Osteoporosis and Fall Risk in the Elderly: Symptoms and Prevention

Osteoporosis is called the "silent disease": it causes no pain and gives no obvious symptoms — until a fracture occurs. A hip fracture in an older person is not just an injury. In 20–30% of cases it leads to death within a year, and in half of cases it permanently robs the person of the ability to walk independently. The good news: osteoporosis can be detected before a fracture, and the risk can be significantly reduced. This article explains how.

Osteoporosis: why bones become fragile

Bone is living tissue. It is constantly being renewed: old bone tissue breaks down and new tissue forms. Up to age 30, formation outpaces breakdown — bones become denser. After 30, the balance gradually shifts. In women after menopause, this process accelerates sharply: in the first 5–7 years after menopause, a woman can lose up to 2–3% of bone mass per year.

Osteoporosis is a condition in which bones become so porous and brittle that they break under minimal stress: a fall from standing height, a sudden movement, or even a cough (in the case of the spine). The most commonly fractured sites are: vertebrae, the hip (femoral neck), and the radius (wrist).

Risk factors for osteoporosis:

female sex and menopause (especially early menopause — before age 45);
age over 65;
low body weight (BMI below 20);
smoking and excessive alcohol consumption;
long-term use of corticosteroids (prednisolone and equivalents);
family history of hip fracture;
sedentary lifestyle;
calcium and vitamin D deficiency.

Symptoms and diagnosis: bone density scanning

Osteoporosis itself causes no pain. But there are indirect signs that should prompt attention:

Loss of height. Losing 2 cm or more compared to one's height in younger years is a sign of vertebral compression fractures, which can occur silently.
Change in posture. The appearance of a "hump" in the upper back (kyphosis) is a sign of vertebral deformity.
Chronic back pain. Especially in the thoracic or lumbar spine, without obvious trauma.
Fracture from minor trauma. If a bone breaks from a fall from standing height or a minor knock, this is a "fragility fracture" requiring investigation for osteoporosis.

The main diagnostic method is bone densitometry (dual-energy X-ray absorptiometry, DXA). This is a painless scan that measures bone mineral density. The result is expressed as a T-score:

T-score of -1.0 or above — normal;
T-score between -1.0 and -2.5 — osteopenia (reduced density, a precursor to osteoporosis);
T-score of -2.5 or below — osteoporosis.

Who should have a bone density scan: all women over 65; women under 65 with risk factors; men over 70; anyone who has had a fragility fracture; people on long-term corticosteroids.

Fall risk: how to assess and reduce it

Osteoporosis and falls are a dangerous combination. The risk of fracture can be reduced in two ways: strengthen the bones and reduce the risk of falls. The second is no less important.

Main causes of falls in older adults:

Balance and coordination problems. Proprioception (the sense of body position in space) deteriorates with age. Balance exercises — tai chi, specific physiotherapy — reduce fall risk by 20–30%.
Muscle weakness. Sarcopenia — age-related muscle loss — begins after 40 and accelerates after 70. Strength exercises (even light ones) slow this process.
Medication side effects. Sleeping pills, tranquillisers, and some blood pressure drugs cause dizziness and slow reactions. Discuss possible alternatives with a doctor.
Orthostatic hypotension. A sudden drop in blood pressure on standing — the person stands up and feels dizzy. Helps to stand up slowly, sitting on the edge of the bed for a few seconds first.
Vision problems. Cataracts and glaucoma reduce spatial perception. Regular eye checks and correction are an important part of fall prevention.
Home hazards. Slippery floors, loose rugs, poor lighting, and the absence of grab rails in the bathroom are all modifiable risk factors.

Practical home checklist: non-slip mats or no mats; grab rails in the bathroom and toilet; a night light or motion sensor in the hallway; comfortable non-slip footwear; clearing objects from the floor (cables, shoes).

Calcium and vitamin D: recommended levels and when to supplement

Calcium and vitamin D are the two key nutrients for bone health. Their deficiency is directly linked to osteoporosis and fracture risk.

Calcium. Normal blood level: 2.15–2.55 mmol/L. Daily requirement for adults over 50: 1,200 mg. Best sources: dairy products (a glass of milk contains around 300 mg of calcium), hard cheeses, sardines with bones, broccoli, fortified foods. If dietary intake is insufficient, a doctor may recommend supplements. Important: calcium from supplements is better absorbed when taken in doses of no more than 500 mg at a time.

Vitamin D. Normal blood level: 30–100 ng/mL (75–250 nmol/L). Most people over 65 are deficient in vitamin D — especially those who spend little time outdoors. Vitamin D is essential for calcium absorption: without it, calcium from food and supplements is barely absorbed. The standard preventive dose for older adults is 800–2,000 IU per day (as recommended by a doctor). Vitamin D levels can be checked with a blood test (25-OH vitamin D).

Important: don't self-prescribe supplements. Excess calcium (especially from supplements) can increase the risk of kidney stones and, according to some evidence, cardiovascular events. Dosage should be determined by a doctor based on test results.

When to see a rheumatologist or endocrinologist

You can start with a GP or gynaecologist (for women). But with confirmed osteoporosis or high fracture risk, a specialist consultation is recommended:

Rheumatologist — a specialist in bone and joint diseases. Prescribes osteoporosis treatment: bisphosphonates, denosumab, teriparatide, and other medications.
Endocrinologist — for suspected secondary osteoporosis (caused by another condition: hyperparathyroidism, hypothyroidism, diabetes, sex hormone deficiency).
Gynaecologist — to discuss hormone replacement therapy in postmenopausal women (in the absence of contraindications, it significantly reduces bone loss).

If you're not sure which specialist to see, use our doctor-routing service. And if you want to understand your symptoms better, describe them to our assistant.

Frequently asked questions

Can osteoporosis be fully cured?

Fully restoring lost bone mass is difficult, but modern medications can significantly slow bone loss and even modestly increase density. The main goal of treatment is to prevent fractures. With regular treatment and adherence to recommendations, fracture risk is reduced by 30–70% depending on the medication.

Does osteoporosis cause pain?

Osteoporosis itself does not cause pain. Pain appears with fractures — including vertebral compression fractures, which can occur without obvious trauma. If an older person develops back pain without a clear cause, this is a reason to have a spinal X-ray.

Do men get osteoporosis too?

Yes. Osteoporosis in men is less common than in women, but the risk rises significantly after age 70. Hip fractures in men have a worse prognosis than in women. Risk factors in men include: low testosterone levels, excessive alcohol consumption, smoking, and long-term use of corticosteroids.

What exercises are beneficial with osteoporosis?

Weight-bearing exercises are beneficial (walking, dancing, light strength training) — they stimulate bone formation. Swimming and cycling are less effective for bones, though good for muscles. Balance exercises (tai chi, yoga) reduce fall risk. Avoid exercises with sharp spinal twisting and jumping. An exercise programme is best agreed with a doctor or physiotherapist.

Do I need calcium supplements if I eat dairy products?

If you regularly eat dairy products, hard cheeses, fish with bones, and green vegetables, you are probably getting enough calcium from food. Supplements are needed by those who don't get sufficient calcium from their diet. Have a blood calcium test and discuss with your doctor whether supplements are needed.

Symptomatica is an informational reference service. Not a medical service; does not diagnose or prescribe treatment. For any symptoms, please consult a doctor.

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