What Is Osteoporosis?
Osteoporosis, which means "porous bone," is a condition that causes bones to gradually thin and weaken, increasing their risk of fractures. About 2 million fractures in the U.S. each year are due to osteoporosis.
Although all bones can be affected by the disease, the bones of your spine, hip, and wrist are most likely to break. If you're older, hip fractures can be particularly dangerous. Having to stay still for a long time during the healing process can lead to serious complications, such as blood clots or pneumonia.
Of the estimated 10 million Americans who have osteoporosis, at least 80% are women or assigned female at birth. Experts believe this is due to women having lighter, less dense bones and experiencing hormonal changes after menopause that speed up bone mass loss.
Osteopenia vs. Osteoporosis
Osteopenia and osteoporosis are related, but they are two separate diagnoses. You could think of osteopenia as "pre-osteoporosis." If you have osteopenia, your bones are also losing mass, and they could break more easily. If you continue to lose more bone density, osteopenia becomes osteoporosis.
When you go for a bone density test, your density is compared to someone of your sex and race who has peak bone mass, usually someone who is between 25 and 30. The result is called a T-score. These are the three possible T-scores:
- −1 to +1: You have normal bone density
- −1 to −2.5: Your bone density is lower than it should be and you have osteopenia
- −2.5 or lower: Your bone density is too low and you have osteoporosis
If you have osteopenia, you can take steps to slow down bone density loss. Some people can even reverse it with treatment.
What Causes Osteoporosis?
When you're younger, bone in your body is broken down and replaced continuously, a process known as bone remodeling. Bone mass usually peaks in your mid- to late-20s.
Bone loss — when bone breakdown happens faster than bone buildup — usually begins in your mid-30s. Bones begin to lose calcium, the mineral that makes them hard, faster than they can replace it. Less bone remodeling takes place, and the bones begin to thin.
If you're a woman or person assigned female at birth, the loss of bone density speeds up during the first 5-7 years after menopause and then slows down again. Scientists believe that’s because of a sharp decline in your body's production of the hormone estrogen, which appears to help keep calcium in the bones.
Although some loss of bone density is a natural part of aging, you’re at a higher risk of getting the very porous bones and fractures associated with osteoporosis if you:
- Are thin or have a small frame
- Smoke, drink more than moderately, or live a sedentary lifestyle
- Have a family history of hip fracture
- Had your ovaries removed, especially before age 40
- Are white or Asian
Certain medical conditions that increase bone breakdown, including kidney disease, Cushing's syndrome, and an overactive thyroid or parathyroid, can also lead to osteoporosis. Steroids and anti-seizure drugs, as well as long-term immobility because of paralysis or illness, can also cause bone loss.
Osteoporosis Tests and Diagnosis
To make a diagnosis, your doctor will usually take a full medical history and order a bone density test and possibly other tests.
During an exam, your doctor will:
- Look at your age, consider whether you've reached menopause, whether you have ever broken a bone as an adult, your own family history, and your habits such as drinking, eating, and exercise.
- Ask about which medications you take. Some drugs, such as corticosteroids, can weaken the bones if taken long-term.
- Measure you to see if you’ve lost height. The doctor will inspect your spine. If it abnormally curves forward, that could be a sign that you've already had spinal fractures due to osteoporosis.
A bone density test is noninvasive. It’s like an X-ray. As you lie on a special table, a robotic arm passes over and measures the concentration of minerals in the bones in your hip, spine, and wrist. Some scans check your entire body. Your doctor will compare your results to what’s normal and find out if you have normal bone density, osteopenia, or osteoporosis.
Osteoporosis Treatment
Your doctor may recommend some steps to help you stop more bone loss and lower your risk of fractures. These include stopping smoking if you smoke, cutting down on alcohol consumption, eating a healthy diet, and exercising.
If your osteoporosis was caused by a medical condition or medications that you take, your doctor will address this. For example, if one of the side effects of a medication is bone loss, there might be an option to switch medications. This isn’t always possible though. In this case, your doctor will check you regularly to monitor your bone health.
Osteoporosis medications
Osteoporosis medications can help limit bone breakdown and maintain bone density, lowering your risk of an osteoporotic fracture. Most of these drugs have been shown to lower the risk of fractures in your hips and back.
Bisphosphonate drugs are usually the standard treatment for osteoporosis. Examples include:
- Alendronate (Fosamax, Binosto)
- Ibandronate (Boniva)
- Risedronate (Actonel, Atelvia)
- Zoledronic acid (Reclast, Zometa)
Other drug options to protect against bone loss include:
- Abaloparatide (Tymlos) and teriparatide (Forteo): A synthetic form of parathyroid hormone for people with osteoporosis who are considered at high risk for fracture. These medications help build bone density.
- Calcitonin: A naturally occurring hormone that helps prevent fracture and may help slow bone loss.
- Denosumab (Prolia, Xgeva): An antibody that prevents the formation of cells that break down bone, resulting in less bone loss.
- Raloxifene (Evista): An estrogen-like drug that helps increase bone density and reduces fracture risk.
- Romosozumab-aqqg (Evenity): An anti-sclerostin antibody that works to increase bone formation and reduce bone loss.
If you start taking a bone-maintenance drug, be sure your doctor knows about all other medicines you’re on. Some drugs can affect the bones, and your doctor may want to switch you to another drug or adjust the dose.
If you’re taking a bisphosphonate, you may be switched to another drug after 5 years, as there's a low risk of thigh bone fracture linked to long-term use of these drugs.
Other osteoporosis medications could include hormone replacement therapy (HRT) — either estrogen alone or a combination of estrogen and progestin — which can prevent and treat osteoporosis.
But research has shown that HRT may increase the risk of breast cancer, heart disease, and stroke in some people. So, HRT isn't generally recommended as a first treatment of osteoporosis, as the health risks are thought to outweigh the benefits.
Osteoporosis Diet
Your body needs calcium and vitamin D to help nourish your bones. If you don’t already include foods high in calcium and vitamin D, adding them to your diet might help you slow down bone loss.
Here are some foods that are high in calcium:
- Low-fat dairy products
- Dark green leafy vegetables, such as turnip greens, spinach, and bok choy
- Broccoli
- Sardines and salmon (with bones)
Some foods are fortified with calcium, which can help you reach your daily recommended amount. They include:
- Soy milk
- Tofu
- Orange juice
- Cereals
- Breads
You can get some vitamin D from the sun, but you can also get some from certain foods, such as:
- Fatty fish
- Fish oils
- Egg yolk
- Liver
Some foods, such as milk and cereals, are fortified with vitamin D.
How much calcium and vitamin D you need depends on many things, including your health and if you can absorb food properly. These are the average recommended amounts:
Calcium
- Women and people assigned female at birth (AFAB) younger than 50: 1,000 milligrams per day
- Women and people AFAB 50 or older: 1,200 milligrams per day
- Men and people assigned male at birth (AMAB) younger than 71: 1,000 milligrams per day
- Men and people AMAB aged 71 or older: 1,200 milligrams per day
Vitamin D
- All adults younger than 55: 400-800 International units (IU) per day
- All adults 55 or older: 800-1,000 IU per day
Fractures from Osteoporosis
Fractures from osteoporosis often happen in the hip, wrist, and spine. Hip fractures often require surgery. Wrist fractures may need casting or surgery.
Spine, wrist, and hip fractures are the most common in seniors. Weak bones can lead to a compression fracture in the vertebrae, the bones that form your spine. Over time, compression fractures can change the strength and shape of your spine. You may lose height or have chronic back pain. In some people, the pain can be severe and lead to other health problems.
Exercises for Osteoporosis
If you have osteoporosis, exercise might help you slow bone loss. It can also help you:
- Increase muscle strength
- Stay flexible
- Improve or maintain your balance
- Improve your posture
- Reduce pain
These can all reduce the risk of falls, lowering your risk of fractures.
Speak with your doctor before starting any new exercise program, especially if you have advanced osteoporosis. Your doctor might refer you to a physical therapist or an osteoporosis-friendly exercise program. You could also look to see if there are exercise programs in your neighborhood that cater to people with osteoporosis. Some personal trainers will work with people with osteoporosis as well.
Whichever type of exercise you decide on, start slowly and don’t believe the "no pain, no gain" way of thinking. If you have pain, stop.
Here are the different types of exercises that help people with osteoporosis.
Strength training. If your muscles are stronger, they can help protect your bones and reduce your risk of falling. You can:
- Use a weight machine.
- Lift free weights.
- Use resistance bands.
- Lift your own body weight.
Impact exercises (also called weight-bearing exercises). These make your body work against gravity and can strengthen bones. You can do low-impact or high-impact exercises, depending on your fitness level and health. For example, walking is a low-impact exercise, while running is high-impact. Others include:
- Dancing
- Stair climbing
- Tennis
- Aerobics
- Some forms of yoga
Balance exercises. Good balance helps you stay upright, which not only helps with walking and doing everyday tasks but can also help you avoid falling if you trip or slip. Exercises include:
- Yoga
- Tai chi
Flexibility exercises. Like balance exercises, flexibility exercises can help you keep from falling, but they can also keep your muscles and joints from getting too stiff:
- Yoga
- Stretching
Osteoporosis Prevention
You can’t prevent all bone loss because some loss happens with age. But you can take certain steps to slow down bone loss, especially if you’ve been diagnosed with osteopenia. The younger you are when you start these prevention steps, the better your chances of keeping your bones as healthy as possible.
- Eat a healthy diet, high in calcium and vitamin D
- Exercise. A combination of weight-bearing activities, muscle strengthening, balance, and flexibility exercises are best.
- Don’t smoke.
- Limit how much alcohol you drink.
Bone density testing won’t prevent osteoporosis, but it can tell you if you have osteopenia and you can take action to reduce the chances of it progressing to osteoporosis. Experts recommend getting a bone density test if you:
- Are a woman aged 65 or older
- Are a woman younger than 65 and have risk factors for osteoporosis
- Are a man over 50 with risk factors for osteoporosis
- Are over 50 and have lost 1.5 inches or more of height
- Take medications that cause bone loss or interfere with bone rebuilding
Takeaways
Some bone loss as you age is normal, but if you lose too much, you can develop osteoporosis, resulting in brittle bones. A bone density test can tell you if you have osteoporosis or osteopenia, which can lead to osteoporosis. If you do have osteoporosis, you might be able to slow down the bone loss and reduce your risk of getting a fracture with certain types of exercise.
Osteoporosis FAQs
What is the main cause of osteoporosis?
The main cause of osteoporosis is aging. As you age, your bones don’t regenerate bone cells as quickly as they did when you were younger. This worsens among women when they enter menopause.
Can vitamin D reverse osteoporosis?
You can’t reverse osteoporosis, but vitamin D combined with calcium may help slow down bone loss.
What is the best thing to do for osteoporosis?
If you have osteoporosis, the best thing you can do is take steps to slow down further bone loss and protect yourself from fractures. This means eating a healthy diet and exercising, which can keep your muscles strong and help you keep your balance and flexibility.
