What are the issues for those in employment?

Although osteoporosis mostly affects people in later life, by which time they’ve retired or are considering retirement, there are a significant number of people of working age with the condition. In addition, there are those people who choose or need to continue working past retirement age.

If you’ve been told you have osteoporosis, it’s quite likely you’ll be wondering what this means for you in the workplace. You may be feeling worried or anxious and, if you have had fractures, you may be in pain.

You may be unemployed and looking for work or you may be thinking about changing jobs. Perhaps you have had a bone density scan and been told you have ‘low bone density’ but feel fully well as osteoporosis causes no symptoms until a bone is broken (fractured).

Yet the diagnosis may leave you wondering if you’ll break a bone easily in your workplace and if you’ll lose your job. You may be suffering persistent pain (especially in your back) or disability as a result of one or more fragility fractures.

These situations are likely to leave you wondering how osteoporosis will affect your work and how work will affect your osteoporosis.

What does it mean for my job and career?

This very much depends on your individual situation. Being told you have osteoporosis need not mean the end of your job or career. Your ability to do your job will depend on whether you are likely to break bones easily doing your job or whether you have pain and mobility problems as a result of fractures that makes some types of work difficult or impossible.

If you are currently in a fit state to work and you’re not in pain from any other cause, you would only need to tell you employer about your osteoporosis if you felt that adjustment was needed in your workplace or to your job role. Not everyone with a diagnosis of osteoporosis on a bone density scan has a high risk of breaking bones. If you have low bone density but no other significant risk factors, such as being over 50 or having broken bones very easily, then your current risk of fracture will still be relatively low; you aren’t ‘disabled’ and you don’t need to make any changes at work. Similarly, if you’ve had fragility fractures but have no lasting effects, including pain problems that affect your ability to work, then having a diagnosis of osteoporosis should have no implications for your employment. However, if one or both of the following applies to you, then there may be some implications for your job or career and the rest of the information in this factsheet will be relevant:

  1. Your ‘fracture risk’ is relatively high and, in addition, your job involves activities which could increase the likelihood of fractures, especially bending and heavy lifting (spinal fractures) or a high risk of falling. Your ‘fracture risk’ is something you may need to discuss in more detail with your doctor or you can contact the charity’s Helpline (‘high risk’ usually means you have been told you have osteoporosis following a DXA scan and you also have other risk factors such as having broken bones easily already, especially in your spine or you are over 50).
  2. You have pain or mobility problems (short or long term) as a result of fractures that could affect your ability to work effectively. In addition, your job involves activities that could increase your pain or symptoms. This could be heavy physical work or other demands such as sitting or standing for long periods. The common sites for fragility fractures are the wrist, hip and spine. For those in employment, the sites most likely to be affected are the wrist and spine. Hip fractures are possible too but are more common in the older population. Some people may suffer rib, arm or pelvic fractures.

I have had fragility fractures. Should I tell my employer?

This will depend on the type of work that you do. If your work doesn’t involve a risk of falling or heavy or awkward lifting that might cause fractures and doesn’t involve any activity you would find difficult following fractures, then you wouldn’t need to discuss osteoporosis with your employer.

If you have no pain or mobility problems as a result of fractures, then you are under no obligation to tell your employer as you don’t have any disability that affects your ability to carry out normal activities. If you’re experiencing problems, such as pain or inability to carry out tasks which you were able to do previously, it’s important to speak to your employers.

This is because both you and your employer have responsibilities in relation to Health and Safety at work legislation. You have a duty to inform your employer about any new symptoms or diagnoses which have relevance to your work and your employer has a duty to make reasonable adjustments within the workplace to accommodate your needs.

The two relevant pieces of legislation are the Health and Safety at Work Act 1974 and the Equality Act 2010. The Equality Act helps to prevent discrimination on grounds of disability in the workplace.

A disability is defined in the Act as:

  • ‘A physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out normal day-to-day activities.’

It states that:

  • ‘substantial’ is more than minor or trivial, e.g. it takes much longer than it usually would to complete a daily task like getting dressed.
  • ‘long-term’ means 12 months or more prone to fracture while osteoarthritis is a disease

Could I lose my job or be told to change my role?

As long as your employer knows about your particular problems, you are protected against unlawful discrimination on the grounds of disability. It’s unlawful for employers to ask about the health of applicants before offering them a job although there are exceptions, such as if they need to know if an applicant can carry out tasks which are an essential part of the job.

Who should I tell? What can be done?

If you are someone with ongoing pain problems after fractures or at high risk of breaking bones and needing to avoid ’risk’ activities, it’s probably best to talk to your line manager in the first instance. If your organisation has an occupational health department, you could be referred for an assessment.

This gives you the chance to explain any difficulties you are experiencing in detail so that your employer has a full understanding of your needs in order to provide you with the right support to continue in your post. It’s often possible to continue in the same role with a few reasonable and simple adjustments. The occupational health department may make recommendations following an assessment. For instance, if you have had spinal compression fractures and have back pain, a visual display unit (VDU) assessment can be helpful and may result in you being offered better seating and more appropriate positioning of computers or other equipment. It may result in the installation of new equipment, for example: rails, ramps, an adjustable-height desk, lifting equipment or a parking space being made available close to your workplace.

If you continue to have problems carrying out your job, it may be possible to have an adaptation to your role so that you are exempt from certain tasks, such as lifting, for instance. Further outcomes might be flexible working arrangements, working part-time or from home or being exempt from shift work.

Throughout proceedings, it is important to keep in close communication with your manager, the occupational health department and, if there is one, the Human Resources (HR) department. If a change to your role is not possible or if you continue to experience problems you may need to consider reducing your hours or, in some cases, changing your job or retiring.

If there are problems between you and your line manager in having your needs understood, your HR department should be able to help. In some cases, involving a trade union representative may be necessary, for instance, if your employer is expecting you to carry out tasks which you feel are unreasonable given your level of pain, disability or risk of fracture. A trade union can be a useful resource for information, guidance and support.

Guidance for employers

Fortunately, there is very useful guidance available, particularly from the Department for Work and Pension (DWP), for employers about employing people with disabilities. It provides useful information under headings such as 'Why recruit disabled people?', 'Help employing disabled people; Disability Law' and so on. It might be beneficial to let your employer know about this guidance for, if both parties are as fully informed as possible, communication and resolution of problems is likely to be quicker and smoother.

There is also a forum called the Employers’ Forum on Disability, which works for the mutual benefit of business and people with disabilities.

Another option is the Access to Work scheme (AtW), which is a specialist service delivered by Jobcentre Plus. An AtW grant can pay for practical support if you have a disability, health or mental health condition. The scheme provides an Employer’s Guide to Access to Work which aims to support employers in supporting their employees with disabilities or health problems. Full details can be found on www.gov.uk and in the contact list below.

What adaptations should I make at work to avoid fractures?

Unfortunately, there’s no simple answer to this question as it’s going to be different in each case depending on the nature of the job. Heavy lifting is usually not feasible. For instance, there will be greater concerns for those in jobs which involve lifting, manual labour or physically demanding work including carers, gardeners, farmers and those who lift boxes and packages, such as supermarket workers and postal workers. 

These jobs will often involve ‘loaded lifting’ types of movement (bending and lifting), which may increase the risk of compression fractures in the spine.

You and your line manager, together with your HR department, will need to discuss your worries, needs and preferences as well as how your employer might be able to help, taking into account employment law legislation.

Adaptations that may be helpful include:

  • precautions to prevent falls, such as no work at heights (ladders, ropes, scaffolds) and the removal of loose rugs that might cause a ‘trip’
  • precautions to help prevent spinal fractures, such as adapting ‘loads’ so they are smaller and more manageable, decreasing repetitive bending, twisting and turning and increasing rest periods to ensure tiredness doesn’t lead to less safe lifting

What adaptations should I make at work to avoid problems with pain and fatigue after fractures?

It will depend on how well you are recovering from any recent fractures, especially taking into account enduring pain and, of course, whether you have other conditions causing pain and disability, such as osteoarthritis.

As a general rule, just as in life outside the workplace, there are some broad guidelines especially following painful spinal compression fractures. It’s best, for instance, to vary jobs throughout the day so that concentrated periods are not spent in one position.

Paying attention to posture will help, especially if you’re in a ‘sitting’ job. Alternate between sitting and standing or walking. Prioritise tasks and pace yourself. Avoid any activity which brings on pain. Always use equipment provided even if you’re currently pain-free.

The particular issues affecting you will also vary depending on the workplace.

If you are using strong pain-relieving medications, there may be company drug policies and safety issues you will need to discuss with your managers.

Which financial help and benefits am I entitled to?

Although work can provide numerous rewards, such as a sense of achievement, improved self-esteem, a sense of independence and social contact, for most people, work is essential for financial reasons. If you have to reduce your working hours, then getting financial help may become important.

A diagnosis of osteoporosis in itself does not entitle you to financial help or benefits as benefits are awarded depending on need resulting from disability, not the condition itself. If you’re suffering persistent pain, changes in posture or disability arising from fragility fractures, you may be entitled to benefits or one-off payments. 

Our factsheet, Living with Osteoporosis: Financial Help After Fractures, contains details of these benefits. For further help, see the contacts below.

What about other options, such as volunteering?

In some situations, continuing in your present job might not be possible. Reducing your hours or moving to a different role within your workplace might be worth discussing before considering a change of employment.

Sometimes, retirement or finding a different type of job might feel like the best choice for you. If you decide to stop your paid job, then voluntary work might be acceptable and give you control over the activities you decide you can manage and the time you spend on them.

Although the work would be voluntary, you might be able to claim expenses, such as travel costs, food and drink. You can also expect to receive a volunteer agreement when you start which covers any training and support you’ll have, health and safety issues and whether or not you’re covered under the organisation’s public liability insurance.

You can find out more on the gov.uk website under 'volunteering and volunteers’ rights'. The types of activity which you can safely carry out will depend on your risk of fracture just as in paid employment.

The same sensible precautions will also need to be taken, such as using lifting equipment where provided and letting the organisation know about your condition if it’s relevant.

Useful contacts

Access to Work (AtW)
This is a specialist disability service from Jobcentre Plus that gives practical advice and support to disabled people, whether they are working, self-employed or looking for employment.
Tel: 0345 268 8489
For employers: www.gov.uk/government/publications/access-to-work-guide-for-employers

An independent, not-for-profit website providing accurate, helpful information on rights and legal issues for people who need it.

Age UK
Age UK inspires, enables and supports older people to help people make the most of later life.
Tel: 0800 169 656

Citizens Advice
Helps people resolve their legal, money and other problems by providing free, independent and confidential advice.
Wales: 08444 77 20 20
England: 08444 111 444
Scotland: 08454 040506

Department for Work and Pensions (DWP)
Contact the DWP for new benefit claims and general enquiries relating to the Jobcentre, Pension Service, Disability and Carers Service or Child Maintenance.
Tel: 0843 504 7178
For employers: www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers

Disability Rights UK
A leading authority on social security benefits for disabled people and publishes the Disability Rights Handbook.
Tel: 020 7250 3222

DIAL Network - Local disability information and advice
Provides information and advice to disabled people and others on all aspects of living with disability (based throughout England and Wales).
Tel: 0808 800 33 33

Equality Advisory and Support Services (EASS)
Advises and assists individuals on issues relating to equality and human rights across England, Scotland and Wales.
Advice line: 0808 800 0082

Equality Commission for Northern Ireland (ECNI)
Tel: 028 90 500 600

For employers:

Employers’ Forum on Disability (EFD)
A leading employers’ organisation focused on disability as it affects business. They make it easier to employ and do business with disabled people. They are supported by a growing list of members from UK business, multinational corporations and the public sector.
Tel: 020 7403 3020

The Advisory Council and Arbitration Service (ACAS)
Provides information, advice, training, conciliation and other services for employers and employees to help prevent or resolve workplace problems.
Tel: 0300 123 1100 (8am-8pm Monday to Friday and 9am-1pm Saturday)
Text Relay service: 18001 0300 123 1100

Law Centres Network
Law Centres defends the legal rights of people who cannot afford a lawyer. They are specialists working in their local communities to uphold justice and advance equality.
Find your local law centre: www.lawcentres.org.uk

Turn2us is a charity that helps people in financial need to access welfare benefits, charitable grants and other financial help online, by phone and face to face through partner organisations.
Tel: 0808 802 2000

Occupational Health & Safety Advisory Service (OHSAS)
Advice and support across a range of workplace services for employers and employees to help prevent or resolve workplace problems.