Understanding osteoporosis

02 March 2022

Osteoporosis, or 'brittle bone disease' as it is sometimes still called, is a progressive condition that causes bones to become more fragile as you get older. According to the charity Age UK, some three million people in the UK are estimated to have osteoporosis, yet it is also known as 'the silent disease' because, often, you won't know you have it until you fall and break a bone.

The fact these statistics come from Age UK also highlights one of the most common misconceptions about osteoporosis: that it is an old person's disease. It is true that osteoporosis is a condition that tends to come on in later life, with more than 300,000 fractures every year being down to osteoporosis.

However, given that about one in two women and one in five men over 50 will break a bone because of osteoporosis, it is, clearly, very much also a condition that can affect people of working age, especially as our working population ages.

So, what are the warning signs, what can you do to prevent or manage osteoporosis, and how can the workplace or your employer help?

Warning signs, risk factors and symptoms

One of the difficulties with detecting osteoporosis is that you're not going to be able to tell from normal day-to-day life that your bones may be getting weaker. That means osteoporosis will often go undetected until you suffer a broken bone and, as the NHS will normally do afterwards, a bone density test is carried out.

There are, however, some 'red flags' to look out for and, if you're concerned, speak to a doctor about. These include severe ongoing back pain, your spine having become curved, and that you have lost height.

Other risk factors of osteoporosis include:

  • Family history (in other words if someone else in your family has had it).
  • Being aged over 50.
  • Your gender. Osteoporosis is more common in women because they have smaller bones and will lose oestrogen during menopause.
  • A low body weight (having a body mass index of less than 19).
  • Some medical conditions, including rheumatoid arthritis, hyperthyroidism and Crohn's disease (some medications for these, such as steroids, can also raise the risk factor).
  • Lifestyle factors, including not enough physical activity, smoking, excessive alcohol, a lack of calcium and vitamin D.

As this NHS guidance shows, treating osteoporosis will normally be through a combination of various medicines called 'bisphosphonates', which slow the rate that bone is broken down in your body, lifestyle changes and preventative measures.

Preventative and lifestyle changes can include taking regular exercise to keep your bones as strong as possible (although, obviously, not exercise that may put you at risk of falls or breaks), healthy eating (including eating more foods rich in calcium and vitamin D), taking daily supplements (especially of vitamin D) and giving up smoking or reducing drinking.

Osteoporosis and work

The Royal Osteoporosis Society has useful advice on managing and living with osteoporosis while still working. It also has a good factsheet here that may be worth reading up on. Business in the Community has a general musculoskeletal health toolkit here, even though it is more aimed at employers.

The Royal Osteoporosis Society emphasises that, while you are not under any formal obligation to tell your employer, if the condition is beginning to affect your ability to carry out tasks in the workplace or, indeed, putting you at risk of, say, falls or fractures, then it is important - and makes sense - that you do have that conversation.

Both you and your employer have responsibilities under health and safety legislation. You have a duty to disclose any new symptoms and diagnoses that may affect your work and, in turn, your employer has a duty to make reasonable adjustments within the workplace to accommodate your needs.

So, what might 'reasonable adjustments' look like in this context?

This is, naturally, going to depend on the nature of your job and how osteoporosis is affecting you. Access to an occupational health (OH) provider can certainly help here, as an OH practitioner can assess you, your role and responsibilities and then work with your employer to put in place the best and most appropriate adjustments.

Adaptations might include precautions to prevent falls, for example not working at heights. Or it might be precautions to help prevent spinal breaks, such as reducing the size of loads or decreasing repetitive bending, twisting and turning, or increasing rest periods to lessen the chance of unsafe lifting.

As osteoporosis can be a painful condition, there may need to be adjustments made to vary your tasks during the day so that you're not, for example, spending too long in one position. Or it may be a question of building in more breaks to cope with fatigue and pain.

Bear in mind too that, if you've been prescribed any strong pain-relieving medication, you should discuss this with your manager, especially if you are working in a safety-critical role or driving for work.

How your employer can help

Apart from the physical adjustments and accommodations outlined above, your employer may be able to help in other ways, too.

Access to an occupational health provider can again be invaluable here, both in terms of adjustments following an initial diagnosis of osteoporosis (as already highlighted) but also through risk managing your workplace role and tasks as or if the condition progresses.

Access to virtual or face-to-face physiotherapy may help, although (obviously) the physiotherapist will need to know they are working with someone who has osteoporosis.

More widely, encouraging more active workplaces and working lives can be an important long-term preventative measure. Adjusting the food or canteen offer to healthier options, as well as foods higher in vitamin D, may be something an employer can consider.

Each workplace is different and so it is important to discuss your options with your employer.

Finally, it is important within all this not to overlook the mental as well as the physical health aspects of osteoporosis.

A diagnosis of osteoporosis can be scary and people will, naturally, feel concerned about what it will mean for the future, both in their work and personal life. There may be anxiety and possibly even depression. There may be worries about future earnings and money.

To that end, for employers to offer mental health support can be invaluable. This could be access to an employee assistance programme, virtual or face-to-face counselling, cognitive behavioural therapy, mental health first aiders or simply mental health and lifestyle apps and self-help advice and guidance.

Access to financial wellbeing support may also be valued by an employee, whether that be advice and guidance on savings and retirement, or budgeting if, for instance, their condition means having to reduce their hours or role or even take early retirement.

The key message through all of this is that, while unpleasant, scary and often painful, osteoporosis is not something that you should feel you have to suffer through on your own.

There is much the NHS can do to help. Equally, however, there is much support your employer can put in place to help you manage and live with osteoporosis so as to be able to continue working, earning and contributing.

About the author

Nic Paton is one of the country's foremost journalists on workplace health, safety and wellbeing, and is editor of Occupational Health & Wellbeing magazine. He also regularly writes on the health and employee benefits and health insurance markets.