Osteoporosis and Bone Health
Osteoporosis weakens bones and raises fracture risk, often with no early symptoms. How it is found, what lowers risk, and what calcium and vitamin D trials have and have not shown.
Content last updated . This page has not been medically reviewed.
What osteoporosis is
Osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease, or when the structure and strength of bone changes, which raises the risk of fractures. [1] It is often called a "silent" disease because you typically have no symptoms and may not know you have it until a bone breaks. [1] Fractures happen most often in the hip, the spine and the wrist. [1]Osteoporosis is not usually painful until a bone is broken, but broken bones in the spine are a common cause of long-term pain. [2] The stage before osteoporosis is called osteopenia: bone density lower than average for your age but not low enough to count as osteoporosis. It does not always lead to osteoporosis. [2]
Who is at higher risk
Losing bone is a normal part of aging, but some people lose it faster. Women lose bone rapidly in the first few years after menopause, and women are at more risk than men, particularly if menopause begins early or the ovaries have been removed; men can be affected too. [2] Other risks include long-term high-dose steroid tablets, some medical conditions, family history (particularly a parent's hip fracture), low body mass index, not exercising, heavy drinking and smoking. [2] Some cancer medicines and glucocorticoid steroids may raise risk. [1]For menopause itself see perimenopause and menopause.
How it is evaluated
A doctor can estimate future fracture risk with an online tool such as FRAX or Q-Fracture, and may refer you for a bone density (DEXA) scan, a short, painless test. [2] A T score between -1 and -2.5 is defined as osteopenia and below -2.5 as osteoporosis. [2]Care and prevention
- Treatment is based on treating and preventing broken bones and on bone-strengthening medicines; whether you need them depends on your future fracture risk. [2]
- Lifestyle: NIAMS lists weight-bearing exercise such as walking, moderate alcohol, not smoking, taking prescribed medications, and a diet rich in calcium and vitamin D. [1]
- Fall prevention matters because falls cause fractures; see falls and balance problems. [3]
- NHS lists a daily vitamin D supplement among the preventive steps for people at risk of osteoporosis; ask your clinician what is right for you. [2] Other sources are more cautious about supplements for people without deficiency (below).
Calcium and vitamin D: what trials show
Evidence labels: established recommendation, promising but limited, mixed, insufficient evidence.| Question | What the source found | Strength of evidence |
|---|---|---|
| Do calcium and/or vitamin D supplements prevent fractures in community-dwelling adults over 50? | A JAMA meta-analysis of 33 randomized trials (51,145 participants) found no significant association with hip, non-vertebral, vertebral or total fractures, and concluded the findings did not support routine use in this group. [4] | Mixed against routine use |
| Vitamin D3 in generally healthy midlife and older adults | The VITAL trial (25,871 participants, median 5.3 years) found no significant effect on total, non-vertebral or hip fractures. [5] | Negative for people without deficiency |
| Vitamin D in healthy people 60 and older | A 2024 meta-analysis of 7 trials found no difference in total fractures and suggested a possible increase in hip fractures in women; it advised against high intermittent doses without calcium in people with unknown vitamin D status. [6] | Mixed; limited by heterogeneity |
These trials mostly studied people who were not selected for deficiency, osteoporosis or low bone mass. [5] They do not tell you what is right if you have been diagnosed with osteoporosis or a low vitamin D level. NIA lists calcium and vitamin D as nutrients where a doctor or dietitian can tell you whether you need a supplement. [7] See supplements for healthy aging, Nutrition for women: iron, folate, calcium and vitamin D and medication interactions.
When to get help
See a doctor if you have a fracture from a minor fall or a cough or sneeze, if you are worried about bone health because of steroids or family history, or if you have had a fall. [2] [8] The UK-based Royal Osteoporosis Society is named by the NHS as the national charity for osteoporosis support. [2]Frequently asked questions
Can osteoporosis be reversed with supplements?
The trials above did not show that calcium or vitamin D supplements prevent fractures in general community groups. [4] Bone-strengthening medicines are the treatment for osteoporosis. [2]
Does osteoporosis only affect women?
No. It affects women and men; risk increases with age. [1]
Is walking good for bones?
NIA says mild weight-bearing activities such as walking or climbing stairs may slow bone loss from osteoporosis. [3]
How do I know if I have osteoporosis?
Because it is silent, a doctor may use risk tools and a bone density scan. [2]
References
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis. Read 2026-10-22.
- NHS. Osteoporosis. Read 2026-10-22.
- National Institute on Aging. Falls and fractures in older adults: causes and prevention. Read 2026-10-22.
- Zhao JG, et al. Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis. JAMA. 2017. Read 2026-10-22.
- LeBoff MS, et al. Supplemental vitamin D and incident fractures in midlife and older adults (VITAL). N Engl J Med. 2022. Read 2026-10-22.
- Vitamin D supplementation and the incidence of fractures in the elderly healthy population: a meta-analysis of randomized controlled trials. J Gen Intern Med. 2024. Read 2026-10-22.
- National Institute on Aging. Dietary supplements for older adults. Read 2026-10-22.
- NHS. Falls. Read 2026-10-22.