Six people buy a book about osteoporosis and only one of them is
reading about their own situation. These pages ask which one you are, and then show
you only your part.
Judith Ashworth · nothing here is sent anywhere · print any of it
First, the things that do not wait
This part is the same for everybody, and it is the only part of this page
that is urgent.
Go to an emergency department, or call an ambulance, if any of these
happen:
Numbness or a change in feeling between your legs, around the back
passage, or in the area you would sit on a saddle
New weakness in a leg or foot, or a leg that gives way
Not being able to pass urine, or losing control of your bladder or bowel
After a fall: you cannot stand or put weight on a leg, or the leg looks
shortened or turned out
A blow to the head, or any fall with loss of consciousness — especially if
you take anything that thins the blood
Telephone your doctor the same day for:
Sudden severe back pain, particularly after an ordinary
movement — lifting, coughing, sneezing, stepping off a kerb
Back pain that wakes you at night, or does not settle when you lie still
Noticing that you have lost height, or that your posture has changed
New pain in a hip, wrist, shoulder or rib after a minor knock
Weight you did not mean to lose
Which of these is you?
Tap one. You can change it, and you can open more than one — a lot of
people are two of these at once.
Nothing is selected yet. Choose the one that
sounds most like your situation and this page will rearrange itself around it.
I have been told I have osteopeniaNot osteoporosis — and almost nobody explains the difference
Osteopenia is not a disease and not a diagnosis of osteoporosis. It is a measurement that sits between two lines on a chart, and on its own it says less than people assume.
It is also the point at which what you do matters most, and the point at which most people are told the least. Very often the whole conversation is four words: come back in two years.
What to ask at your next appointment
Take this page in with you. Nobody minds a piece of paper; most doctors are relieved by one.
What was my actual number, and at which sites was it measured?
Is this something you are watching, or something you want to act on — and why?
Does my risk come from this number, or from something else in my history?
When should the next scan be, and what would make it sooner?
Is there anything I am doing, or taking, that is working against me?
Your sheets
The most useful sheet here, for a reason most people are never told
Scans done on different machines cannot be compared directly. Guidance for this test is to repeat it at the same centre, on the same scanner, because every machine has its own calibration and its own margin of error. When two different systems are compared, the amount of change needed before it counts as a real change becomes roughly three times larger.
So if you moved, changed insurance, or simply went where the appointment was free, two of your numbers may not be telling you what they appear to be telling you. Write down the centre and the machine every time. If nobody told you which scanner it was, that is a fair question for reception, and they can answer it.
Date
Centre / clinic
Scanner make & model
Site measured
Result
Same machine as last time?
What I was told
Height is measured, not remembered — ask for it at every appointment
Date
Height
Measured where, and by whom
The one part of this page you can act on today without asking anyone.
The floor, everywhere
Loose rugs and mats: taped down, backed with non-slip, or gone
Cables and chargers out of every walking line
Nothing stored on the floor along a route you walk at night
Pet beds and bowls out of doorways and off the route to the bathroom
Light
A lamp you can reach from the bed without getting up
A night light on the whole route from bed to bathroom
A switch at the top and the bottom of every staircase
Bulbs replaced the day they go, including the awkward ones
The bathroom
A non-slip mat inside the bath or shower
A grab rail fixed into the wall, not a suction one
A bath mat that grips the floor on the outside as well
Nothing you need stored above shoulder height
Stairs and steps
A handrail running the full length, on at least one side
Every step the same height, with nothing left on any of them
The edge of each step visible against the rest
The bottom step lit
Kitchen
Everyday things between hip and shoulder height
A step stool with a handle, and no chairs used as ladders
Outside your door
The path clear of moss, ice and leaves
A light that comes on when you approach
A rail at the front steps
On your feet
Shoes that fasten and grip, indoors as well as out
No backless slippers, no socks alone on hard floors
Trailing hems and dressing gown cords shortened
Worth asking about
Your eyes: last tested when?
Your ears: balance and hearing are connected more than people think
Anything you take that makes you light-headed when you stand up
I have just been diagnosed with osteoporosisThe first month is mostly decisions made in twelve-minute appointments
The diagnosis usually arrives by letter or in a rushed appointment, and then you are expected to make decisions about it.
Nothing about this needs to be decided today. What helps is walking into the next appointment with your own numbers, your own list of everything you take, and your own questions written down.
What to ask at your next appointment
Take this page in with you. Nobody minds a piece of paper; most doctors are relieved by one.
Which of my numbers is the one you are actually watching?
What is the plan, and what is the plan meant to achieve?
What would make you change it?
Of everything on my list, is anything working against my bones?
What should make me telephone you rather than wait for the next appointment?
Who do I call if something happens at the weekend?
Your sheets
The most useful sheet here, for a reason most people are never told
Scans done on different machines cannot be compared directly. Guidance for this test is to repeat it at the same centre, on the same scanner, because every machine has its own calibration and its own margin of error. When two different systems are compared, the amount of change needed before it counts as a real change becomes roughly three times larger.
So if you moved, changed insurance, or simply went where the appointment was free, two of your numbers may not be telling you what they appear to be telling you. Write down the centre and the machine every time. If nobody told you which scanner it was, that is a fair question for reception, and they can answer it.
Date
Centre / clinic
Scanner make & model
Site measured
Result
Same machine as last time?
What I was told
Height is measured, not remembered — ask for it at every appointment
Date
Height
Measured where, and by whom
Including the ones people forget to mention
Include vitamins, minerals, herbal things, antacids and indigestion remedies, anything bought over the counter, anything a relative recommended, and anything taken only sometimes. The ones that get left off a list are usually the ones worth mentioning.
What it is
How much
When in the day
Started when
Who told me to take it
This sheet deliberately does not tell you the answer.
Whether any of these applies to you depends on your own spine, your own scan, and whether you have had a fracture. That is a question for your doctor or a physiotherapist, and not one a book can answer for a person it has never examined.
So this is not a list of things to avoid. It is a list of things to ask about, by name.
Bending forward from the waist — to pick something up, to make a bed, to load a machine
Curling the trunk — sit-ups, crunches, some abdominal machines
Twisting the spine under load — golf swings, some yoga and Pilates positions
Lifting anything heavy from below knee height
High-impact movement — jumping, running on hard ground
Standing on one leg with your eyes closed
Ask it like this: “Given my scan and my history, is there anything on this list I should not be doing — and anything I should be doing that I am not?”
The one part of this page you can act on today without asking anyone.
The floor, everywhere
Loose rugs and mats: taped down, backed with non-slip, or gone
Cables and chargers out of every walking line
Nothing stored on the floor along a route you walk at night
Pet beds and bowls out of doorways and off the route to the bathroom
Light
A lamp you can reach from the bed without getting up
A night light on the whole route from bed to bathroom
A switch at the top and the bottom of every staircase
Bulbs replaced the day they go, including the awkward ones
The bathroom
A non-slip mat inside the bath or shower
A grab rail fixed into the wall, not a suction one
A bath mat that grips the floor on the outside as well
Nothing you need stored above shoulder height
Stairs and steps
A handrail running the full length, on at least one side
Every step the same height, with nothing left on any of them
The edge of each step visible against the rest
The bottom step lit
Kitchen
Everyday things between hip and shoulder height
A step stool with a handle, and no chairs used as ladders
Outside your door
The path clear of moss, ice and leaves
A light that comes on when you approach
A rail at the front steps
On your feet
Shoes that fasten and grip, indoors as well as out
No backless slippers, no socks alone on hard floors
Trailing hems and dressing gown cords shortened
Worth asking about
Your eyes: last tested when?
Your ears: balance and hearing are connected more than people think
Anything you take that makes you light-headed when you stand up
I have already broken somethingThis is the loudest signal there is, and it is very often not followed up
A bone broken by a fall from standing height, after fifty, is not just an accident — it is information. It is the clearest thing anyone will ever know about your bones, and it is worth more than a scan.
It is also the thing most likely to go unexamined, because the hospital fixed the wrist and everybody moved on. The months afterwards are the window in which somebody should be looking.
What to ask at your next appointment
Take this page in with you. Nobody minds a piece of paper; most doctors are relieved by one.
Does the fracture I had count as a fragility fracture?
Has anyone looked at my bones since it happened?
Is there a fracture liaison service, or anything like it, here?
Should I have a scan, and should it be now rather than later?
What is being done so that the next one does not happen?
Your sheets
How a bone broke matters more than which bone it was
Write down how it happened, not just what broke. A bone that broke from a fall at standing height or less, after the age of fifty, is treated differently from one broken in a car or falling off a ladder — and that distinction is often the whole conversation.
When
Which bone
How it happened — what height did I fall from
Was I scanned afterwards
Who followed it up
The most useful sheet here, for a reason most people are never told
Scans done on different machines cannot be compared directly. Guidance for this test is to repeat it at the same centre, on the same scanner, because every machine has its own calibration and its own margin of error. When two different systems are compared, the amount of change needed before it counts as a real change becomes roughly three times larger.
So if you moved, changed insurance, or simply went where the appointment was free, two of your numbers may not be telling you what they appear to be telling you. Write down the centre and the machine every time. If nobody told you which scanner it was, that is a fair question for reception, and they can answer it.
Date
Centre / clinic
Scanner make & model
Site measured
Result
Same machine as last time?
What I was told
The one part of this page you can act on today without asking anyone.
The floor, everywhere
Loose rugs and mats: taped down, backed with non-slip, or gone
Cables and chargers out of every walking line
Nothing stored on the floor along a route you walk at night
Pet beds and bowls out of doorways and off the route to the bathroom
Light
A lamp you can reach from the bed without getting up
A night light on the whole route from bed to bathroom
A switch at the top and the bottom of every staircase
Bulbs replaced the day they go, including the awkward ones
The bathroom
A non-slip mat inside the bath or shower
A grab rail fixed into the wall, not a suction one
A bath mat that grips the floor on the outside as well
Nothing you need stored above shoulder height
Stairs and steps
A handrail running the full length, on at least one side
Every step the same height, with nothing left on any of them
The edge of each step visible against the rest
The bottom step lit
Kitchen
Everyday things between hip and shoulder height
A step stool with a handle, and no chairs used as ladders
Outside your door
The path clear of moss, ice and leaves
A light that comes on when you approach
A rail at the front steps
On your feet
Shoes that fasten and grip, indoors as well as out
No backless slippers, no socks alone on hard floors
Trailing hems and dressing gown cords shortened
Worth asking about
Your eyes: last tested when?
Your ears: balance and hearing are connected more than people think
Anything you take that makes you light-headed when you stand up
Write down the ones you got up from and felt silly about — those are the ones that show the pattern
Date & time
Where, and what I was doing
Did I hurt anything
Did I tell anyone
I am on treatment and not sure about itQuestions to ask — and one thing never to do on your own
Most people on a bone medicine have the same three questions and ask none of them: how long am I on this, what is normal to feel, and what happens when I stop.
All three have answers. They are answers your own prescriber has and this page does not, because they depend on which medicine, which dose, how long, and on you.
Never stop or change a bone medicine on your own. Some have to be stopped in a particular way, some need something else to follow them, and stopping one quietly can leave you worse off than before you started. If something about it is hard to live with, that is a reason to talk to your prescriber — not a reason to stop and say nothing.
What to ask at your next appointment
Take this page in with you. Nobody minds a piece of paper; most doctors are relieved by one.
How long am I meant to be on this, and is there a review date?
What is normal to feel on it, and what is not?
Is there anything I should tell you about straight away?
Is there anything I should tell a dentist, or a surgeon, before any procedure?
What happens when I stop — does anything need to follow it?
If I cannot tolerate this one, what else is there?
Your sheets
Including the ones people forget to mention
Include vitamins, minerals, herbal things, antacids and indigestion remedies, anything bought over the counter, anything a relative recommended, and anything taken only sometimes. The ones that get left off a list are usually the ones worth mentioning.
What it is
How much
When in the day
Started when
Who told me to take it
A diary is the only thing that turns “sometimes” into something a prescriber can use
Never stop or change a bone medicine on your own. Some are stopped in a particular way, some need something else to follow them, and stopping one without telling anyone can leave you worse off than before you started. If something about it is hard to live with, that is a reason to talk to your prescriber — and a reason they will want to hear about.
Date
What I noticed
How long it lasted
What I was doing / had taken
Nothing is wrong yet, and I want to keep it that wayThe years right after menopause are the window nobody uses
Bone is lost fastest in the few years either side of menopause, and that is also the stretch in which almost nobody thinks about it, because nothing hurts and nothing has happened.
This is the only group on this page that can act before there is anything to act on.
What to ask at your next appointment
Take this page in with you. Nobody minds a piece of paper; most doctors are relieved by one.
Given my age and my history, should I be scanned — and when?
Does anything in my family history change that answer?
Is there anything in my life, or anything I take, that is working against me?
What would you want to know about before it became a problem?
Is my height being measured at these appointments?
Your sheets
The most useful sheet here, for a reason most people are never told
Scans done on different machines cannot be compared directly. Guidance for this test is to repeat it at the same centre, on the same scanner, because every machine has its own calibration and its own margin of error. When two different systems are compared, the amount of change needed before it counts as a real change becomes roughly three times larger.
So if you moved, changed insurance, or simply went where the appointment was free, two of your numbers may not be telling you what they appear to be telling you. Write down the centre and the machine every time. If nobody told you which scanner it was, that is a fair question for reception, and they can answer it.
Date
Centre / clinic
Scanner make & model
Site measured
Result
Same machine as last time?
What I was told
Height is measured, not remembered — ask for it at every appointment
Date
Height
Measured where, and by whom
The one part of this page you can act on today without asking anyone.
The floor, everywhere
Loose rugs and mats: taped down, backed with non-slip, or gone
Cables and chargers out of every walking line
Nothing stored on the floor along a route you walk at night
Pet beds and bowls out of doorways and off the route to the bathroom
Light
A lamp you can reach from the bed without getting up
A night light on the whole route from bed to bathroom
A switch at the top and the bottom of every staircase
Bulbs replaced the day they go, including the awkward ones
The bathroom
A non-slip mat inside the bath or shower
A grab rail fixed into the wall, not a suction one
A bath mat that grips the floor on the outside as well
Nothing you need stored above shoulder height
Stairs and steps
A handrail running the full length, on at least one side
Every step the same height, with nothing left on any of them
The edge of each step visible against the rest
The bottom step lit
Kitchen
Everyday things between hip and shoulder height
A step stool with a handle, and no chairs used as ladders
Outside your door
The path clear of moss, ice and leaves
A light that comes on when you approach
A rail at the front steps
On your feet
Shoes that fasten and grip, indoors as well as out
No backless slippers, no socks alone on hard floors
Trailing hems and dressing gown cords shortened
Worth asking about
Your eyes: last tested when?
Your ears: balance and hearing are connected more than people think
Anything you take that makes you light-headed when you stand up
I am looking after somebody elseYou are managing appointments, medicines and a house that is not yours
You are often the one who notices first — that they are shorter, that they are holding the furniture, that there was a fall they did not mention.
You are also the one who will be asked what medicines they take, and will not know. These sheets exist so that somebody does.
If they are able to decide for themselves, these are their notes and their appointment. Ask before you fill anything in, and ask before you speak for them. Most people want the help and want to be asked.
What to ask at your next appointment
Take this page in with you. Nobody minds a piece of paper; most doctors are relieved by one.
May I come in with them, and can you talk to me directly?
What should I be watching for between appointments?
What do I do if they fall and seem to be all right?
What do I do if they fall and are not all right?
Is there anything about the house you would want changed?
Your sheets
Including the ones people forget to mention
Include vitamins, minerals, herbal things, antacids and indigestion remedies, anything bought over the counter, anything a relative recommended, and anything taken only sometimes. The ones that get left off a list are usually the ones worth mentioning.
What it is
How much
When in the day
Started when
Who told me to take it
The one part of this page you can act on today without asking anyone.
The floor, everywhere
Loose rugs and mats: taped down, backed with non-slip, or gone
Cables and chargers out of every walking line
Nothing stored on the floor along a route you walk at night
Pet beds and bowls out of doorways and off the route to the bathroom
Light
A lamp you can reach from the bed without getting up
A night light on the whole route from bed to bathroom
A switch at the top and the bottom of every staircase
Bulbs replaced the day they go, including the awkward ones
The bathroom
A non-slip mat inside the bath or shower
A grab rail fixed into the wall, not a suction one
A bath mat that grips the floor on the outside as well
Nothing you need stored above shoulder height
Stairs and steps
A handrail running the full length, on at least one side
Every step the same height, with nothing left on any of them
The edge of each step visible against the rest
The bottom step lit
Kitchen
Everyday things between hip and shoulder height
A step stool with a handle, and no chairs used as ladders
Outside your door
The path clear of moss, ice and leaves
A light that comes on when you approach
A rail at the front steps
On your feet
Shoes that fasten and grip, indoors as well as out
No backless slippers, no socks alone on hard floors
Trailing hems and dressing gown cords shortened
Worth asking about
Your eyes: last tested when?
Your ears: balance and hearing are connected more than people think
Anything you take that makes you light-headed when you stand up
Write down the ones you got up from and felt silly about — those are the ones that show the pattern