Osteoporosis
Also called: thin bones, brittle bones, weak bones, bone loss, low bone density
Osteoporosis is a condition where bones lose strength and become fragile, so they break more easily, even after a small fall. It usually causes no symptoms until a bone breaks. Tests can find it early, and medicines, exercise and fall prevention lower the chance of fractures.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Osteoporosis means the bones have become thin and weak. Bone is living tissue. Old bone is always being broken down and new bone is made to replace it. With osteoporosis, the body removes bone faster than it can rebuild it. Over time the bones become fragile and can break (fracture) after a minor fall, a bump, or sometimes even a strong cough or sneeze. The earlier stage of bone loss, before it reaches osteoporosis, is called osteopenia.
The condition develops slowly over many years and is often silent. Many people only find out they have it after they break a bone. The wrist, hip and the small bones of the spine (vertebrae) are the most common places to break. Broken spine bones can lead to back pain, loss of height and a bent, stooped back.
Osteoporosis is very common in older people, and it affects women more than men. Women lose bone quickly in the first years after the menopause, when the hormone oestrogen falls. Men, younger adults and even children can also be affected, often because of another illness or a medicine such as long-term steroid tablets. The good news is that a scan can measure bone strength, and treatment can lower the risk of future fractures.
In Pakistan: what studies show
Hospital studies using DEXA scans found osteoporosis in about a third of women past menopause (33.3% in the spine in one Islamabad study), and low vitamin D is very common (73% in pooled Pakistani studies). An estimated 36,524 hip fractures happened in people over 50 in 2015, and this number is expected to rise by 214% by 2050.
- One hospital study in Islamabad that used DEXA scans found osteoporosis in the spine in 33.3% of 237 women past menopause, and in the hip in 24.9%.[1] (cross-sectional, data Sep 2019 - Feb 2020)
- A study of 1,205 women aged 20 to 80 that used a heel ultrasound scan (a screening test, less exact than DEXA) found osteoporosis in 27.2% and osteopenia (early bone loss) in 29.8%.[2] (cross-sectional, data not stated)
- In a DEXA study of 291 men and women at research centres in Islamabad, Lahore and Karachi, 48% had low bone density (osteopenia or osteoporosis).[3] (cross-sectional multicentre, data 2015-2016)
- In the same three-city study, 84% did not have enough vitamin D, but in that study low vitamin D was not linked to lower bone density.[3] (cross-sectional multicentre, data 2015-2016)
- A review that pooled studies from South Asia found that 73% of adults in the Pakistani studies had vitamin D deficiency, the highest in the region.[4] (systematic review/meta-analysis, data studies published 2001-2019)
- Experts estimated that 36,524 hip fractures happened in people over 50 in Pakistan in 2015, using fracture rates borrowed from Indians living in Singapore because Pakistan has no national hip fracture data.[5] (modelled estimate, data 2015)
- The International Osteoporosis Foundation expects the yearly number of hip fractures in people aged 50 and over in Pakistan to rise by 214% by 2050, as the population ages.[6] (modelled estimate, data projection to 2050)
- In one hospital study of 210 people with a broken hip, the average age was 73.1 years, and none had been treated for osteoporosis before the break.[7] (cross-sectional, data not stated)
What we do not know yet: There is no national DEXA-based survey of osteoporosis in Pakistan; most numbers come from single hospitals or heel ultrasound screening, which can give different results from DEXA. Pakistan has no measured national hip fracture rates (estimates borrow rates from Indians in Singapore), and studies disagree on whether low vitamin D is linked to low bone density; Pakistan-specific GBD figures could not be opened.
Pakistan studies cited
- Ziad A, Wahla MS, Riaz N, et al. Osteoporosis within a cohort of postmenopausal Pakistani women using dual X-Ray bone densitometry. Khyber Medical University Journal 2021;13(4):193-6. doi:10.35845/kmuj.2021.21685. Open source
- Tariq S, Baig M, Tariq S, et al. Status of bone health and association of socio-demographic characteristics with bone mineral density in Pakistani females. Pakistan Journal of Medical Sciences 2019;35(3):812-817. doi:10.12669/pjms.35.3.551. Open source
- Saqib MAN, Rafique I, Hayder I, et al. Comparison of vitamin D levels with bone density, calcium, phosphate and alkaline phosphatase - an insight from major cities of Pakistan. Journal of the Pakistan Medical Association 2018;68(4):543. Open source
- Siddiqee MH, Bhattacharjee B, Siddiqi UR, et al. High prevalence of vitamin D deficiency among the South Asian adults: a systematic review and meta-analysis. BMC Public Health 2021;21:1823. doi:10.1186/s12889-021-11888-1. Open source
- Naureen G, Johansson H, Iqbal R, et al. A surrogate FRAX model for Pakistan. Archives of Osteoporosis 2021;16:34. doi:10.1007/s11657-021-00894-w. PMID 33595723. Open source
- International Osteoporosis Foundation Overview of Osteoporosis in Pakistan (from The Asia Pacific Regional Audit: Epidemiology, costs and burden of osteoporosis in 2025). International Osteoporosis Foundation 2025. Open source
- Arshad A, Ibrahim MT, Arshad H, et al. Clinical characteristics and outcomes of patients presenting with hip fractures at a tertiary care hospital in Pakistan. Archives of Osteoporosis 2021;16:25. doi:10.1007/s11657-021-00895-9. Open source
Symptoms
- Often no symptoms at all until a bone breaks
- A bone that breaks after a minor fall or small knock, often the wrist, hip or spine
- Back pain, sometimes sudden, caused by a collapsed spine bone (compression fracture)
- Loss of height over time
- A stooped or bent-forward posture, sometimes called a hump
- A rib that breaks or hurts after coughing or sneezing
- Long-term back pain after spine fractures
Causes and risk factors
Causes
- Normal ageing, as bone loss slowly speeds up from middle age
- Lower oestrogen after the menopause in women, or low testosterone in men
- Not getting enough calcium or vitamin D, or not absorbing them well from the gut
- Hormone problems such as an overactive thyroid, overactive parathyroid glands (glands in the neck that control calcium) or pituitary disorders
- Long-term illnesses such as rheumatoid arthritis, Crohn's disease, coeliac disease or long-term kidney disease
- Certain medicines, especially steroid tablets taken for more than three months, some epilepsy medicines and some hormone treatments for breast or prostate cancer
What makes it more likely
- Being a woman, especially after the menopause
- Older age
- Menopause before age 45, or removal of the womb and ovaries before 45
- A parent who broke a hip, or a family history of osteoporosis
- Low body weight (a body mass index, or BMI, of 19 or less)
- Smoking and drinking a lot of alcohol
- Little regular exercise or long periods in bed
- Past or current eating disorders, or periods stopping for many months because of severe dieting or over-exercise
Complications
The main danger of osteoporosis is a broken bone. A broken hip is the most serious. It often needs surgery and a hospital stay, and many older people lose some of their independence afterwards. Some do not survive the following months. Time in bed after a fracture can also lead to bed sores, blood clots in the legs and chest infections. Broken spine bones can cause long-term back pain, loss of height and a curved back. A badly curved spine can make breathing harder. Living with pain and the fear of falling can also affect mood and daily life.
When to see a doctor
- A fall followed by pain in the hip or groin, or a bone that looks out of shape: this could be a broken bone, so get emergency help
- Sudden, severe back pain, even without a clear injury
- New pain in the thigh, hip or groin while taking a bisphosphonate medicine
- Trouble swallowing, pain when swallowing, chest pain or stomach pain while taking bisphosphonate tablets
- Jaw pain, a loose tooth or a mouth sore that does not heal while on bone-strengthening treatment
- Noticeable loss of height or a back that is becoming more curved
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Diagnosis
Doctors usually start by working out your chance of breaking a bone. They ask about your age, past fractures, falls, medicines such as steroid tablets, family history, smoking and alcohol. Online tools such as FRAX or QFracture use this information to estimate your risk of a fracture over the next 10 years. This is recommended for adults who have already had a fragile bone break, those on long-term steroid tablets and older adults who have had falls.
The main test is a DEXA scan (a quick, painless, low-radiation X-ray that measures bone density, usually at the hip and spine). The result is given as a T-score, which compares your bones with those of a healthy young adult. A score of -2.5 or lower means osteoporosis, and a score between -1 and -2.5 means osteopenia. Blood tests for calcium, vitamin D, kidney function and thyroid function help look for other causes. Spine X-rays may be done to look for silent fractures.
Treatment
- Your doctor estimates your fracture risk and may arrange a DEXA scan to decide whether medicine is needed.
- Any cause that can be treated, such as low vitamin D, a thyroid problem or a medicine that weakens bone, is looked for and managed.
- Make sure you get enough calcium and vitamin D, from food first; your doctor may add a supplement.
- If your risk is high, or you have already had a fragility fracture, a bisphosphonate is usually the first medicine offered.
- If bisphosphonates do not suit you or the osteoporosis is severe, a specialist may use other options such as denosumab, teriparatide, romosozumab, raloxifene or hormone replacement therapy (HRT).
- Take steps to prevent falls at home and keep active with weight-bearing and balance exercise.
- Your treatment is reviewed regularly for side effects, and after about three to five years of a bisphosphonate your doctor checks whether to continue or take a break.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Bisphosphonates | main first-choice treatment; slow down bone breakdown and lower the risk of fractures (tablets or a drip into a vein) | Alendronate (1 brand), Zoledronic acid (38 brands) |
| Parathyroid hormone treatments | builds new bone; daily injection for a small number of people with very low bone density when other treatments have not worked | Teriparatide (1 brand) |
| Calcium and vitamin D supplements | fill gaps when diet or sunlight do not give enough; often given alongside other bone medicines | Calcium carbonate (3 brands), Cholecalciferol (135 brands), Tricalcium phosphate + Vitamin D (1 brand) |
Also used (not yet in our price list): Risedronate, Ibandronate, Denosumab, Romosozumab, Raloxifene, Hormone replacement therapy (HRT), Calcitriol
Self-care and prevention
Self-care
- Do regular weight-bearing exercise such as brisk walking or dancing, plus muscle-strengthening exercise
- Practise balance exercises such as tai chi or yoga to lower your chance of falling
- Eat foods rich in calcium and vitamin D, and get some sunlight, which helps the body make vitamin D
- Stop smoking and avoid or cut down on alcohol
- Make your home safer: remove loose rugs, add grab bars and night lights, and wear well-fitting, low-heeled shoes
- Have regular eye and hearing checks
- If you take a bisphosphonate tablet, follow the instructions exactly: empty stomach, a full glass of water, and stay upright afterwards
- Ask your doctor whether any of your medicines make you drowsy or unsteady
Prevention
- Stay active throughout life with weight-bearing and strength exercise
- Eat a balanced diet with enough calcium, vitamin D and protein, and keep a healthy body weight
- Do not smoke and limit alcohol
- Ask for a fracture risk check if you have had a broken bone after a minor fall, take long-term steroid tablets or have had falls
- Women with an early menopause should talk to their doctor about hormone treatment to protect their bones
Common questions
Can osteoporosis be cured?
Bone that is already lost cannot always be fully rebuilt, and collapsed spine bones do not regain their shape. But treatment can slow bone loss, and some medicines can increase bone density. Most importantly, treatment lowers the chance of future fractures.
Is osteoporosis painful?
Osteoporosis itself does not hurt. Pain comes when a bone breaks. Broken spine bones are a common cause of long-term back pain, which your doctor can help you manage.
How long do I need to take bisphosphonates?
They usually take months to start working and are often taken for five years or more. After about three years of the drip or five years of tablets, your doctor reviews your risk. Some people continue, while others can take a break with regular checks.
Do men get osteoporosis?
Yes. It is less common in men than in women, but men can lose bone too. In men it is more often linked to another cause, such as low testosterone, steroid tablets, heavy drinking or a long-term illness.
What is the difference between osteopenia and osteoporosis?
Both mean lower than normal bone density. Osteopenia is the milder, earlier stage, while osteoporosis means the bones are weak enough to break easily. Whether osteopenia needs medicine depends on your overall fracture risk.
Sources
- NICE. Osteoporosis (QS149) - NICE quality standard (2017 (updated 2022)).
- NICE. Bisphosphonates for treating osteoporosis (TA464): Information for the public (2017).
- NHS. Osteoporosis - NHS (2022).
- NHS. Osteoporosis - Causes - NHS (2022).
- NHS. Osteoporosis - Treatment - NHS (2022).
- MedlinePlus. Osteoporosis: MedlinePlus Medical Encyclopedia (2025).
- StatPearls (NCBI Bookshelf). Osteoporosis - StatPearls - NCBI Bookshelf (2023).
- Journal of the Pakistan Medical Association. Frequency of osteoporosis in an ambulatory setting in Lahore using quantitative calcaneal ultrasound (2013).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Vitamin D deficiencyRheumatoid arthritisOsteoarthritisOveractive thyroid (hyperthyroidism)