Bone health information for everyone

Does it Require a More
Extensive Workup?

In some people, bone loss and fragility fractures may be due to another underlying medical condition that requires different investigations or treatment. If any of these situations sound familiar, explore the sections below to learn more.

You developed osteoporosis and/or fractures at a young age

Osteoporosis is uncommon in younger individuals. Developing it or having fractures at a young age may suggest another underlying cause.

Learn more →

You continue to have fractures despite being on osteoporosis treatment

Most osteoporosis medicines reduce fracture risk. Continuing to fracture despite treatment deserves further assessment.

Learn more →

You have a strong family history of fragile bones

Some bone disorders are inherited and may affect several family members.

Learn more →

You have persistent bone pain

Persistent or unexplained bone pain is not typical of uncomplicated osteoporosis.

Learn more →

You have unusual dental problems

Frequent tooth loss, poorly formed teeth, repeated dental problems or delayed tooth development may sometimes be associated with certain bone disorders.

Learn more →

Your blood test results are unusual

Certain blood test results can provide important clues that another bone disorder may be present.

Learn more →

You have unusual bone shape or bone deformities

Changes in bone shape or body structure may suggest an inherited or developmental bone disorder.

Learn more →

You Broke bones Frequently as a Child

Multiple fractures during childhood, particularly after minor injuries, are not always simply ‘bad luck’.

Learn more →

None of this replaces a conversation with your doctor

Remember: Many bone conditions share similar symptoms. The information on this page is not intended to diagnose a specific condition. If any of these symptoms or experiences apply to you, keep a record of them and discuss them with your healthcare professional.

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The information provided on the APCO BoneConnect (“Platform”) is intended for educational and informational purposes only. It is designed to improve understanding of bone health, osteoporosis, fragility fractures, and related bone conditions. It is not intended to provide medical advice or to diagnose, prevent, monitor, or treat any medical condition. Many bone conditions, as well as many other medical conditions, can present with similar signs and symptoms. The information on this Platform cannot determine the cause of your symptoms or whether you have a particular condition. Nothing on this Platform creates a doctor-patient relationship or any other professional relationship between APCO and you.

If any of the symptoms, experiences, or situations described on this Platform apply to you, keep a record of them and discuss them with your doctor or another qualified healthcare professional. They can assess your individual circumstances, determine whether further investigations or referral to a specialist are appropriate, interpret test results, establish a diagnosis, and recommend suitable management. Please confirm all information obtained from this Platform with other sources and your doctor or qualified healthcare professional. APCO does not warrant or guarantee any treatment, therapy, medication, device, diagnosis, or recommendation of any author or other person available through this Platform. References to symptoms, risk factors, tests, imaging, laboratory investigations, medications, treatments, healthcare services, or specialist referrals are provided solely to support informed discussions with your healthcare professional. They should not be interpreted as recommendations for any particular individual. If you are experiencing a medical emergency, do not use this Platform. Please immediately call a doctor or qualified healthcare professional and the relevant emergency services.

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You developed osteoporosis and/or fractures at a young age

Why it matters

Osteoporosis is uncommon in younger individuals. Developing it or having fractures at a younger age may suggest another underlying cause.

Common symptoms and experiences

  • Osteoporosis before age 50
  • Fragility fracture at a young age
  • No obvious risk factors
  • Family members with similar problems


Published literature

Reference 1: 

This review explores osteoporosis in younger adults, a condition that is less common and often more challenging to diagnose than osteoporosis in older people. The authors explain that bone loss at a younger age is frequently linked to underlying medical conditions, certain medicines, or lifestyle factors rather than ageing alone. The paper highlights the importance of identifying and treating the underlying cause, alongside measures to protect bone health and prevent fractures. It reinforces that early assessment can help improve long term bone health outcomes.

Herath M, Cohen A, Ebeling PR, Milat F. “Dilemmas in the Management of Osteoporosis in Younger Adults.” JBMR Plus. 2022 Jan 19;6(1):e10594. doi: 10.1002/jbm4.10594. PMID: 35079682; PMCID: PMC8771004.
https://pubmed.ncbi.nlm.nih.gov/35079682/

Reference 2: 

This review explains that osteoporosis is not always caused by ageing or menopause and may sometimes result from other medical conditions or medicines. The authors describe how identifying these underlying causes is an important part of choosing the most appropriate treatment. The paper highlights that investigating secondary osteoporosis can help prevent further bone loss and reduce the risk of fractures. It reinforces the importance of discussing individual risk factors and medical history with a healthcare professional.

Sobh MM, Abdalbary M, Elnagar S, et al. “Secondary Osteoporosis and Metabolic Bone Diseases.” J Clin Med. 2022 Apr 24;11(9):2382. doi: 10.3390/jcm11092382. PMID: 35566509; PMCID: PMC9102221.
https://pubmed.ncbi.nlm.nih.gov/35566509/

Reference 3: 

This paper highlights that not all people with fragile bones or repeated fractures have osteoporosis. Through a series of patient cases, the authors show that osteogenesis imperfecta, a rare inherited bone disorder, can sometimes be mistaken for osteoporosis, particularly in adults. The paper emphasises the importance of recognising features that may suggest an underlying rare bone disorder so that people receive the correct diagnosis and treatment. It reinforces that persistent or unusual bone fragility should be discussed with a healthcare professional.

Costache A, Riza AL, Popescu M, et al. “Diagnostic Challenges in Bone Fragility: Osteogenesis Imperfecta Case Series.” Biomedicines. 2025 Apr 3;13(4):865. doi: 10.3390/biomedicines13040865. PMID: 40299462; PMCID: PMC12025295.
https://pubmed.ncbi.nlm.nih.gov/40299462/

You continue to have fractures despite being on osteoporosis treatment

Why it matters

Osteoporosis medicines help reduce fracture risk. If you continue to experience fractures despite treatment, it is important to review whether you are taking your medicines and supplements regularly and correctly, whether other medications or newly developed medical conditions are affecting your response to treatment. Further assessment may be needed to understand why fractures are still occurring.

Published literature

Reference 1: 

This study examines why some women continue to experience fractures despite receiving osteoporosis treatment. The researchers found that previous fractures, frequent falls and reduced vitality were associated with a higher risk of experiencing multiple fractures during treatment. The paper highlights that osteoporosis medicines reduce fracture risk but cannot eliminate it completely, and that experiencing a fracture does not necessarily mean treatment has failed. It reinforces the importance of reviewing individual fracture risk factors and considering further assessment when fractures continue to occur despite treatment.

Díez-Pérez A, Adachi JD, Adami S, et al. “Risk Factors for Treatment Failure With Antiosteoporosis Medication: The Global Longitudinal Study of Osteoporosis in Women (GLOW).” J Bone Miner Res. 2014 Jan;29(1):260–267. doi: 10.1002/jbmr.2023. PMID: 23794198; PMCID: PMC4878143.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4878143/

Reference 2: 

This study examines the characteristics of women who experience fractures despite receiving osteoporosis treatment. The researchers found that women who had fractures during treatment were generally older, had experienced more previous fractures and falls, engaged in less physical activity, and reported poorer quality of life. The paper highlights that some patients remain at high risk of fractures despite receiving osteoporosis medication. It reinforces the importance of recognising inadequate treatment outcomes early, reassessing individual fracture risk factors, and considering additional interventions to improve bone health and prevent further fractures.

Jakob F, Marín F, Martín-Mola E, et al. “Characterization of Patients With an Inadequate Clinical Outcome From Osteoporosis Therapy: The Observational Study of Severe Osteoporosis (OSSO).” QJM. 2006 Aug;99(8):531–543. doi: 10.1093/qjmed/hcl073. PMID: 16861718.

https://pubmed.ncbi.nlm.nih.gov/16861718/

You have a strong family history of fragile bones

Why it matters

Some bone disorders are inherited and may affect several family members.

Common symptoms and experiences

  • Parent fractured a hip
  • Multiple relatives with fractures
  • Known inherited bone disorder


Published literature

Reference 1: 

This study investigates how inherited genetic changes can cause fragile bones and increase the risk of fractures. The researchers identified mutations in the WNT1 gene associated with osteogenesis imperfecta and early-onset osteoporosis, including cases affecting multiple members of the same family. The paper highlights the important role of genetics in bone formation and strength, demonstrating that some bone disorders can be inherited and may cause recurrent fractures from a young age. It reinforces the importance of considering family history and possible genetic causes when assessing individuals with unexplained bone fragility.

Keupp K, Beleggia F, Kayserili H, et al. “Mutations in WNT1 Cause Different Forms of Bone Fragility.” Am J Hum Genet. 2013 Apr 4;92(4):565–574. doi: 10.1016/j.ajhg.2013.02.010. PMID: 23499309; PMCID: PMC3617378.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3617378/

Reference 2: 

This study investigates the relationship between a family history of hip fractures and the risk of fractures in subsequent generations. Using health records from over 261,000 individuals and their parents, the researchers found that people whose parents had experienced hip fractures were at greater risk of osteoporotic fractures themselves. The association was particularly strong when the parent experienced a hip fracture at a younger age. The paper highlights that family history is an important factor in assessing bone health and fracture risk. It reinforces the importance of discussing family fracture history with a healthcare professional, even when an inherited bone disorder has not been diagnosed.

Yang S, Leslie WD, Yan L, et al. “Objectively Verified Parental Hip Fracture Is an Independent Risk Factor for Fracture: A Linkage Analysis of 478,792 Parents and 261,705 Offspring.” J Bone Miner Res. 2016 Sep;31(9):1753–1759. doi: 10.1002/jbmr.2849. PMID: 27061748.

https://pubmed.ncbi.nlm.nih.gov/27061748/

You have persistent bone pain

Why it matters

Persistent or unexplained bone pain is not typical of uncomplicated osteoporosis.

Common symptoms and experiences

  • Bone pain without injury
  • Pain affecting several bones


Published literature

Reference 1: 

This review explains the differences between osteoporosis, osteomalacia and fragility fractures, highlighting how these conditions affect bone strength and health. The authors describe osteoporosis as a largely silent disease that often causes no symptoms until a fracture occurs, whereas osteomalacia may cause persistent bone pain, tenderness and muscle weakness. The paper highlights that unexplained or ongoing bone pain may indicate an underlying metabolic bone disorder rather than uncomplicated osteoporosis. It reinforces the importance of investigating persistent bone pain to identify the underlying cause and ensure appropriate diagnosis and treatment.

Jha SS, Srivastava A, Kambhampati SBS, Elhence A. “Introduction to Osteoporosis, Osteomalacia, and Fragility Fractures.” Indian J Orthop. 2023 Dec 8;57(Suppl 1):25–32. doi: 10.1007/s43465-023-01015-0. PMID: 38107821; PMCID: PMC10721584.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10721584/

Reference 2: 

This review explains that osteomalacia is a metabolic bone disorder that affects the mineralisation of bones and may cause persistent bone pain, muscle weakness and increased fracture risk. The authors describe how osteomalacia can result from vitamin D or mineral deficiencies, inherited conditions or other underlying medical disorders. The paper highlights that osteomalacia may sometimes be mistaken for osteoporosis, leading to delayed diagnosis or inappropriate treatment. It reinforces the importance of investigating persistent or unexplained bone pain to identify underlying bone disorders and ensure appropriate treatment.

Arboleya L, Braña I, Pardo E, et al. “Osteomalacia in Adults: A Practical Insight for Clinicians.” J Clin Med. 2023 Apr 5;12(7):2714. doi: 10.3390/jcm12072714. PMID: 37048797; PMCID: PMC10094844.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10094844/

 

Reference 3: 

This review examines osteomalacia, a metabolic bone disorder caused by impaired bone mineralisation, with a particular focus on vitamin D deficiency. The authors explain that osteomalacia may cause persistent bone pain, muscle weakness and an increased risk of fractures, and can sometimes be mistaken for osteoporosis. The paper highlights that low bone density does not always indicate osteoporosis, as other underlying conditions may affect bone strength. It reinforces the importance of investigating persistent or unexplained bone pain to distinguish between different bone disorders and ensure appropriate diagnosis and treatment.

Minisola S, Colangelo L, Pepe J, et al. “Osteomalacia and Vitamin D Status: A Clinical Update 2020.” JBMR Plus. 2020 Dec 21;5(1):e10447. doi: 10.1002/jbm4.10447. PMID: 33553992; PMCID: PMC7839817.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7839817/

 

You have unusual dental problems

Why it matters

Some bone disorders also affect teeth and dental development.

Common symptoms and experiences

  • Early tooth loss
  • Recurrent dental problems
  • Poorly formed teeth
  • Delayed tooth eruption


Published literature

Reference 1: 

This review explores how hypophosphatasia, a rare inherited bone disorder, can affect oral health as well as the bones. The authors explain that dental problems, such as loose teeth, early tooth loss, and poor tooth support, may be among the earliest signs of the condition. The paper highlights the importance of recognising these features so that people can receive an accurate diagnosis and appropriate care. It also emphasises the value of close collaboration between dental and medical professionals in managing hypophosphatasia.

Lira Dos Santos EJ, Mohamed FF, Kramer K, et al. “Dental manifestations of hypophosphatasia: translational and clinical advances.” JBMR Plus. 2025 Jan 6;9(2):ziae180. doi: 10.1093/jbmrpl/ziae180. PMID: 39872235; PMCID: PMC11770227.
https://pubmed.ncbi.nlm.nih.gov/39872235/

Reference 2: 

This study examined dental health in adults living with hypophosphatasia and found that many experienced ongoing dental problems, including early tooth loss and other oral complications. The authors also explored how these dental findings were related to biological markers of the disease. The study highlights that dental changes can provide important clues to the diagnosis and severity of hypophosphatasia. It reinforces the importance of regular dental care and medical follow up as part of the long term management of this rare bone disorder.

Sinha P, Gabor R, Haupt-Harrington R, et al. “Dental manifestations in adult hypophosphatasia and their correlation with biomarkers.” JIMD Rep. 2022 Jun 28;63(5):434-445. doi: 10.1002/jmd2.12307. PMID: 36101824; PMCID: PMC9458606.
https://pubmed.ncbi.nlm.nih.gov/36101824/

Your blood test results are unusual

Why it matters

Certain blood test results can provide important clues that another bone disorder may be present.

Common symptoms and experiences

  • Very low alkaline phosphatase (ALP) levels
  • Low serum phosphate levels
  • Other unexplained bone blood test results


Published literature

Reference 1: 

This article discusses the challenges of recognising and managing hypophosphatasia, a rare inherited bone disorder that can affect adults. The author explains that its symptoms, such as repeated fractures, bone pain, and dental problems, may resemble other bone conditions, making diagnosis difficult. The paper highlights the importance of early recognition and accurate diagnosis to ensure people receive the most appropriate care. It also emphasises that increasing awareness of hypophosphatasia can help reduce delays in diagnosis and treatment.

Inoue D. “Diagnosis and treatment of adult hypophosphatasia: Still a big challenge?” Osteoporos Sarcopenia. 2024 Mar;10(1):1-2. doi: 10.1016/j.afos.2024.03.002. Epub 2024 Mar 16. PMID: 38690541; PMCID: PMC11056387.
https://pubmed.ncbi.nlm.nih.gov/38690541/

Reference 2: 

This Asia-Pacific consensus provides practical recommendations for the diagnosis and lifelong management of X-linked hypophosphatemia (XLH), taking into account the healthcare needs and resources across the region. The authors emphasise the importance of recognising XLH early, confirming the diagnosis, and providing coordinated care through a multidisciplinary team. The paper also highlights the need for a smooth transition from paediatric to adult care so that treatment and monitoring continue throughout life. Its overall aim is to improve health outcomes and quality of life for people living with XLH in the Asia-Pacific region.

Munns CF, Yoo HW, Jalaludin MY, et al. “Asia-Pacific Consensus Recommendations on X-Linked Hypophosphatemia: Diagnosis, Multidisciplinary Management, and Transition From Pediatric to Adult Care.” JBMR Plus. 2023 May 1;7(6):e10744. doi: 10.1002/jbm4.10744. PMID: 37283655; PMCID: PMC10241092.
https://pubmed.ncbi.nlm.nih.gov/37283655/

You have unusual bone shape or bone deformities

Why it matters

If your bones or structure look different from what is typically expected, it may be worth discussing the possibility of an inherited or developmental bone disorder with your healthcare professional.

Common symptoms and experiences

  • Bowed legs
  • Limb length difference
  • Chest wall shape
  • Short stature


Published literature

Reference 1: 

This paper highlights that not all people with fragile bones or repeated fractures have osteoporosis. Through a series of patient cases, the authors show that osteogenesis imperfecta, a rare inherited bone disorder, can sometimes be mistaken for osteoporosis, particularly in adults. The paper emphasises the importance of recognising features that may suggest an underlying rare bone disorder so that people receive the correct diagnosis and treatment. It reinforces that persistent or unusual bone fragility should be discussed with a healthcare professional.

Costache A, Riza AL, Popescu M, et al. “Diagnostic Challenges in Bone Fragility: Osteogenesis Imperfecta Case Series.” Biomedicines. 2025 Apr 3;13(4):865. doi: 10.3390/biomedicines13040865. PMID: 40299462; PMCID: PMC12025295.
https://pubmed.ncbi.nlm.nih.gov/40299462/

Reference 2: 

This review provides an overview of fibrous dysplasia and McCune-Albright syndrome, rare conditions that can affect the bones and, in some people, other parts of the body. The authors explain how advances in research have improved understanding of the genetic changes that cause these conditions and are helping to guide new treatment approaches. The paper highlights the importance of early diagnosis, regular monitoring, and coordinated care to manage symptoms and reduce complications. It also offers hope that ongoing research may lead to more effective treatments in the future.

Palmisano B, Berry C, Boyce A, et al. “Fibrous dysplasia/McCune-Albright syndrome: state-of-the-art advances, pathogenesis, and basic/translational research.” Orphanet J Rare Dis. 2025 Aug 8;20(1):414. doi: 10.1186/s13023-025-03909-8. PMID: 40781626; PMCID: PMC12335126.
https://pubmed.ncbi.nlm.nih.gov/40781626/

You broke bones frequently as a child

Why it matters

Multiple childhood fractures are not always simply “bad luck.”

Common symptoms and experiences

  • Several fractures during childhood
  • Fractures after minor injuries
  • Family members with similar histories


Published literature

Reference 1: 

This review examines the causes, diagnosis and management of osteoporosis in children and adolescents, particularly those who experience recurrent fractures. The author explains that while fractures are relatively common during childhood, frequent fractures, especially following minor injuries, may indicate an underlying condition affecting bone strength. The paper highlights that childhood bone fragility can result from inherited genetic disorders, chronic medical conditions or certain medications. It reinforces the importance of assessing childhood fracture history, identifying underlying causes and ensuring appropriate evaluation and treatment to protect bone health and reduce future fracture risk.


Ward LM. “A Practical Guide to the Diagnosis and Management of Osteoporosis in Childhood and Adolescence.” Front Endocrinol (Lausanne). 2024 Jan 25;14:1266986. doi: 10.3389/fendo.2023.1266986. PMID: 38374961; PMCID: PMC10875302.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10875302/

Reference 2: 

This review examines how genetic factors contribute to bone fragility and recurrent fractures during childhood. The authors explain that while childhood fractures are common, repeated fractures may sometimes indicate an underlying inherited bone disorder. The paper highlights that both rare genetic mutations and the combined effects of multiple common genetic variations can influence bone density, bone strength and fracture risk. It reinforces the importance of considering genetic factors and childhood fracture history when assessing bone health, as some individuals may have an increased susceptibility to osteoporosis and fractures later in life.

Ghatan S, Costantini A, Li R, et al. “The Polygenic and Monogenic Basis of Paediatric Fractures.” Curr Osteoporos Rep. 2021 Oct;19(5):481–493. doi: 10.1007/s11914-021-00680-0. PMID: 33945105; PMCID: PMC8551106.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8551106/

Low calcium intake

Reference 1:

This review examined calcium intake among adults around the world and found that many populations do not consume enough calcium to support good bone health. The authors highlight that low calcium intake is particularly common in many Asian countries, where average intakes are often well below recommended levels. Because calcium is essential for building and maintaining strong bones, inadequate intake may increase the risk of osteoporosis and fractures. The study emphasises the importance of promoting calcium rich foods and other practical ways to help people meet their daily calcium needs.

Balk EM, Adam GP, Langberg VN, et al. “Global dietary calcium intake among adults: a systematic review.” Osteoporos Int. 2017 Dec;28(12):3315-3324. doi: 10.1007/s00198-017-4230-x. Epub 2017 Oct 12. Erratum in: Osteoporos Int. 2018 May;29(5):1223. doi: 10.1007/s00198-018-4447-3. PMID: 29026938; PMCID: PMC5684325.

https://pubmed.ncbi.nlm.nih.gov/29026938/

Reference 2:

This review explores the important role of calcium in maintaining healthy bones throughout life. The authors explain that adequate calcium intake helps build and maintain bone strength, while long term low intake may contribute to bone loss and increase the risk of fractures. The paper also discusses the importance of obtaining calcium from a balanced diet, with supplements considered when dietary intake is insufficient. Overall, the review reinforces that meeting daily calcium needs is an important part of supporting lifelong bone health.

Cormick G, Belizán JM. “Calcium Intake and Health.” Nutrients. 2019 Jul 15;11(7):1606. doi: 10.3390/nu11071606. PMID: 31311164; PMCID: PMC6683260.
https://pubmed.ncbi.nlm.nih.gov/31311164/

Reference 3:

This review explores how common calcium deficiency is around the world and the impact it can have on health. The authors explain that many people do not consume enough calcium, particularly in low and middle income countries, increasing the risk of poor bone health and fractures. The paper highlights the importance of consuming enough calcium throughout life to help build and maintain strong bones. It also emphasises the need for practical strategies, such as improving access to calcium rich foods, fortified foods, and nutrition education, to help people meet their daily calcium needs.

Shlisky J, Mandlik R, Askari S, et al. “Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes.” Ann N Y Acad Sci. 2022 Jun;1512(1):10-28. doi: 10.1111/nyas.14758. Epub 2022 Mar 5. PMID: 35247225; PMCID: PMC9311836.
https://pubmed.ncbi.nlm.nih.gov/35247225/

High sodium intake

Reference 1:

This review explored whether eating too much salt affects bone health in postmenopausal women. The authors found that while high salt intake may increase calcium loss from the body, there is currently not enough high quality evidence to clearly determine its long term effects on bone mineral density or fracture risk. The paper highlights the need for more research to better understand this relationship. In the meantime, following general recommendations to limit excessive salt intake remains an important part of maintaining overall health.

Imash D, Gusmanov A, Chan MY. “High salt intake and bone health in postmenopausal women: exposing the lack of studies – a systematic review and meta-analysis.” Front Endocrinol (Lausanne). 2025 Nov 19;16:1694539. doi: 10.3389/fendo.2025.1694539. PMID: 41347127; PMCID: PMC12672310.
https://pubmed.ncbi.nlm.nih.gov/41347127/

Reference 2:

This study explored whether salt intake was linked to bone health in postmenopausal women in southern India. The authors found that women who consumed more salt were more likely to have weaker bones, poorer bone structure, osteoporosis, and vertebral fractures. These findings suggest that excessive salt intake may be associated with poorer bone health in this population. The study adds to growing evidence that a balanced diet, including limiting excess salt, may help support healthy bones.

John R, Cherian KE, Kapoor N, et al. “Excess dietary salt is associated with an altered bone strain index, degraded bone microarchitecture, vertebral fractures, and increased prevalence of osteoporosis in postmenopausal women – A study from a teaching hospital in southern India.” Aging Med (Milton). 2024 Oct 10;7(5):606-613. doi: 10.1002/agm2.12360. PMID: 39507226; PMCID: PMC11535168.
https://pubmed.ncbi.nlm.nih.gov/39507226/

Lower protein intake among older adults

Reference 1:

This review explored how protein intake and regular exercise can help slow the progression of age-related muscle loss in older adults living in the community. The authors found that combining adequate protein with strength or resistance exercise was more effective than either approach alone in helping to maintain muscle strength and physical function. The paper highlights that preserving muscle health is important for reducing the risk of falls, fractures, and loss of independence. It also reinforces the value of healthy lifestyle habits in supporting active and healthy ageing.

Li L, He Y, Jin N, Li H, Liu X. “Effects of protein supplementation and exercise on delaying sarcopenia progression in Asian community-dwelling older adults.” Food Chem X. 2022 Jan 20;13:100210. doi: 10.1016/j.fochx.2022.100210. PMID: 35128383; PMCID: PMC8808080.
https://pubmed.ncbi.nlm.nih.gov/35128383/

Reference 2:

This consensus paper encourages a broader focus on maintaining muscle health throughout life rather than only identifying or treating sarcopenia after it develops. The authors explain that healthy muscles are essential for mobility, balance, independence, and overall wellbeing, especially as people age. The paper highlights the importance of regular physical activity, good nutrition, and early action to help preserve muscle strength and function. It also encourages healthcare professionals and the public to view muscle health as an important part of healthy ageing alongside bone health.

Chen LK, Hsiao FY, Akishita M, et al. “A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update.” Nat Aging. 2025 Nov;5(11):2164-2175. doi: 10.1038/s43587-025-01004-y. Epub 2025 Nov 4. PMID: 41188603.
https://pubmed.ncbi.nlm.nih.gov/41188603/

High prevalence of lactose intolerance

Reference 1:

This review explores how lactose intolerance may affect bone health. The authors explain that people who avoid dairy because of lactose intolerance may miss out on important nutrients, particularly calcium, if these nutrients are not replaced from other foods. The paper highlights that getting enough calcium is important for maintaining strong bones and reducing the risk of fractures. It also emphasises that there are many ways to meet calcium needs, including lactose free dairy products and other calcium rich foods.

Hodges JK, Cao S, Cladis DP, Weaver CM. “Lactose Intolerance and Bone Health: The Challenge of Ensuring Adequate Calcium Intake.” Nutrients. 2019 Mar 28;11(4):718. doi: 10.3390/nu11040718. PMID: 30925689; PMCID: PMC6521087. https://pubmed.ncbi.nlm.nih.gov/30925689/

Reference 2:

This review explores whether drinking milk can help support bone health in Asian populations, particularly those at higher risk of osteoporosis. The authors highlight that many people in Asia consume less milk than recommended, which may contribute to lower calcium intake and poorer bone health. The paper explains that milk provides important nutrients for strong bones and discusses practical options for people who cannot tolerate regular milk, such as lactose free milk and yoghurt. Overall, the review suggests that finding suitable ways to include dairy or alternative calcium rich foods in the diet may help support lifelong bone health.

Jiao H, Xu Y, Zhang Y, et al. “Is it advisable for Asians to drink milk, especially those at risk of osteoporosis?” Front Nutr. 2025 Jun 25;12:1586623. doi: 10.3389/fnut.2025.1586623. PMID: 40635901; PMCID: PMC12239142.

https://pubmed.ncbi.nlm.nih.gov/40635901/

Reference 3:

This review explores ways to protect bone health in populations where calcium and vitamin D intake is often too low. The authors explain that getting enough of these nutrients is essential for building and maintaining strong bones, yet deficiencies remain common in many parts of the world. The paper highlights that healthy eating, safe sun exposure, regular physical activity, and, where needed, fortified foods or supplements can all help support bone health. It also emphasises the importance of public health efforts to improve awareness and make nutritious foods more accessible, particularly for people at greater risk of osteoporosis.

Yeum KJ, Ju S, Choe U. “Strategies for preventing bone loss in populations with inadequate calcium and vitamin D intake.” Nutr Res Pract. 2025 Apr;19(2):155-169. doi: 10.4162/nrp.2025.19.2.155. Epub 2025 Mar 13. PMID: 40226767; PMCID: PMC11982687.

https://pubmed.ncbi.nlm.nih.gov/40226767/

Vitamin D deficiency

Reference 1:

This review examined how common vitamin D deficiency is around the world and found that it remains a widespread public health concern. The authors explain that many people do not get enough vitamin D because of factors such as limited sun exposure, diet, and lifestyle. As vitamin D plays an important role in maintaining strong bones and muscles, low levels may increase the risk of poor bone health. The study highlights the importance of improving awareness and ensuring people have adequate vitamin D through safe sun exposure, diet, fortified foods, or supplements when needed.

Cui A, Zhang T, Xiao P, Fan Z, Wang H, Zhuang Y. “Global and regional prevalence of vitamin D deficiency in population-based studies from 2000 to 2022: A pooled analysis of 7.9 million participants.” Front Nutr. 2023 Mar 17;10:1070808. doi: 10.3389/fnut.2023.1070808. PMID: 37006940; PMCID: PMC10064807.
https://pubmed.ncbi.nlm.nih.gov/37006940/

Reference 2:

This review examined vitamin D levels among adults living in South Asia and found that vitamin D deficiency is very common across the region. The authors explain that factors such as limited sun exposure, lifestyle, skin pigmentation, and diet may all contribute to low vitamin D levels. Because vitamin D is essential for maintaining healthy bones and muscles, addressing this deficiency is an important part of supporting lifelong bone health. The study highlights the need for greater awareness and practical strategies to help people achieve adequate vitamin D levels.

Siddiqee MH, Bhattacharjee B, Siddiqi UR, MeshbahurRahman M. “High prevalence of vitamin D deficiency among the South Asian adults: a systematic review and meta-analysis.” BMC Public Health. 2021 Oct 9;21(1):1823. doi: 10.1186/s12889-021-11888-1. PMID: 34627207; PMCID: PMC8501935. https://pubmed.ncbi.nlm.nih.gov/34627207/

Vegetarian and plant-based diets

Reference 1:

This review explores how vegetarian diets may affect bone health. The authors explain that while well planned vegetarian diets can provide many health benefits, they may also be lower in important nutrients such as calcium, vitamin D, protein, and vitamin B12 if not carefully balanced. The paper highlights that these nutrients play an important role in maintaining strong bones and reducing the risk of fractures. It also emphasises that people following vegetarian diets can support their bone health by choosing a varied, nutrient-rich diet and including fortified foods or supplements when needed.

Falchetti A, Cavati G, Valenti R, et al. “The effects of vegetarian diets on bone health: A literature review.” Front Endocrinol (Lausanne). 2022 Aug 5;13:899375. doi: 10.3389/fendo.2022.899375. PMID: 35992115; PMCID: PMC9388819. https://pubmed.ncbi.nlm.nih.gov/35992115/

Reference 2:

This review examines how vegetarian diets may influence bone mineral density, a measure of bone strength. The authors explain that people following vegetarian diets may have lower bone mineral density if they do not consume enough nutrients that are important for healthy bones, such as calcium, vitamin D, and protein. However, the paper also highlights that a well planned vegetarian diet can support good bone health when these nutritional needs are met. The review emphasises the importance of choosing a balanced diet to help maintain strong bones throughout life.

Chuang TL, Lin CH, Wang YF. “Effects of vegetarian diet on bone mineral density.” Tzu Chi Med J. 2020 Sep 16;33(2):128-134. doi: 10.4103/tcmj.tcmj_84_20. PMID: 33912409; PMCID: PMC8059457.
https://pubmed.ncbi.nlm.nih.gov/33912409/

Reference 3:

This review examined how vegan and vegetarian diets may affect bone mineral density and fracture risk. The authors found that people following plant based diets, particularly vegan diets, may have lower bone mineral density and a higher risk of fractures if they do not get enough nutrients that support bone health. The paper highlights the importance of consuming adequate calcium, vitamin D, protein, and other key nutrients when following a plant based diet. It also emphasises that well planned vegetarian and vegan diets can support healthy bones when nutritional needs are carefully met.

Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno LA, Julián C. “Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis.” Nutr Rev. 2019 Jan 1;77(1):1-18. doi: 10.1093/nutrit/nuy045. PMID: 30376075.
https://pubmed.ncbi.nlm.nih.gov/30376075/

I think I might be at risk of osteoporosis

Why should I ask?

Osteoporosis is often called the “silent disease” because there are usually no symptoms until a fracture occurs. If you have risk factors, it is important to discuss your bone health before a fracture happens. Some common risk factors include but not limited to: Family history, Smoking, Alcohol, Low Body Weight, Age and Previous Falls.

Questions to ask your Doctor

1Should I have a bone health assessment?
2Should I have a DXA (bone density) scan?
3What are my personal risk factors for osteoporosis and fractures?
4Are any of my medications affecting my bone health?
5What lifestyle changes can I adopt to maximise my bone health?

I am experiencing height loss, stooped posture, or bone pain

Why should I ask?

Losing height, developing a stooped posture or experiencing persistent back pain may not simply be part of ageing. These symptoms can sometimes be caused by vertebral fractures that happen without a major injury.

Questions to ask your Doctor

1Could my symptoms be caused by osteoporosis?
2Should I have spinal imaging or a VFA?
3Could I have had a vertebral fracture without realising it?
4What treatments are available if I have vertebral fractures?
5How can I reduce my risk of future fractures?

I have risk factors for osteoporosis, but my DXA scan was normal. Should I still be concerned?

Why should I ask?

A normal bone density result does not always mean your bones are healthy. Some people may still be at increased fracture risk because of other risk factors or underlying conditions that affect bone quality.

Questions to ask your Doctor

1Does a normal DXA scan mean I do not have osteoporosis?
2Am I still at risk of fractures?
3Should my fracture risk be assessed using other tools?
4Are there additional tests I should have?
5How often should my bone health be reviewed?

I am worried about being on an osteoporosis medication

Why should I ask?

Many people are concerned about possible side effects of osteoporosis medicines. Understanding both the benefits and risks can help you make an informed decision with your doctor.

Questions to ask your Doctor

1Why are you recommending this medication?
2What are the common side effects?
3How common are the serious side effects?
4What happens if I decide not to take treatment?
5Are there other treatment options that may be suitable for me?

I am going through menopause

Why should I ask?

Bone loss accelerates during and after menopause because of declining oestrogen levels. Acting early can help maintain bone strength and reduce future fracture risk.

Questions to ask your Doctor

1Does menopause increase my risk of osteoporosis?
2Should I have a DXA scan?
3Am I getting enough calcium and vitamin D?
4Would hormone therapy or any other treatment benefit me?
5What lifestyle changes can I adopt to maximise my bone health?

I have another medical condition that may affect my bones

Why should I ask?

Some medical conditions can weaken bones, affect bone quality or interfere with the body’s ability to absorb important nutrients. Others may increase your risk of falls and thus fractures. These include diabetes, rheumatoid arthritis, thyroid disease, kidney disease, celiac disease, etc among others.

Questions to ask your Doctor

1Does my medical condition increase my risk of osteoporosis or fractures?
2Should I have a DXA (bone density) scan or other bone health tests?
3Are there treatments that can help protect my bones?
4Do I need to see a bone specialist?
5How often should my bone health be monitored
6What blood and urine tests should I get done to find out if I have other medical conditions that may be contributing to my osteoporosis?

I take long-term medicines

Why should I ask?

Some medicines can reduce bone strength or increase fracture risk, particularly if they are taken over a long period. Your doctor can help determine whether you need additional monitoring or treatment. Examples include steroid medications like prednisolone and some cancer treatments.

Questions to ask your Doctor

1Could this medication affect my bones?
2Should I have a DXA scan?
3Do I need calcium or vitamin D supplements?
4Should I take an osteoporosis medication to help protect my bones?
5How often should my bone health be reviewed in this situation?

I am falling more often and am worried about my balance

Why should I ask?

Most fragility fractures occur after a fall. Identifying the causes of falls and improving balance and strength can significantly reduce your fracture risk.

Questions to ask your Doctor

1Why might I be falling more often?
2Could the medications that I am on for my other medical conditions be contributing?
3Should my vision or hearing be checked?
4Would physiotherapy or balance training help?
5Can I be referred to a falls prevention programme?

I’m an older man

Why should I ask?

Although osteoporosis is often thought of as a women’s disease, men can also develop osteoporosis and experience serious fractures. Unfortunately, osteoporosis in men is frequently under-recognised and underdiagnosed.

Questions to ask your Doctor

1Can men develop osteoporosis?
2Should I have a bone density test?
3What are my personal risk factors?
4Do I need treatment to reduce my fracture risk?
5What lifestyle changes can I adopt to maximise my bone health?

My blood tests show low vitamin D and/or low calcium

Why should I ask?

Vitamin D and calcium play essential roles in maintaining healthy bones. Low levels may contribute to bone loss and increase the risk of fractures if left untreated.

Questions to ask your Doctor

1What may have caused my low vitamin D and/or calcium levels?
2Do I need supplements?
3How much calcium and vitamin D should I be taking?
4Should my levels be checked again after I start calcium/vitamin D supplementation?
5Are there other tests needed to identify the underlying cause of my low vitamin D and/or calcium levels?