Osteoporosis (bone thinning)

How to say it: ost-E-O-per-oh-sis

Osteoporosis is the lowering of your bone strength. This is sometimes called bone thinning or reduced bone density.

Your bones contain special bone cells. These keep your bones strong by making new healthy bone. If they cannot do this, then the amount of tissue inside your bones goes down, and they will become weaker.

If your bone density is lower than it should be, but not yet causing problems, this is called osteopenia (say ost-E-O-peen-ee-a).

If your bone density is even lower, this is called osteoporosis.

If you have osteoporosis your bones become weaker and more fragile. This means that they are more likely to break.

On this page:

What causes osteoporosis
Symptoms of osteoporosis
Tests and checks for osteoporosis
Treating and preventing osteoporosis
Living with osteoporosis

What causes osteoporosis?

Lots of things can cause osteoporosis. But if you have a liver condition you might be at more risk.

Cirrhosis

Your liver has a very important role in getting nutrients from your food. If you have liver disease, then you might not get all the nutrients you need. This includes the things you need for healthy bones. So you will be at more risk of getting osteoporosis.

Steroid medicines

If you have an autoimmune condition, like autoimmune hepatitis, you might be given steroid medicines. You might also need to take steroids after a liver transplant. Steroids can work very well but they are strong medicines. One of the side effects is an increased risk of osteoporosis.

Alcohol and smoking

If you smoke, or drink a lot of alcohol, the cells that replace your bone tissue will not work as well as they should. This can lead to osteoporosis.

Other causes

Osteoporosis is not only caused by liver disease. There are lots of other risk factors. Including other medical conditions and a family history of the condition. Hormones can also play a part. The condition is more common in women after the menopause.

What are the symptoms of osteoporosis?

Most people will not know that they have osteoporosis unless they have a scan to look for it.

The main symptom of osteoporosis is breaking bones more easily than you should.

But if you think you could be at risk of osteoporosis, talk to your medical team about checks. Do not wait for symptoms to appear.

Tests and checks for osteoporosis

If you have cirrhosis, or you take strong steroid medicine, you should have checks for osteoporosis. This could involve:

FRAX index

This is a calculation that takes into consideration several risk factors, including:

Your age
If you are male or female
If you take steroid medicines
If you smoke
If you have suffered previous fractures
If either of your parents suffered a hip fracture

If you have had a scan on your bones the results from this can also be included in the FRAX index calculation.

Bone density scan (DEXA scan)

You might also be offered a bone density scan. This might be called a DEXA scan.

The scan looks at the density of your bones to tell doctors how strong they are.

A bone density scan is a type of X-ray. But it uses a lower dose of radiation than a normal X-ray. It can pick up very small changes in your bone density. This means it can spot a problem before your bones are so weak that they break easily.

The scan will usually look at the bones in your hip and the bottom of your spine.

Treating and preventing osteoporosis

Diet, supplements and exercise

It is important that you get enough calcium and vitamin D. These help to keep your bones strong. The best way to do this will depend on your condition. Talk to your medical team about what will work for you. This could mean adding some new foods into your diet or taking supplements.

Always talk to your medical team before taking any extra vitamins or supplements. Some supplements can change the way your medicines work or cause more damage to your liver.

Keeping to a healthy weight can reduce your risk of osteoporosis.

Exercise is also important. Regular weight-bearing exercise is good for your bones. Weight-bearing exercise is anything where your feet and legs are supporting your weight.

High impact exercise like running, dancing or skipping is especially good. But if you are not already doing this kind of exercise, start with something lower impact, like walking regularly.

If you find it hard to be active, ask your medical team for advice or for a referral to a physiotherapist.

Find out more about eating, drinking and keeping active.

Alcohol and smoking

Stopping smoking and cutting down or giving up drinking can both help your bones. Speak to your medical team or GP to find out if there are any services in your area that can help.

Download our thinking about cutting down on alcohol factsheet

More help with stopping smoking

Changing medicines

Some medicines can increase your risk of breaking bones. If you have, or are at risk of osteoporosis, ask your doctor or pharmacist to check your regular medicines. You may need to stop some medicines or change to a different type.

Medicines to treat osteoporosis

Medicines are sometimes used to treat osteoporosis.

Bisphosphonates

These are usually taken as weekly tablets. If you have problems with bleeding from your digestive system (varices) you might need to have bisphosphonate in a drip instead. The drip is given in hospital, usually once a year.

Denosumab

If you need treatment for osteoporosis and cannot have bisphosphonate tablets you might be given a medicine called denosumab. This is given as an injection usually once every 6 months. You will have to go to your hospital or GP to be given the injection.

There are also other medicines available if you have severe osteoporosis and are at high risk of fractures. Or if you are not able to take the medicines above.

Living with osteoporosis

Being told you are at risk of bone fractures can be very worrying. There may be diet and exercise changes that could help. But it is important to get personal advice from your medical team to work out the best plan for you. This needs to take into account your medical condition, your medicines, and what is practical for you at the moment.

The Royal Osteoporosis Society also has lots of information including videos of exercises that can help your bones.

Getting support

It can help to talk to other people who have a similar experience. The British Liver Trust offers a variety of support, including support groups and an online forum.

We also have a helpline run by our team of specialist liver nurses.

Find out more about how we can support you.

We also offer support to those closest to someone with a liver condition. You can find more information in our Family, friends, and carers section.

More information:

Find out about other cirrhosis complications

Special thanks

We would like to thank all of the medical specialists, and people with personal experience of cirrhosis who helped us to plan, develop, and review this information.

Including members of our patient advisory group, Jennifer Voller, Michael Kennedy, Dr Victoria Kronsten, Senior Clinical Research Fellow in Hepatology, King’s College Hospital, Katharine Caddick, Consultant Nurse, North Bristol Trust, Maria-Emanuela Maxan, Senior Clinical Research Fellow in Hepatology, King’s College Hospital and Dr Vishal Patel, Consultant Hepatologist, Kings College hospital.

Published: March 2025