Osteoporosis assessment and treatment
Working out your risk of breaking a bone because of thinning bones, using a risk score and sometimes a bone density (DEXA) scan, then agreeing treatment to lower that risk.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It works out your risk of breaking a bone and aims to lower it, since osteoporosis usually has no symptoms until a fracture happens.
- The decision to treat is based on your overall fracture risk, not on the DEXA scan number alone.
- Treatment (often bisphosphonates plus calcium and vitamin D) reduces fracture risk but does not remove it completely.
- Medicines are usually taken for years and then reviewed; some have rare long-term risks that should be discussed.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Identifies your risk of breaking a bone before a fracture happens
People at low fracture risk, for whom medicine offers little benefit and is best avoided.
No recovery is needed. You can return to normal activity straight away. Results usually follow within days to weeks.
A clear plan and summary shared with you and your GP.
No recovery is needed. You can return to normal activity straight away. Results usually follow within days to...
You learn how to take the medicine and what side effects to expect. Tummy upset with tablets, or short-lived...
Treatment works silently to protect bone; you will not feel a difference. Calcium, vitamin D, activity, and falls...
Treatment is reviewed, sometimes with a repeat DEXA scan. Depending on your risk, it may continue or you may be...
What is osteoporosis assessment and treatment?
Osteoporosis means bones have become thinner and more fragile, so they break more easily, sometimes after only a minor fall or bump. Assessment is about working out how likely you are to break a bone, and treatment is about lowering that risk.
Assessment usually starts with a fracture-risk score (such as FRAX or QFracture), which uses your age, history, and risk factors. A bone density scan called a DEXA (or DXA) may then measure how strong your bones are, giving a T-score. The decision to treat is based on your overall risk, not the scan alone.
Treatment most often uses medicines such as bisphosphonates (for example alendronic acid), along with enough calcium and vitamin D and steps to prevent falls. The aim is to reduce the chance of future fractures, especially of the hip and spine, which can seriously affect health and independence.
Osteoporosis usually has no symptoms until a bone breaks, so assessment is about prevention. Treatment lowers risk but does not remove it entirely, and the right plan is tailored to you.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Fracture-risk assessment (FRAX or QFracture)
A questionnaire-based score using your age, sex, weight, history of fractures, and other risk factors to estimate your chance of a fragility fracture over the next 10 years...
Bone density scan (DEXA / DXA)
A quick, low-radiation scan, usually of the hip and spine, that measures bone density and gives a T-score. Used to refine risk where it is near a treatment threshold, and to...
Bisphosphonate medicines
First-line treatment for most people (for example weekly alendronic acid or risedronate, or an intravenous option). They slow bone loss and reduce fracture risk. Usually...
Other medicines
Options such as denosumab (an injection), or bone-building treatments for higher-risk people, plus hormone-related treatments in selected cases. Used when bisphosphonates are...
Preparing for your treatment
- Bring a list of your medicines and supplements, including any steroids and any calcium or vitamin D you take.
- Note any previous broken bones, especially after minor falls, and any family history of hip fracture or osteoporosis.
- Mention conditions or treatments that affect bones, such as long-term steroids, early menopause, or certain hormone treatments.
- For a DEXA scan, wear loose clothing without metal zips or buttons over the hip and spine if possible.
- Tell the team if you might be pregnant, as DEXA uses a small amount of radiation.
- Have a think about falls at home, as reducing falls is part of treatment.
- Bring details of any dental problems, as these are relevant before certain bone medicines.
What happens
Assessment usually begins with a fracture-risk score based on your history and risk factors. If a bone density scan is needed, you lie on a couch while a DEXA scanner passes over your hip and spine. It is usually not painful, takes about 10 to 20 minutes, and uses only a small amount of radiation.
Your clinician combines the risk score, the scan (if done), and your circumstances to estimate your fracture risk and whether treatment is likely to help. They explain the options, including medicines, calcium and vitamin D, and falls prevention.
If treatment is recommended, they explain how to take it (for example weekly tablets on an empty stomach with water, sitting upright), the side effects, and the plan for review. Dental health is often checked before certain medicines. You usually agree a plan together and receive a summary, with your GP kept informed.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- People at low fracture risk, for whom medicine offers little benefit and is best avoided.
- People with very poor kidney function or uncorrected low calcium, for whom certain bone medicines are unsuitable until addressed.
- Oral bisphosphonates may be unsuitable for people with certain swallowing or oesophageal problems.
- People expecting treatment to make bones feel different or to remove all fracture risk.
Delay or rearrange if…
- You have low vitamin D or calcium that needs correcting before starting treatment.
- You have an active dental problem or planned dental surgery that should be dealt with first for certain medicines.
- You may be pregnant, which affects DEXA scanning and treatment.
- You are acutely unwell or have unstable kidney function.
- Key results or a fracture-risk assessment are missing.
Alternatives to discuss
- No medicine, with attention to calcium, vitamin D, activity, and falls prevention, for lower-risk people.
- A different bone medicine if the first is not tolerated or suitable.
- Hormone-related treatments in selected situations, such as around the menopause.
- Treating an underlying cause, such as steroid use or an overactive thyroid.
- Watchful monitoring with a repeat scan if risk is borderline.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Identifies your risk of breaking a bone before a fracture happens
- Can substantially reduce the risk of hip and spine fractures with treatment
- Helps protect mobility and independence by preventing serious fractures
- Tailors treatment to your risk, avoiding unnecessary medicine in low-risk people
- Includes practical steps, such as falls prevention, that help beyond medicines
Risks & complications
- Tummy upset, heartburn, or indigestion with oral bisphosphonate tablets
- Flu-like symptoms for a day or two after an intravenous bisphosphonate or first doses
- The inconvenience of strict instructions for taking tablets (empty stomach, upright, with water)
- Anxiety about results or about being on long-term medicine
- Low calcium levels, especially if vitamin D is low (checked beforehand)
- Difficulty tolerating tablets, needing a switch to a different medicine
- Eye inflammation with some bisphosphonates (rare but needs checking if eyes become painful or red)
- Osteonecrosis of the jaw (a jawbone healing problem), more likely with poor dental health and certain dental procedures
- Atypical thigh-bone (femoral) fractures, mainly with long-term use
- A rebound increase in spine fracture risk if denosumab is stopped without a follow-on medicine
For most people the benefit of preventing a serious fracture clearly outweighs the small risks of treatment. The rare risks of osteonecrosis of the jaw and atypical thigh fractures rise with longer use, which is why treatment is reviewed and sometimes paused. Look after dental health, and tell your clinician about jaw or thigh pain. If you take denosumab, do not stop it without a plan, because of rebound fracture risk.
Published figures to discuss
Treatment lowers fracture risk on average, but the size of benefit depends on your starting risk, and an individual cannot be promised they will avoid a fracture. The rare adverse effects below become more likely with longer treatment, which is why duration is reviewed. The figures are cautious ranges from registry and review data and should be discussed in your own context.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Atypical femoral fracture (long-term bisphosphonate use) | Rises from roughly 2.5 per 10,000 person-years at up to 5 years to about 13 per 10,000 at 8 or more years in one registry | Still uncommon, and risk falls again after stopping; balanced against many more fractures prevented. | NICE NG259 — Fragility fracture risk assessmentnice.org.ukPublished figure |
| Osteonecrosis of the jaw (osteoporosis doses) | Rare at the doses used for osteoporosis; much higher with cancer-level dosing | More likely with poor dental health and certain dental procedures; dental care reduces risk. | NICE NG259 — Fragility fracture risk assessmentnice.org.ukSource-linked context |
| Gut side effects with oral bisphosphonates | Common but usually mild; vary by person and medicine | Correct dosing technique reduces them; a switch may help if troublesome. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Assessment involves no physical recovery. With treatment, the goal is steady protection of your bones over time, while managing any side effects, rather than a quick change you can feel.
- No physical after-effects from the DEXA scan
- Mild tummy upset when starting tablets, often manageable
- Short-lived flu-like symptoms after an infusion
- Not feeling any different, since treatment works silently
- Being reviewed after several years rather than stopping abruptly
Aftercare
- Take oral bisphosphonates exactly as directed: on an empty stomach with a full glass of water, sitting or standing upright, and not lying down for the advised time.
- Keep up calcium and vitamin D as recommended, through diet or supplements.
- Stay active with weight-bearing and strength exercises as advised.
- Reduce falls at home, for example by improving lighting, removing trip hazards, and checking eyesight.
- Maintain good dental health and tell your dentist you take a bone medicine before procedures.
- Attend reviews and any repeat scans so treatment can be checked and adjusted.
- Do not stop denosumab without a follow-on plan, and report jaw or thigh pain promptly.
- Clear instructions on how and when to take the medicine
- Calcium and vitamin D sorted through diet or supplements
- Dental check-up arranged if advised before certain medicines
- A falls-prevention plan for home
- Review and repeat-scan dates noted
- Contact details for side-effect queries
⚠ Get urgent help if…
- New, persistent thigh or groin pain (possible atypical femoral fracture) — get it checked
- Jaw pain, swelling, or a non-healing sore in the mouth (possible osteonecrosis of the jaw)
- Severe heartburn, chest pain, or difficulty swallowing after oral bisphosphonates
- Painful, red eyes or blurred vision after a bisphosphonate
- Symptoms of low calcium, such as numbness, tingling, or muscle cramps
- Any new bone pain or a suspected new fracture after a fall
- Signs of a serious allergic reaction to a medicine — seek urgent help
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result from assessment is a clear understanding of your fracture risk and a plan that fits it. A good result from treatment is fewer fractures than you would otherwise have had, especially of the hip and spine. Because osteoporosis has no symptoms, you will not feel treatment working; its value is measured in fractures prevented.
Treatment lowers risk substantially for many people but does not remove it entirely, and a fracture can still happen. A DEXA result describes your bone density at one point; the decision to treat depends on your whole risk picture, not the number alone.
Treatment is usually given for several years and then reviewed, because the balance of benefit and rare long-term risks changes over time. Some people have a treatment break (drug holiday) after a few years of bisphosphonates, with monitoring, while higher-risk people continue. Denosumab is different and should not be stopped without a follow-on medicine. Your risk is reassessed over time, and the plan adjusted.
Related tests, treatments or support
Osteoporosis care often sits alongside treatment of related issues, such as managing steroid use, the menopause, an overactive thyroid, or conditions that affect calcium and vitamin D. Falls-prevention, physiotherapy, and dental care are commonly combined with medicines. Your clinician coordinates these so the plan is joined up.
Follow-up & long-term care
You should be reviewed to check how you are tolerating treatment, with a repeat DEXA scan at intervals where appropriate, and a formal review of long-term medicines after a few years. Make sure you know who is responsible for your reviews and how to contact them about side effects. A summary is usually shared with your GP.
- Take your bone medicine correctly and consistently.
- Keep calcium and vitamin D adequate through diet or supplements.
- Continue weight-bearing and strengthening activity as advised.
- Keep reducing fall risks at home and check eyesight regularly.
- Maintain dental health and inform your dentist about bone medicines.
- Attend reviews and repeat scans, and never stop denosumab without a plan.
Repeat, follow-on and what comes next
- Treatment is reviewed after a few years and may continue, change, or pause depending on risk.
- A medicine may be switched if it is not tolerated or not suitable.
- Denosumab must be followed by another medicine if stopped, to avoid rebound spine fractures.
- Repeat scans help judge whether treatment is working and whether to adjust it.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear plan and summary shared with you and your GP.
- Correct-dosing advice and a named contact for side effects.
- Calcium and vitamin D sorted, with falls-prevention advice.
- Scheduled reviews and repeat scans, and a long-term medicine review.
- Clear safety-netting for jaw or thigh pain and for stopping denosumab safely.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether a DEXA scan is needed and how quickly it is reported
- The type of appointment (assessment versus follow-up review)
- Blood tests, such as calcium and vitamin D, before treatment
- The medicine chosen (tablets, infusions, or injections) and how it is given
- Repeat scans and reviews over the years of treatment
- Any falls-prevention, physiotherapy, or dental input arranged
- The DEXA scan fee and reporting turnaround
- The consultation fee and what assessment it includes
- Which blood tests are included before starting treatment
- The cost of the chosen medicine and how it is administered
- Review and repeat-scan costs over the treatment period
- What happens, and what it costs, if a result is borderline and needs repeating
- How results and a plan are shared with you and your GP
On the NHS? Fracture-risk assessment, DEXA scans, and treatment are available on the NHS when clinically indicated; private care may be used for a faster scan, appointment, or second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Deciding to treat (or not) on the DEXA number alone, without the overall risk picture.
- Not explaining the rare jaw and thigh-bone risks, or the importance of dental health.
- Not warning that denosumab should not be stopped without a follow-on plan.
- No clear instructions on how to take tablets safely.
- Implying treatment removes all fracture risk.
Marketing red flags
- Claims that a supplement or device can 'reverse' or 'cure' osteoporosis.
- Selling repeat scans or treatments without a clear risk-based reason.
- Promising that treatment guarantees you will not break a bone.
- Pushing private bone scans to low-risk people who do not need them.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What is my fracture risk, and how much would treatment reduce it?
- Is treatment recommended for me, and which option suits my situation?
- How long should I take it, and when will it be reviewed or paused?
- What side effects should I watch for, and what symptoms need urgent attention?
- Do I need calcium and vitamin D, and how should I take my medicine correctly?
- What can I do to reduce my risk of falls?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is osteoporosis assessment and treatment available on the NHS?
Who is offered a fracture-risk assessment?
Does the DEXA scan number decide whether I need treatment?
How long will I need to take the medicine?
Are bone medicines dangerous?
Will treatment cure my osteoporosis?
Why do I need calcium, vitamin D, and exercise too?
Do I need to tell my dentist?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG259 — Fragility fracture risk assessment NICE TA464 — Bisphosphonates for treating osteoporosis Royal Osteoporosis Society — Bone density scan (DXA/DEXA) NHS — Osteoporosis Incidence of atypical femoral fractures on osteoporosis therapy (PMC) Bisphosphonate drug holidays: evidence review (PMC) NICE NG259 — Identifying vertebral fragility fractures NICE NG259 — Deciding whether treatment is appropriate
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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