Osteoporosis

Osteoporosis is a long-term condition that makes bones weak, so they break more easily. It develops slowly over several years and usually causes no obvious symptoms, so many people only find out when they break a bone after a minor fall or injury (NHS). It is most common in older adults and in women after the menopause, but anyone can have it.

Who is at risk of osteoporosis?

The NHS lists these as things that raise the chance of having it (NHS):

• getting older, and the menopause
• a parent with osteoporosis
• a white ethnic background
• not having enough calcium or vitamin D
• being underweight, smoking and drinking too much alcohol
• not getting much exercise
• some health conditions, such as diabetes or rheumatoid arthritis, and taking steroid tablets

Of these, the one desk life most directly touches is exercise. The NHS advice for keeping bones strong includes regular weight-bearing exercise, strengthening exercise and balance exercise, along with calcium, vitamin D, a balanced diet and reducing the chance of falls (NHS).

How osteoporosis can change posture

When osteoporosis affects the spine, the signs can look like “bad posture”: back pain, a curved spine or hunched posture, and getting shorter. The NHS explains that these can be caused by small breaks in the bones of the spine (NHS), known as a vertebral fracture.

Simple checks can hint at this. A review of physical examination in women found that any gap between the back of the head and the wall, when standing with the back against it, made a hidden spinal fracture more likely, as did a gap of less than two finger-widths between the lowest rib and the top of the pelvis. No single check could rule osteoporosis in or out without further tests (Green et al., 2004). The wall posture test uses the same idea as a self-check.

This matters because a rounded upper back in later life is not always a matter of how you sit. If your back is becoming more curved or you are losing height, see a GP rather than assuming it is your desk. The general term for the curve is thoracic kyphosis.

How is osteoporosis diagnosed?

A GP will assess your risk, ask about symptoms and may refer you for a DEXA scan, which measures how strong your bones are (NHS). The results are explained under bone density and Z-score. Treatment options include medicines that slow bone loss and medicines that build new bone.

Exercise with osteoporosis

A UK consensus statement on exercise for osteoporosis recommends (Brooke-Wavell et al., 2022):

• resistance and impact exercise to keep bones as strong as possible
• strength and balance training to reduce falls
• spinal extension exercise, to improve posture and possibly reduce the risk of falls and spinal fractures
• avoiding postures with a high degree of spinal flexion, meaning bending forwards, in exercise and in daily life
• for people with a spinal fracture or several low-trauma fractures, usually keeping impact no higher than brisk walking

It also found little evidence that physical activity causes significant harm, and judged that the benefits generally outweigh the risks.

The Royal Osteoporosis Society says most people with osteoporosis can exercise safely. It suggests adapting exercises that can put pressure on the spine, such as sit-ups, touching your toes and the “roll-down” and “curl-up” in Pilates, and seeing a physiotherapist if you have painful spinal fractures, have broken many bones or have had many falls (Royal Osteoporosis Society). This applies to stretching routines too: if you have osteoporosis, ask which forward-bending stretches suit you.

When to see a doctor

See a GP if you have back pain that isn’t getting better after a few weeks, your spine is becoming curved or your posture hunched, or you think you may be at risk and are worried. Ask for an urgent GP appointment or contact NHS 111 if you have recently had a fall or injury and the pain is not getting better. Call 999 or go to A&E if you have severe pain after a fall or injury (NHS).