Bad to the Bone: World Osteoporosis Day 2026

George Thorogood and the Destroyers made Bad to the Bone sound like an excellent condition in their 1982 classic. In medicine, being bad to the bone can mean a wrist broken on a pavement, a vertebra crushed while lifting a shopping bag, or a hip fracture that leads to a fatal blood clot, an infection caused by immobilisation, or death.

World Osteoporosis Day, observed annually on October 20, carries a fitting message for 2026: “Build, protect, strengthen your bones for life.” One in three women and one in five men over 50 will experience an osteoporosis-related fracture during their remaining lifetime.

A lady recently contacted Ask the Doctor about her 91-year-old relative, who had broken her hip and undergone surgery. A successful discharge from hospital still leaves a family needing to know how to help someone out of bed, manage pain, prevent pressure sores and support a safe return to walking.

Living bone is a dynamic organ. Cells called osteoclasts remove old bone, while osteoblasts make new bone. With osteoporosis, bone density silently deteriorates, and changes in its internal architecture leave it more vulnerable to fracture. Osteoarthritis primarily affects the joints, and both conditions often coexist.

A broken bone after a fall from standing height or less is commonly called a fragility fracture. Vertebral fractures may cause sudden back pain, but many are discovered incidentally. Clinical clues can include loss of height, a developing stoop (including the classic “dowager’s hump”), or clothes fitting differently.

Increasing age, Caucasian ethnicity, a previous fragility fracture, low body weight, smoking, heavy alcohol use and having a parent who fractured a hip are risk factors.

Women face accelerated bone loss around menopause as oestrogen levels fall. Men can develop osteoporosis too, including as a result of low testosterone and other illnesses.

Long-term use of steroid tablets, such as prednisolone, can weaken bones. If you need them, ask about bone protection and do not stop taking them abruptly. Overactive thyroid disease, malabsorption and certain cancer treatments are other reasons to assess bone health.

For people with type 2 diabetes, bone density does not capture every aspect of bone quality. Poor vision, neuropathy and episodes of low blood glucose can add to the risk of falling.

A DEXA scan measures bone mineral density, usually at the hip and spine, and sometimes at other sites. It is quick, painless and uses a low radiation dose.

In postmenopausal women and men aged 50 or older, a T-score of −2.5 or below at an appropriate site meets the bone-density definition of osteoporosis. Younger people require a different interpretation. Doctors combine clinical history with bone-density measurements when available.

A normal calcium blood test does not rule out osteoporosis. That test measures calcium circulating in the blood, not how much strong bone you have. Nor should a scan become a reason to postpone care indefinitely after a clear fragility fracture.

Milk, yoghurt, cheese and sardines eaten with their soft bones can contribute to calcium intake. Many adult calcium recommendations fall around 1,000 to 1,200 milligrammes daily, depending on age and sex. Vitamin D helps calcium absorption, and living in sunny Trinidad and Tobago does not guarantee adequate levels.

Weight-bearing activity and progressive resistance exercise are key components of a bone-health plan. Balance training helps address the risk of falling. Swimming is excellent exercise, but buoyancy means it provides less skeletal loading than activity on land.

Someone with vertebral fractures, severe osteoporosis or poor balance needs tailored advice from a physiotherapist before attempting vigorous exercise or heavy lifting.

Loose rugs, slippery bathrooms, poor lighting and trailing wires are dangers in the home. Review eyesight, footwear and medicines that cause dizziness or sedation. The journey to the toilet at night can be particularly arduous for some.

Effective medicines reduce fracture risk. Bisphosphonates, including alendronate and zoledronic acid, slow bone breakdown. Other options include denosumab. Menopausal hormone therapy can also protect bone in appropriately selected women. People at very high risk may benefit from bone-building treatments such as teriparatide.

Unfortunately, these treatments are expensive and have limited availability in our setting. Rare complications include osteonecrosis of the jaw and unusual thigh-bone fractures.

A fracture should open a door to prevention, but a recommendation offers limited comfort if the scan, medicine or rehabilitation remains out of reach.

Although my favourite era for music is the 1980s, George Thorogood can keep the swagger. I would settle for bones strong enough to carry us to the market, into the garden and offices, and onto the dance floor.