Preventing osteoporosis is a major concern for the more than 40 million people in the United States who are at high risk of developing this disease. Literally meaning “porous bones,” osteoporosis is caused by low bone mass and deterioration of bone tissue that can lead to stooped posture, painful and debilitating fractures, collapsed vertebrae and loss of mobility. Though it can strike at any age, osteoporosis most commonly affects older adults. The earlier you can take steps to prevent osteoporosis, the better—but bone-building strategies can be effective as you age, too. Understand the risks, when to get a bone scan and what you can do now to protect yourself.
How Your Bones Age
Bones have a dense outer shell that encases a sponge-like inner tissue. When bones weaken—due to nutrient deficiencies, atrophy from lack of use or hormonal changes that occur with age—the holes in the spongy tissue get larger and more numerous. Over time, this causes the bone to lose density and become more brittle. Once this happens, any trip, slip or fall can cause a fracture.
Most of us build more bone than we lose until we’re about 30 years old, reaching our peak bone density in our twenties. But after age 35, bone breakdown happens more quickly than bone building, putting us at risk for osteoporosis. This age-related risk is more pronounced in women, who naturally do not have as much bone tissue as men. In addition, estrogen level drops that come with the onset of menopause can contribute to a more rapid loss of bone mass. One in two women will experience an osteoporosis-related fracture in their lives, compared to one in four men. Researchers have recently found that the combination of bone thinning and age-related depletions in skeletal muscle mass also increases the risk of fractures, especially in older men.
Osteoporosis Risk Factors
Often called the silent disease, osteoporosis sets in without triggering alarm bells: You might not know you have it until your bones become so weak that a sudden strain, bump or fall causes a fractured wrist, a cracked rib or a collapsed vertebra. These are the most common sites for fractures, because of how the body bears weight and how people tend to fall.
Besides gender and increasing age, common risk factors for osteoporosis include:
- Small body frame: Underweight people put less pressure on their skeletons, which means less bone strengthening from daily activities.
- Ethnicity: White and Asian individuals are at greater risk.
- Family history of osteoporosis: This disease tends to be hereditary, though you can still develop it if no one in your family has had it before.
- Smoking, or excess caffeine, alcohol or sodium intake: Each of these disrupts the bone-building process.
- Low sex hormones: The body uses estrogen and testosterone as part of the bone-building process, so low levels can impact density.
- Some medications: Prescriptions such as oral corticosteroids (used to treat inflammation, pain and chronic conditions such as asthma and rheumatoid arthritis) and seizure and acid reflux medications can contribute to decreased bone density.
- History of nontraumatic fracture: Bones need a reason to break, so having a fracture that’s not related to a significant injury (like a twist or a fall) is a good sign that bones are becoming too thin. This type of fracture is one of the highest predictors of osteoporosis risk.
- Celiac disease: The disease can impact the small intestine's ability to adequately absorb calcium (as well as other important nutrients).
- Eating disorders (such as anorexia nervosa): Restrictive diets are often low in calcium and vitamin D—bone-strengthening essentials.
The best test for osteoporosis is the dual emission x-ray absorptiometry (DEXA) scan—a very low level x-ray that measures the density of bones and predicts the risk of fracture. DEXA scans are available at most hospitals, imaging facilities and many doctors’ offices.
The National Osteoporosis Foundation (NOF) recommends that men get a bone density screening at age 70, women at age 65—though at Canyon Ranch we suggest women consider screening prior to age 50 because they already have a 50 percent lifetime risk of developing a fragility fracture by then.
The NOF also recommends screenings if:
- You’re a younger postmenopausal women, a woman in the menopausal transition or a man age 50 to 69 with clinical risk factors for a fracture.
- You’ve had a fracture after age 50.
- You have a condition (like rheumatoid arthritis) or take medications, like those mentioned above, that can cause low bone mass or bone loss.
Talk to your doctor about when you should be screened based on your risk factors and lifestyle.
How to Protect Yourself
Though these healthy habits have their most powerful effects the earlier you put them to work for you, starting them at any age can still bring you benefits that can help fend off osteoporosis. If you’ve already been diagnosed, these steps can help slow or even stop the progression of the disease.
- Get enough calcium. Bones contain a lot of calcium, which makes this a crucial nutrient in your diet. You should consume at least 1,000–1,200 mg of calcium each day (a cup of fat-free milk provides about 300 mg), mostly through your diet. Leafy greens, dairy products and beans are all good sources. If you’re lactose intolerant or aren’t getting enough calcium in your diet, talk to your doctor about a supplement. It’s also important to get enough magnesium, vitamin K and B vitamins.
- And don’t forget vitamin D. Vitamin D helps your body absorb calcium. According to recommendations from the Institute of Medicine, people who are 70 or younger should get 600 IU each day; older people need 800 IU, while those who are vitamin D deficient should aim for 1,000 IU each day. Talk to your doctor about the amount that’s right for you—some people need between 1,000 and 2,000 IU each day to prevent bone loss. Vitamin D can be found in enriched or fortified juices, cereals and dairy products, as well as fatty fish, such as salmon or canned light tuna. Ten to 15 minutes of sun exposure also provides a healthy dose vitamin D, so consider this yet another reason to go outside for some fresh air each day. Your doctor may check your vitamin D level and, depending on the result, may suggest you take a supplement (there are also calcium/vitamin D combos available) if your diet or lifestyle are lacking.
- Do weight-bearing exercises. Studies have shown that resistance exercise increases bone density and reduces the risk of fractures. The physical stress from lifting weights activates bone cells called osteoblasts to build bone, according to researchers at the University of New Mexico. And activities that put impact on your legs and feet, such as walking, hiking and jogging, can have the same effect. They also help improve balance and agility, which can minimize falls. Aim to exercise aerobically for at least 30 minutes most days of the week and do strength training moves a few times a week. “Keep in mind the power of exercise: If your muscles are strong and you have good balance, your likelihood of a fall and fracture is reduced—independent of your bone density.”
- Lower Your Sodium Intake. When you overload on salt, your body excretes more calcium in your urine. Try to keep sodium below 2,300 mg a day, the equivalent of about a teaspoon of salt, unless you are age 51 or older, have high blood pressure or are African American, in which case you should aim for a maximum of 1,500 mg.
- Curb caffeine consumption. While the research is mixed on the caffeine and osteoporosis connection, it’s smart to limit your consumption. Stick to a maximum of 300 mg, or three cups of coffee, a day.
- Don’t smoke. Cigarette smoke generates free radicals, toxic molecules that upset the balance of hormones in the body (like estrogen) that bones need to stay strong. Smoking also leads to increased levels of the hormone cortisol, which impedes production of the bone-building hormone calcitonin.
- Limit alcohol. Alcohol interferes with calcium absorption. Experts suggest that women and men limit themselves to one and two drinks a day, respectively.