By Sarah Leyland (Osteoporosis Specialist Nurse Clinical Adviser, Royal Osteoporosis Society)
At Scoliosis Support & Research, more and more we hear from our community about people living with both scoliosis and osteoporosis. These two conditions often overlap, particularly later in life, yet the links between them can feel confusing. We wanted to provide a clear and reliable outline of what osteoporosis is, how it connects to scoliosis, and what it means for bone and spinal health.
We are grateful to the Royal Osteoporosis Society for contributing this expert piece, which we hope will help raise awareness and support our community in understanding both conditions more fully.
What is osteoporosis?
Osteoporosis is a condition where your bones become weaker and break (fracture) more easily, sometimes after a minor bump or fall – or even as the result of a cough, sneeze, or hug if your bones are very weak.
These types of breaks caused by osteoporosis are referred to as ‘fragility fractures’.
Who is affected by osteoporosis?
While typically associated with post-menopausal women, osteoporosis also affects men and younger people too. It’s estimated that over 3.5 million people in the UK are currently living with the condition, with 1 in 2 women and 1 in 5 men over the age of 50 expected to break a bone as a result.
What causes osteoporosis?
After reaching the age of 30, your bone density starts to decrease very gradually. This becomes more important for women who have gone through the menopause, as levels of oestrogen – the female sex hormone that helps keep bones strong – decrease.
There are risk factors that both men and women should consider, including having a family history of osteoporosis, or a linked health condition such as coeliac disease or rheumatoid arthritis. Smoking, and not eating a healthy, balanced diet, can also increase your osteoporosis risk, while medications such as corticosteroids, and some breast cancer or prostate cancer treatments, can affect bone density too. It’s important to speak to your doctor before making any changes to your medication.
What are the symptoms?
Osteoporosis is known as the ‘silent condition’ as it doesn’t have any symptoms – it’s the broken bones as a result of osteoporosis that cause pain, rather than the condition itself. Spinal fractures can also lead to height loss and a hunched spine, which can be a sign that someone has osteoporosis.
How is it diagnosed?
As a first step, you can complete the Great British Bone Check from the Royal Osteoporosis Society to find out if you may be at risk of osteoporosis. If your doctor thinks you might have the condition, they can refer you for a range of scans and tests to help them find out if your bones have lost strength.
There’s no simple way to look inside your bones, but a combination of different tests can be used to build up a picture of your bone health and your risk of breaking a bone. The most commonly used test is a DXA scan, which uses very low dose X-rays to measure the density of your bones.
What are the medicines used for osteoporosis?
You may be offered an osteoporosis medicine to help strengthen your bones if your risk of breaking a bone is increased.
Osteoporosis medicines can work by slowing down cells that break down bone (osteoclasts) – known as ‘antiresorptive’ drugs – or by stimulating the cells that build new bone (osteoblasts) – known as ‘anabolic’ drugs. Some medicines work in both these ways.
What are the dangers of osteoporosis?
Osteoporosis as a condition is vastly under-diagnosed and, therefore, many people with an increased risk of breaking bones miss out on the medicines that can strengthen their bones. Spinal fractures are a common sign of the condition and, while sometimes people aren’t even aware that they’ve suffered a spinal fracture, for others they cause debilitating back pain and height loss, making daily tasks once taken for granted suddenly impossible.
Another potential end result of osteoporosis can be a devastating hip fracture, which can completely shatter someone’s life, sometimes causing loss of independent living and permanent disability. Sadly, it can sometimes result in people dying earlier because they never recover properly.
What lifestyle and diet measures should people introduce to prevent osteoporosis?
Lifestyle plays an important role in maintaining good bone health, and having a low body weight, smoking, and drinking too much alcohol are all risk factors that you can change.
Weight-bearing impact exercises (such as walking, jogging, or racket sports) and muscle-strengthening exercises (such as lifting weights or using resistance bands) are a great way of keeping your bones strong too.
Eating a balanced diet with a wide variety of foods from each food group will usually ensure that you have all the nutrients needed to build and maintain healthy bones.
Vitamin D is important, since it helps your body to absorb calcium, which gives bones their strength. You can get vitamin D from safe sunlight exposure, although you should consider taking a daily supplement of 10mg (400 units) of vitamin D from the end of September to the beginning of April. Most adults need 700mg of calcium a day, although those at risk of osteoporosis may be advised by their doctor to increase their intake.
How can you help to manage the pain from broken bones?
If you’ve broken bones, you may be able to manage the pain with pain-relieving medications, depending on the severity of your pain and what’s causing it. If you’re experiencing persistent pain, talk to your healthcare team for advice and support.
There are also some practical steps you can take:
- Understand your pain and what triggers it
- Pace yourself by planning and prioritising your daily tasks
- Learn relaxation techniques
- Find something to distract you from the pain
- Some muscle-strengthening exercises can help with pain
- Together with your healthcare team, make a ‘flare-up plan’ to help you cope through an episode of pain
- Know who is there for you, if you need help – the Royal Osteoporosis Society has a network of support groups and an online community forum
- Be aware of how your mood can affect your pain levels
Other ways to help relieve pain, such as complementary therapies, hydrotherapy, or using a TENS machine, may also help.
Scoliosis-specific FAQ
What are the differences between the two conditions?
While scoliosis is either a condition you are born with or that develops during life, osteoporosis usually develops as a result of another condition or medication, or as part of the ageing process. It’s a weakening of the bones, making them more likely to break. This can result in broken bones, especially of the wrist, hip, and spine.
Scoliosis means a sideways curve and twisting in the spine. In osteoporosis, the spinal fractures heal but the bones stay in a flattened or wedge shape, often causing an excessive outward curve in the spine (kyphosis). Though the fracture pain resolves, surrounding structures – muscles, ligaments, and nerves – are often affected by the changed spinal shape, resulting in long-term pain.
Where are the similarities between the two?
Osteoporosis and the type of scoliosis that develops during later life are what, in medical terms, are called ‘degenerative skeletal’ conditions. This means the normal processes in the body get out of balance, often as part of old age. This leads, for both scoliosis and osteoporosis, to changes in the shape and workings of the skeleton.
Both conditions affect the spine. Scoliosis, and spinal fractures with osteoporosis, can cause long-term pain as well as issues with body image, such as a loss of self-esteem because of postural changes.
Scoliosis and spinal fractures with osteoporosis vary enormously in the level of pain or other symptoms, both physical and emotional, they may cause. For some people there are minor changes that may even go unnoticed. For others, there are very serious pain and symptom problems that can affect quality of life.
Does osteoporosis cause scoliosis?
Not generally. In osteoporosis, weak bones can lead to spinal fractures, but it’s the forward curve of the spine that becomes exaggerated – it isn’t usual for the spine to become twisted or curve sideways, although it can happen if your spine is badly damaged by multiple fractures. People with an existing mild scoliosis may find it increases due to the changes caused by spinal fractures.
Does scoliosis cause osteoporosis?
No. Osteoporosis is an underlying weakening of bones. But it’s possible that if bones are very weak because of osteoporosis and there’s already a marked scoliosis, the uneven pressure on bones in the spine may increase the risk of them becoming more flattened or squashed down (spinal fractures).
How do I know if scoliosis or osteoporotic fractures are causing my back pain or other symptoms?
Your doctor or other healthcare professional will examine you and discuss your symptoms and medical history to diagnose what conditions you may have. An X-ray may be needed to find out what has happened to your spine, and you will be referred to a specialist for further advice or treatment if necessary.
Scoliosis and osteoporosis fractures in the spine can occur together. Further discussion and explanation after any investigations will help you to understand your own situation.
Knowing you have either scoliosis or spinal fractures can be helpful so you can understand and get any help or treatment you may need. Even if spinal fractures aren’t causing troublesome symptoms, they can be an important sign that you have osteoporosis and may benefit from a medicine to strengthen your bones.
