The short answer
- Osteoporosis matters because of the fracturesThe NHS says it is not usually painful until a bone breaks. The wrist, the hip and the bones of the spine are where breaks are most common.
- The GP works out the risk of a breakThey use an online tool such as FRAX, and may refer your relative for a bone density scan, called a DEXA scan.
- Bone tablets come with instructions that matterThe NHS says bisphosphonates are taken on an empty stomach with a full glass of water, staying upright for 30 minutes afterwards.
- Preventing falls is the main job at homeA family and a carer can make the house safer, keep a steady routine and help your relative stay strong on their feet.
Clinical content comes from the NHS, NICE guideline NG259 and the Royal Osteoporosis Society, linked where it is used. Carers on PrimeCarers charge £18 to £25 an hour with our fee included; agencies charge £28 to £35.
Why fractures matter
What osteoporosis is, and why the broken bones are what matter
The NHS describes osteoporosis as a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years, and the NHS says it is often only diagnosed when a fall or a knock breaks a bone.
A broken wrist
One of the three most common
A broken hip
Surgery and recovery
A bone in the spine
Can happen without a fall
Other bones
Ribs, arm or pelvis
Osteoporosis itself does not usually hurt. The NHS says it is not usually painful until a bone is broken, and that a broken bone is often the first sign. Some older people develop a stooped, bent-forward posture, which the NHS explains happens when bones in the spine have broken and can no longer support the weight of the body. The stage before osteoporosis, when bone density is lower than average but not low enough to be called osteoporosis, is called osteopenia.
Everybody loses bone with age. The NHS lists what makes it happen faster: the menopause, especially an early one, taking high-dose steroid tablets for a long time, a parent who broke a hip, a low body weight, heavy drinking and smoking, some hormone and bowel conditions, and long periods of inactivity such as bed rest. Men can have osteoporosis too.
This is why the rest of this page is about fractures more than bones. The medicines strengthen bones slowly, and the NHS says bisphosphonates take 6 to 12 months to work. In the meantime, what protects your relative is avoiding falls and being helped to move in a way that does not strain fragile bones. The mobility and falls care guide covers falls in general, and this page covers what osteoporosis adds.
How the GP checks
How the GP works out the risk of a broken bone
There is no single test for how likely a break is. The GP combines your relative's age, history and risk factors in a calculator, and may add a scan.
- 1
Somebody asks the question
The GP, or after a fractureNICE says the risk should be assessed in everyone aged 50 and over who has already had a fragility fracture, a break from a small knock or a fall from standing height, or who takes steroid tablets long term. It should be considered in all women from 65 and all men from 75. - 2
A risk calculator
At the surgeryThe GP enters your relative's details into a tool such as FRAX or QFracture, which estimates the chance of a major break over the next ten years. NICE asks for a full clinical assessment alongside it. - 3
A bone density scan
A DEXA scan, 10 to 20 minutesThe NHS describes it as short and painless. It compares bone density with a healthy young adult and gives a T score: below minus 2.5 is osteoporosis, and between minus 1 and minus 2.5 is osteopenia. - 4
A decision about treatment
With your relativeThe NHS says the decision depends on age, sex, the scan and the risk of breaking a bone, as well as past injuries. Your relative can decide not to take a medicine.
The guidance behind this is NICE guideline NG259, osteoporosis: risk assessment, published on 29 July 2026. It replaces the older guideline CG146, so if you are reading an older leaflet that mentions CG146, NG259 is the current one. NICE also says a check of the spine should be considered at the same appointment as a DEXA scan for women from 60 and men from 70, because spinal fractures can be missed.
If your relative has already broken a bone and is over 50, the NHS says a fracture liaison service can help prevent further breaks. Not every area has one, so ask the GP surgery. The Royal Osteoporosis Society explains the scan and the risk tools in more detail.
The medicines
The bone medicines, and the instructions a carer should know
Several kinds of medicine are used, and the GP or specialist chooses between them. What a family and a carer need to know is how each one is given, and which side effects to report.
| What it does | How it is given | |
|---|---|---|
| Bisphosphonates, such as alendronic acid, risedronate, ibandronic acid and zoledronic acid | Slow the rate bone is broken down, which keeps bone density and lowers the risk of a break | A tablet, a liquid to swallow, or an injection. The NHS says they usually take 6 to 12 months to work |
| Raloxifene | Works on bone like the hormone oestrogen. Only for women after the menopause | A tablet every day |
| Teriparatide | Helps build new bone. Used for a small number of people with very low bone density | An injection once a day |
| Denosumab and romosozumab | May be used if other medicines are not suitable, or osteoporosis is severe | An injection every month or every few months |
| HRT | Keeps bones strong in women around the menopause | Tablets, patches, gel or spray, discussed with the GP |
Bisphosphonates, such as alendronic acid, risedronate, ibandronic acid and zoledronic acid
- What it does
- Slow the rate bone is broken down, which keeps bone density and lowers the risk of a break
- How it is given
- A tablet, a liquid to swallow, or an injection. The NHS says they usually take 6 to 12 months to work
Raloxifene
- What it does
- Works on bone like the hormone oestrogen. Only for women after the menopause
- How it is given
- A tablet every day
Teriparatide
- What it does
- Helps build new bone. Used for a small number of people with very low bone density
- How it is given
- An injection once a day
Denosumab and romosozumab
- What it does
- May be used if other medicines are not suitable, or osteoporosis is severe
- How it is given
- An injection every month or every few months
HRT
- What it does
- Keeps bones strong in women around the menopause
- How it is given
- Tablets, patches, gel or spray, discussed with the GP
From the NHS page on treating osteoporosis. Which medicine suits your relative is a decision for their doctor, and the leaflet in the packet is the instruction to follow.
The tablets with the strictest instructions are the bisphosphonates. For alendronic acid, the NHS says to take it on an empty stomach, usually 30 minutes before breakfast, with plain tap water and before any other medicine. It should not be taken with mineral water, tea, coffee, juice or milk, because these reduce how much is absorbed. It is taken sitting up or standing, and the person should stay upright for 30 minutes afterwards, so it is never taken at bedtime. The NHS says the usual adult dose is once a week, on a day that suits the person's routine.
This fits a morning routine, and it is one reason a carer's morning visit can help. The carer can prompt the tablet before breakfast, make sure it goes down with a glass of tap water, and keep your relative upright and busy for the half hour before food. On the weekly day, write the day on the calendar and in the carer's notes. Can carers give medication? explains the difference between prompting a medicine and giving it. If a medicine is an injection your relative cannot give themselves, a carer may only give it if a nurse or other professional has trained them and signed them off for that person, which delegated healthcare tasks explains.
Calcium and vitamin DSection titled Calcium%20and%20vitamin%20D
The NHS says your relative's healthcare team will ask about their diet and may suggest changes or supplements, and that calcium and vitamin D may be prescribed to take at a different time from the bisphosphonate. Follow what the GP advises on both, and ask the pharmacist how to space them around the bone tablet. Elderly nutrition covers eating well when appetite is poor.
Preventing falls
Preventing falls is the main job at home
The NHS says having osteoporosis does not mean somebody will definitely break a bone, and that there are things that lower the risk of a fall or a break. The house, the routine and your relative's strength and balance are where a family and a carer can help.
| What raises the risk | What helps | Who to ask |
|---|---|---|
| Around the house | ||
| Loose rugs, trailing wires and clutter on the way to the kitchen or the toilet | Rugs moved or held down with a non-slip mat, wires tucked away, walkways kept clear | The family and the carer, who walk the same routes every day |
| A dark landing and stairs, and the walk to the toilet at night | The landing and stairs well lit, and the lights switched on when walking about at night | The family, and the carer on an evening visit |
| A slippery bath or shower floor, and no rail to hold | A non-slip mat in the bath or shower, and grab rails in the bathroom and on the stairs | The council, through a free care needs assessment that looks at making the home safer |
| Standing on a chair or reaching up high for things | Everyday things kept within easy reach, and somebody else doing the high jobs | The family and the carer |
| The person | ||
| Slippers that are loose, backless or worn smooth | Shoes or slippers that fit well, do not slip off and have a good grip | The family |
| Several medicines, or tablets that cause dizziness | A review of every medicine they take, and getting up slowly from a chair or bed | The GP or the pharmacist |
| Eyesight or hearing that has changed | Regular sight tests and hearing checks, glasses kept clean and hearing aids working | An optician, and the GP about hearing |
| Weak legs and poor balance, or two or more falls in a year | Strength and balance exercise, and a falls assessment | The GP, who can refer to a local falls service |
| The bones and moving about | ||
| Bone tablets taken the wrong way, so less is absorbed or the food pipe is irritated | Each dose taken exactly as the leaflet in the packet says | The pharmacist, who can go through the leaflet with you |
| Being lifted under the arms or pulled up by the arms | A moving and handling plan, with equipment chosen for the person | An occupational therapist or physiotherapist |
| Lying on the floor after a fall with no way to call for help | A personal alarm they wear, or a mobile phone they keep with them | The council or a telecare provider |
Around the house
What raises the risk
Loose rugs, trailing wires and clutter on the way to the kitchen or the toilet
What helps
Rugs moved or held down with a non-slip mat, wires tucked away, walkways kept clear
Who to ask
The family and the carer, who walk the same routes every day
What raises the risk
A dark landing and stairs, and the walk to the toilet at night
What helps
The landing and stairs well lit, and the lights switched on when walking about at night
Who to ask
The family, and the carer on an evening visit
What raises the risk
A slippery bath or shower floor, and no rail to hold
What helps
A non-slip mat in the bath or shower, and grab rails in the bathroom and on the stairs
Who to ask
The council, through a free care needs assessment that looks at making the home safer
What raises the risk
Standing on a chair or reaching up high for things
What helps
Everyday things kept within easy reach, and somebody else doing the high jobs
Who to ask
The family and the carer
The person
What raises the risk
Slippers that are loose, backless or worn smooth
What helps
Shoes or slippers that fit well, do not slip off and have a good grip
Who to ask
The family
What raises the risk
Several medicines, or tablets that cause dizziness
What helps
A review of every medicine they take, and getting up slowly from a chair or bed
Who to ask
The GP or the pharmacist
What raises the risk
Eyesight or hearing that has changed
What helps
Regular sight tests and hearing checks, glasses kept clean and hearing aids working
Who to ask
An optician, and the GP about hearing
What raises the risk
Weak legs and poor balance, or two or more falls in a year
What helps
Strength and balance exercise, and a falls assessment
Who to ask
The GP, who can refer to a local falls service
The bones and moving about
What raises the risk
Bone tablets taken the wrong way, so less is absorbed or the food pipe is irritated
What helps
Each dose taken exactly as the leaflet in the packet says
Who to ask
The pharmacist, who can go through the leaflet with you
What raises the risk
Being lifted under the arms or pulled up by the arms
What helps
A moving and handling plan, with equipment chosen for the person
Who to ask
An occupational therapist or physiotherapist
What raises the risk
Lying on the floor after a fall with no way to call for help
What helps
A personal alarm they wear, or a mobile phone they keep with them
Who to ask
The council or a telecare provider
From the NHS pages on osteoporosis, falls and alendronic acid, the Royal Osteoporosis Society pages on avoiding falls and balance exercise, and NHS moving and handling guidance. Nothing here replaces advice from your relative's own GP, physiotherapist or occupational therapist.
Use the table on a walk round the house with your relative, following the route from the bed to the toilet and from the chair to the kitchen. Somebody who has broken a bone may start doing less out of fear, and doing less weakens the legs that keep them upright, so read fear of falling if your relative has stopped going out or wants somebody close by all the time.
Plan for a fall as well as against one. The NHS says to wear a personal alarm or carry a mobile phone, and pendant alarms and sensors explains the options for somebody who lives alone. After a fall: the checklist covers what to do in the first days after one, including asking the GP to look at bone health if nobody has yet.
If you want somebody at home to help with moving about safely, walking outdoors and the morning routine, you can search for carers near you and compare their rates. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, against £28 to £35 at an agency. Every carer's identity, right to work and accepted criminal-record check (Enhanced DBS issued within the last 18 months, DBS Update Service, Scottish PVG or Access NI) are checked and they are interviewed online before they appear. Every visit booked through PrimeCarers is insured, by the carer's own policy or by cover PrimeCarers arranges where they do not hold one. We do not check training or qualifications, so ask the carer yourself about their experience with falls and moving and handling.
Back pain and the spine
Spinal fractures and back pain: when to see the GP
A broken bone in the spine can go unnoticed. NICE says spinal fractures are the most common type of osteoporotic fracture, and that people often have no symptoms, so they can go undiagnosed.
Back pain in someone with osteoporosis: who to contact
0 of 9 ticked
Mention it to the GP
The same day: an urgent GP appointment or 111
Now: 999 or A&E
When a bone in the spine breaks, the Royal Osteoporosis Society explains that it takes between 6 and 12 weeks to heal, usually without an operation, and that the bone heals in its new compressed shape. That is where the height loss and the curve come from. The charity recommends staying as active as possible, because it lowers the risk of chest infections, constipation and blood clots, and resting for a while only if the early pain is severe. Pain relief that lets your relative keep moving is part of the treatment, so ask the GP if the painkillers are not doing that.
The NHS lists other ways to manage the pain, including warm baths or hot packs, cold packs, relaxation and massage. A carer can help with the practical side, such as a warm bath with somebody there and short walks spread through the day. Exercises for posture come from a physiotherapist.
Moving and exercise
Moving safely, the exercise that helps, and after a hip fracture
Fragile bones change how your relative should be helped to move, and they make exercise more important rather than less. Both are things a physiotherapist or occupational therapist can plan with you.
What keeps bones safe
- Ask for an occupational therapist or physiotherapist to assess how your relative moves, and follow the plan they write
- Use the equipment the plan sets out, such as a slide sheet, a raised seat or a frame, and nothing it rules out
- Let your relative do what they can themselves, with time to stand up slowly from a chair or bed
- Keep up the strength and balance exercises the physiotherapist or falls service gave them
- Ask the GP or physiotherapist before starting new exercise if your relative has had spinal fractures or several broken bones
What puts them at risk
- Lifting under the arms, sometimes called a drag lift, which NHS moving and handling guidance classes as unsafe
- Pulling your relative up by the hands or arms, or letting them hold on round your neck
- Trying to lift somebody off the floor after a fall, which the NHS says not to do
- Anybody using a hoist they have not been shown how to use, family members included
- Stopping all activity to keep them safe, which weakens the muscles and bones that protect them
NHS Fife's moving and handling guidance classes the underarm lift as unsafe, saying lifts like it pose a high risk of injury to both the person being moved and the person lifting. It says safer alternatives such as hoists, stand aids and slide sheets can replace lifting in almost all situations. NICE notes that most spinal fractures happen after lifting, twisting or bending rather than a fall, so how your relative is helped to move matters as much as where they walk. If your relative needs more than a steadying hand to get up, ask the council for a care needs assessment so an occupational therapist can plan the move and the equipment. Transfers, hoists and two carers explains how that works and when two people are needed.
The exercise that helps bonesSection titled The%20exercise%20that%20helps%20bones
The NHS says weight-bearing exercise, where the feet and legs support the body's weight, and resistance exercise, where muscles work against a weight, are particularly important for bone density. For people over 60 it suggests things such as brisk walking and keep-fit classes. The Royal Osteoporosis Society says most people with osteoporosis can exercise safely, that it helps to combine impact, strength and balance exercise, and that exercise is not a replacement for an osteoporosis medicine. A daily walk with somebody beside them is the simplest start, and physio at home explains how to get a physiotherapist to set the rest.
After a hip fractureSection titled After%20a%20hip%20fracture
A broken hip in somebody with osteoporosis is two problems: the operation and recovery, and the weak bones that let it happen. The NHS says that if osteoporosis is found because of a broken bone, your relative should still be offered treatment to lower the risk of another. Hip fracture recovery at home covers the weeks after surgery. Before your relative leaves hospital, ask whether their bone health has been assessed and who will follow it up, the fracture liaison service or the GP.
Questions
Questions families ask about osteoporosis
It can be treated rather than cured. The NHS says bisphosphonates slow the rate that bone is broken down, which keeps bone density and lowers the risk of a break, and that some medicines such as teriparatide can increase bone density. Exercise and preventing falls help alongside it. The NHS treatment page covers each option.
The NHS says to take it on an empty stomach, usually 30 minutes before breakfast, with plain tap water, before any other medicine and never with tea, coffee, juice, milk or mineral water. She should take it sitting or standing and stay upright for 30 minutes, so not at bedtime. Heartburn, or pain when swallowing, is a reason to stop and speak to a doctor or 111. The leaflet in the packet is the instruction to follow.
That is the GP's decision, and it is reasonable to ask. NICE says the risk of a break should be assessed in everyone aged 50 and over who has had a fragility fracture or takes steroid tablets long term, and considered in all men from 75 and all women from 65. The GP starts with a risk calculator such as FRAX, and refers for a DEXA scan where it will help the decision.
The Royal Osteoporosis Society says most people with osteoporosis can exercise safely, and that exercise helps keep bones strong. It suggests talking to a doctor or physiotherapist first if she has had spinal fractures or many broken bones, or is recovering from a break. Strength and balance exercise also makes a fall less likely.
Not by lifting her. The NHS says to call 999 if somebody has fallen and may have hurt their head, back, neck or hip, or cannot get up, and not to try to lift them yourself. If she is unhurt and can get up on her own, somebody can talk her through it and bring something sturdy, such as a heavy chair, for her to hold. After a fall: the checklist covers what to do next.
Carers on PrimeCarers charge £18 to £25 an hour with our fee included, and agencies charge £28 to £35. A council care needs assessment is free and may lead to help towards the cost. Our pricing explains the rate and our fee, and local authority funding explains how the council decides who pays.
The GP or practice nurse first. The Royal Osteoporosis Society, the UK's national charity for osteoporosis, runs a helpline with specialist nurses and has local support groups, and families can contact it as well as the person with osteoporosis.