Risk factors you can change

Smoking weakens your bones, making them more likely to break. In particular, smoking increases your chance of breaking a bone in your spine or hip.

If you smoke, stopping can reduce your chance of osteoporosis and broken bones. The NHS website Quit smoking has information and advice to help you stop smoking.

E-cigarettes and vaping

We know less about the effects of e-cigarettes or vaping on your bones. The information we have shows that the chance of breaking a bone is higher in people who use e-cigarettes than those who do not.

Drinking too much alcohol increases your chance of osteoporosis and breaking a bone. Drinking alcohol also increases your chance of falling over. In particular, drinking more than three and a half units a day increases your chance of breaking your hip.

The recommended amount of alcohol is 14 units or less per week for both men and women. Find out more about what a unit of alcohol is on the NHS website. They also have advice and support to help you cut down or stop drinking.

Body weight is often measured as BMI (body mass index). You can work out your BMI using the NHS online calculator.

Being underweight can increase your chance of breaking a bone. Guidance varies around the point at which being underweight becomes a risk factor for osteoporosis. The NHS calculator classes being underweight as having a BMI of less than 18.5kg/m².

A healthy BMI for your bones and your general health is between 20 and 25kg/m².

The chance of developing osteoporosis and broken bones is also related to how much muscle you have. Having a reduced muscle mass and strength increases your chance of falls and broken bones.

For some people, gaining weight can be difficult. The NHS website has some tips to help you gain weight by adding healthy calories to your diet.

If you are worried that you are underweight and are finding it difficult to gain weight, speak to your GP.

Having enough calcium, vitamin D, protein and other nutrients helps to keep your bones healthy.

If you do not have enough of these important nutrients, you may have a higher chance of osteoporosis and breaking a bone.

Calcium helps to build your bones. And vitamin D helps your body to absorb and use calcium. It also helps to keep your muscles strong. If you have low levels of vitamin D, you are also more likely to fall over. So, not getting enough calcium and vitamin D can increase your chance of osteoporosis and broken bones.

Find out more about calcium and vitamin D and eating well for your bones.

Protein is also important for your bone and muscle health. A diet that is high in protein can increase bone strength and reduce the chance of broken bones. Sources of protein include:

• meat, fish and eggs

• dairy, such as milk, cheese and yoghurt

• dairy alternatives, such as soya and almond milk products

• beans, peas, lentils, nuts and seeds.

Planned weight loss in people who are overweight or obese can help to improve health in many ways. It can improve your heart health and reduce your chance of diabetes and some cancers.

Large amounts of weight loss, particularly over a short time, can affect bone strength. But we do not know yet the impact that this has on the chance of breaking a bone.

A restricted calorie diet may reduce bone strength. The more weight you lose, the more bone strength you may lose. We do not know yet if this increases the chance of a broken bone.

Surgery for obesity (sometimes called bariatric surgery) also causes reduced bone strength. People who have had surgery for obesity have an increased chance of broken bones.

Weight loss medicines

The use of weight loss medicines is increasing. These include medicines such as semaglutide (brand name Wegovy), tirzepatide (Mounjaro) and liraglutide.

We have not used these medicines to treat obesity for very long. So, it is not currently clear how they affect our bones. Some studies have shown that using these weight loss medicines has a similar effect on your bones as a restricted calorie diet. The effect may be greater in people who lose more weight. We do not yet know if these medicines increase your chance of breaking a bone.

Contact your GP if you have questions about weight loss medicine and your bone health.

If you lose weight rapidly, up to a third of the weight you lose will be lean mass. Lean mass includes muscles, bones, organs and body water. Losing lean mass can reduce bone strength and increase the chance of falls. This makes it more likely that you will break a bone.

Falling over can increase your chance of breaking a bone, especially if you have osteoporosis. A combination of good balance, coordination and reflexes can help to reduce your risk of a slip, trip or fall. The good news is there are things you can do to help yourself stay steady on your feet.

See osteoporosis: Avoiding slips, trips and falls for more information and tips on how to reduce your chance of falling over. Or watch our short video 5 simple ways to help prevent broken bones.

Age UK (www.ageuk.org.uk) also has information on preventing falls, including a guide on Staying steady (PDF).