical history.

• Coeliac disease
• Overactive thyroid or parathyroid glands
• Low testosterone in men
• Rheumatoid arthritis
• Type 2 diabetes
• Chronic kidney disease
• Inflammatory bowel disease
• Long-term corticosteroid use

Warning signs that something has changed

The reason osteoporosis is so commonly missed is that it gives you no warning. There's no pain, no stiffness, no obvious sign that your bones are thinning. The first indication for many people is a fracture that seems out of proportion to what caused it. A fall from standing height that breaks a wrist. A minor twist that fractures a vertebra. A bump that cracks a rib.

These are called fragility fractures, and they're the hallmark of osteoporosis. If you've had one, it's important to know that it roughly doubles your chance of having another. A vertebral fracture makes a subsequent fracture within the next year four times more likely. That's why investigation and treatment after a first fracture matters so much.

There are a few subtle signs worth being aware of. If you've lost more than 2cm of height over time, or more than 4cm cumulatively, that could suggest vertebral fractures. If you've developed a noticeable forward curve in your upper back, that's another signal. New or sudden mid-to-lower back pain after a minor strain or movement can also point to a vertebral fracture.

None of these mean you definitely have osteoporosis, but they're all worth mentioning to your GP.

What can you do about it?

The good news is that osteoporosis is one of the most manageable conditions I see. There's a lot you can do. Both prevention and treatment are well supported by evidence, and the earlier you start, the better. Even if you've already been diagnosed, treatment can slow bone loss, strengthen existing bone, and significantly reduce your risk of fractures.

Exercise

The most effective forms of exercise for bone health are resistance training (lifting weights, using resistance bands, bodyweight exercises) and impact exercise (walking, jogging, stair climbing, dancing). These load the skeleton in a way that stimulates new bone formation.

One of the most striking studies in this area is the LIFTMOR trial, conducted at Griffith University in Australia. Postmenopausal women with low bone density did 30-minute supervised resistance and impact training sessions twice a week. After eight months, the exercise group gained 2.9% bone density at the lumbar spine, while the control group lost 1.2%. There was only one minor adverse event across the entire study. The evidence is clear: heavy resistance training is safe and effective, even in people with osteoporosis.

What's equally important is knowing what doesn't build bone. Swimming and cycling are excellent for cardiovascular fitness, but they don't load the skeleton through gravity, so they don't stimulate bone formation. Yoga can improve balance (which helps prevent falls), but on its own it's not osteogenic (meaning it doesn't generate the mechanical forces needed to trigger new bone growth). If bone health is your goal, you need weight-bearing and resistance exercise.

It's never too late to start. The LIFTMOR trial enrolled women aged 58 to 75. Exercise programs have also been shown to reduce falls by 23% and may reduce fall-related fractures by 27%. If you're unsure where to begin, an exercise physiologist or physiotherapist with experience in bone health can design a safe program tailored to your situation.

Nutrition

Calcium is the primary building block of bone tissue. The Australian recommended daily intake for people over 50 is 1,300mg for women and 1,000mg for men aged 50-70 (increasing to 1,300mg after 70). Food sources are the best way to get your calcium.

Your body can only absorb about 500mg of calcium at a time, so spreading your intake across the day is more effective than having it all at once.

Calcium from dietary sources is preferred because it comes packaged with other nutrients your body needs. When dietary intake consistently falls short of the recommended amount, a supplement can help fill the gap. Your GP can advise on whether supplementation is appropriate for your situation.

Protein also matters for bone. The recommended intake for older adults is 1.0-1.2g per kilogram of body weight per day. Higher protein intake is associated with higher bone density and reduced hip fracture risk. The old concern that high-protein diets are bad for bones has been thoroughly debunked.

Vitamin D

Vitamin D is essential for calcium absorption. Without adequate vitamin D, your body absorbs only 10-15% of the calcium you eat. With healthy vitamin D levels, that figure rises to 30-40%. The recommended target is a blood level of at least 50 nmol/L at the end of winter.

About 36% of Australians are vitamin D deficient at the end of winter. In Adelaide specifically, the UV index stays below 3 for most of the day between May and August. During those months, you need 15 to 30 minutes of midday sun exposure on your face and arms to produce adequate vitamin D. In summer, only 2 to 8 minutes is needed. Food sources of vitamin D (salmon, eggs, fortified milks) contribute some, but they're rarely enough on their own.

Your GP can check your vitamin D level with a simple blood test and advise whether supplementation is appropriate.

Medical treatment

For people with osteoporosis or high fracture risk, medications are available that can significantly reduce fracture risk. Some work by slowing bone breakdown. Others actively build new bone. Your GP can assess your individual risk using a combination of your clinical history, DXA results, and a fracture risk assessment tool, and advise whether medication is appropriate for you.

If you're already on treatment and it's working, the most important thing is to stay on it. Medication adherence is one of the biggest challenges in osteoporosis management, often because people feel fine and question whether they still need it. The answer, in most cases, is yes.

When to talk to your GP

You don't need to wait for a fracture to start the conversation. Consider seeing your GP about your bone health if:

• You're a woman over 50 or a man over 70
• You've been through menopause, especially early menopause (before 45)
• You've had a fracture from a minor fall or bump at any age over 50
• You have a parent or sibling who had a hip fracture or osteoporosis
• You've taken corticosteroid medications for more than three months
• You have a condition associated with bone loss (coeliac disease, thyroid problems, rheumatoid arthritis, low testosterone, type 2 diabetes, chronic kidney disease)
• You've noticed height loss, a change in posture, or new back pain

Your GP can assess your overall fracture risk, refer you for a DXA scan if appropriate, check for secondary causes with blood tests, and help you build a plan that includes lifestyle measures and, if needed, medication.

Osteoporosis is common, it's treatable, and the earlier it's identified, the more effective the interventions are. Understanding your own risk is the first step. The second is knowing that there's a lot that can be done about it.

Clinical information in this article is informed by the 2024 RACGP/Healthy Bones Australia guideline for osteoporosis management and fracture prevention, Australian Institute of Health and Welfare data, and published research including the LIFTMOR trial (Watson et al. 2018). This is general information only. Your GP can advise on what's relevant for your individual situation.

Written by

Dr David Nguyen

MBBS · FRACGP

I see patients with bone health concerns regularly in my practice at Pro Health Care Glenelg, and osteoporosis is one of the most underdiagnosed conditions I encounter. I wrote this guide to help you understand what's happening, what your results mean, and what you can do about it.

Learn more about Dr David Nguyen → First published: 15 April 2026 · Last reviewed: 15 April 2026