Osteoporosis Specialist UK

Practice information from Dr Syed Kashif Hussain Kazmi, Consultant Endocrinologist. View professional profile on Top Doctors.

Quick answer

Osteoporosis makes bones weaker and more likely to break. A specialist assessment estimates fracture risk, looks for treatable causes such as vitamin D, calcium or hormone problems, and plans treatment and follow up. Dr Kazmi offers virtual consultations across the UK and in person care in Cambridge.

What is osteoporosis?

Osteoporosis is a condition in which bones lose density and strength, so they break more easily, often after a minor fall or even without one. Fractures of the spine, hip and wrist are most common. It is frequent after the menopause and in older age, but it can also affect younger adults and men.

Bone health is influenced by hormones, calcium and vitamin D, medicines (especially long term steroids and some cancer treatments), other conditions such as coeliac disease or an overactive thyroid, as well as smoking, alcohol, activity and falls. Finding and treating an underlying cause is an important part of care.

Metabolic bone disease and calcium and parathyroid disorders are among the conditions assessed by the practice.

What are the symptoms of osteoporosis?

Osteoporosis is usually silent until a fracture occurs. Signs that should prompt assessment include:

A fracture after a minor fall or low-impact injury
Loss of height or a stooped posture
Sudden back pain that may be due to a spinal (vertebral) fracture
A bone density (DXA) scan that shows low bone density

When should you see an osteoporosis specialist?

A specialist assessment may be helpful when:

You have had a fragility fracture
A DXA scan shows osteoporosis or low bone density and you want to understand the cause and options
You take long term steroids or other medicines that can weaken bone
You have an early menopause, low testosterone, parathyroid disease or another condition linked to bone loss
You are on, or have stopped, osteoporosis treatment and need a review of what to do next
Calcium or vitamin D levels are abnormal

How is osteoporosis assessed?

The aims are to estimate fracture risk and look for treatable causes. Assessment may include:

A fracture risk calculation such as FRAX or QFracture, as recommended by NICE
DXA bone density scan, and spine imaging if a vertebral fracture is suspected
Blood tests: calcium, vitamin D, parathyroid hormone, kidney and liver function, thyroid function, coeliac screen and, where relevant, sex hormones
Screening for other causes of bone loss guided by your history

How is osteoporosis treated?

The plan balances your fracture risk with the benefits and risks of each option. Broad approaches include:

Foundations

Adequate calcium and vitamin D, weight-bearing and strength exercise, reducing alcohol and stopping smoking, and strategies to reduce falls.

Bone-strengthening medicines

Options include bisphosphonate tablets or an annual infusion, denosumab, and others for people at very high risk. Duration, safety checks and dental advice are explained in advance.

Treating the underlying cause

For example correcting hyperparathyroidism, replacing deficient hormones or adjusting medicines that affect bone.

Follow-up

Planned review, including when repeat scans are useful and when treatment may be paused, continued or changed. Some medicines, such as denosumab, need careful planning when they are stopped.

Bone density (DXA) scan explained: T-scores, osteopenia and osteoporosis

A DXA scan measures bone mineral density, usually at the hip and spine. The result is reported as a T-score: -1.0 or higher is normal, between -1.0 and -2.5 is low bone density (osteopenia), and -2.5 or lower is osteoporosis. Your treatment decision also depends on your overall fracture risk.

What is a DXA bone density scan?

A DXA (dual-energy X-ray absorptiometry) scan uses a very low dose of X-rays to measure how dense your bones are, usually at the lower spine and hip. It is quick and painless, and you stay clothed apart from removing metal items.

What does a T-score mean?

The T-score compares your bone density with that of a healthy young adult. Osteopenia is not a disease in itself, but it signals that bone health is worth looking after.

The World Health Organization categories used in the UK are:

T-score of -1.0 or above: normal bone density
T-score between -1.0 and -2.5: low bone density, often called osteopenia
T-score of -2.5 or below: osteoporosis

Is the scan the only thing that matters?

No. Doctors estimate your chance of a fracture over the next ten years using tools such as FRAX or QFracture, which combine your scan with age, previous fractures, family history, smoking, alcohol, certain medicines and other conditions. Someone with osteopenia and several risk factors may need treatment, while someone with a similar score and few risk factors may not.

What can cause bone loss besides ageing?

It is worth checking for treatable contributors, which include:

Low vitamin D or calcium intake
An overactive thyroid or an overactive parathyroid gland
Early menopause or low sex hormone levels
Long-term steroid tablets and some other medicines
Coeliac disease and other conditions affecting absorption

When is a specialist opinion useful?

A specialist review can help after a fragility fracture, when bone loss is unexpectedly fast or occurs in a younger person or man, when blood tests suggest a hormonal cause, or when you are unsure about starting or continuing bone treatment.

When to seek urgent help

Seek urgent medical help for sudden severe back pain, or hip, groin or thigh pain with difficulty walking after a fall, as these may be fractures. Call 999 if you cannot move, are in severe pain or have lost feeling or movement in your legs.

Common questions

Can osteoporosis be reversed?

Bone density can improve with treatment, and the main goal is to reduce the chance of future fractures. The plan depends on your risk and cause.

Do I need to stop treatment after a certain number of years?

Duration depends on the medicine and your fracture risk. A planned review is part of safe treatment rather than automatic stopping.

Is a DXA scan included in the consultation?

Scans and tests are arranged separately where needed, and the arrangements and any costs are confirmed before you proceed.

Do I need a scan if I am healthy?

Not routinely. Scans are usually advised when your risk of fracture is raised, for example after a fracture, with certain medicines or conditions, or with other risk factors. Your GP can advise.

Can bone density improve?

Treatment, weight-bearing exercise, enough calcium and vitamin D, and treating underlying causes can slow bone loss and, in some people, improve density. The main aim is to reduce your chance of fractures.

Related patient guides

When should you see an endocrinologist?: Signs a hormone, thyroid, diabetes or bone problem may need a specialist, and how to prepare.

Osteoporosis & Bone Health