TL;DR: Osteoporosis is a common condition caused by low bone mass and a higher risk of fractures. Bone loss can happen for many reasons, and anyone can develop osteoporosis. That’s why it’s important for everyone to know how to keep their bones healthy!
May is a month of renewal as plants and trees flourish with new growth and generations gather for graduations and gorgeous sun-filled days.
May is also Osteoporosis Awareness and Prevention Month. Just like the natural world, our bones are in a constant state of regrowth.
✨My mom has severe osteoporosis. I worry about her, and I worry about my own bones getting weaker during the menopause transition. But as a nerdy girl, I know that by connecting and learning from others, I can worry less and instead do the things that might actually help. So two years ago, I read Why Bone Health Should be a Priority by Nerdy Girl alumna Chana Davis. Connecting with Chana is how I first discovered Those Nerdy Girls. I’m honored to be here now, sharing information about prioritizing bone health!
➡️ Osteoporosis develops slowly over time.
Bone is a living tissue that’s constantly being broken down and built up. In fact, our whole skeletal structure is replaced about every 10 years [archived link]. This process is called remodeling.
In early adulthood, bone remodeling favors growth, making bones stronger. By age 30, bones typically reach their peak mass and then remain stable for a while. After age 50 or so, the remodeling process shifts to favor bone breakdown over regrowth, resulting in gradual bone loss.
Osteoporosis is a lifelong chronic condition caused by severe bone loss and an increased risk of a bone break (fracture), often in the wrist, hip, or spine. There’s no cure, and we’re still learning [archived link] more about why and how osteoporosis develops. The good news is that there are plenty of ways to prevent and treat osteoporosis, keeping our bones strong and bodies safe.
➡️ Many factors can slow down (or speed up) bone loss.
✅EXERCISE is one of the best ways to strengthen bones. Weight-bearing activities (like walking, dancing, or stair climbing) cause small impacts on your bones, which tells your body to grow more bone. Resistance training (like push-ups, squats, or weights) pulls on your bones, which also promotes bone regrowth. These exercises, as well as other activities that improve balance, can help protect your bones by reducing the risk of fractures from falls.
✨Check out this TNG post: How can I prevent falls at home?
✅ NUTRIENTS support bone health.
Some key nutrients for bone health are:
- Calcium: Combined with phosphorus, calcium helps form hydroxyapatite (a bone mineral that gives bones strength). Getting adequate amounts of calcium also prevents your body from taking calcium out of your bones to use in other places in the body.
- Vitamin D: Supports bone remodeling. It also helps calcium get absorbed into the body from the gut.
- Protein: Proteins provide structure and shape to bone in the form of collagen. Minerals fill in this framework to make bones hard. Together, they make bones strong and resilient.
Recommended daily amounts of each of these nutrients vary by age, pregnancy, nursing, and other factors. Your clinician can help you know if you’re getting enough from your diet. If needed, they can recommend ways to supplement.
Vitamin D is unique in that our bodies can make it when our skin is exposed to sunlight. But there’s a limit to how much vitamin D our bodies can make at one time[archived link], so not being sun safe only raises the risk of skin damage. Plus, you can also get vitamin D from foods and supplements. Routine vitamin D testing and supplementation aren’t recommended [archived link] for everyone. Many clinicians still recommend it for some people, so it’s best to discuss your individual needs with your clinician.
✅ SEX and AGE both affect osteoporosis risk. Older women generally have the highest risk. To start, women generally reach a lower peak bone mass than men. And then during the menopause transition, they lose more too. The average woman loses 7-10% [archived link] of bone mass, or even up to 20% [archived link], within a 5- to 7-year period beginning in the late stage of perimenopause. Both of these explain why women have four times the risk [archived link] of developing osteoporosis compared with men.
💡For transgender women and men, the age of transitioning and type of gender-affirming treatment may influence osteoporosis risk [archived link]. Discuss with your clinician how best to monitor your bone health and keep your bones strong.
After menopause, systemic estrogen hormone therapy may lower your chances[archived link] of getting osteoporosis. In fact, some estrogen-containing medications are FDA-approved for osteoporosis prevention in people with higher risks. Your clinician can help you weigh your overall risks and benefits to know if this option might be right for you.
✨ For info on menopause hormone therapy, check out this TNG post: What types of hormone therapy can help with hot flashes and other menopause symptoms?
✅ OTHER osteoporosis risk factors [archived link] include:
- Family history of osteoporosis or hip fracture
- White or Asian ancestry
- Low body weight, especially if 127 lbs (57.6 kg) or less [archived link]
- Menopause (especially if early or premature)
- A diet low in calcium, vitamin D, or protein
- Low levels of physical activity
- Smoking
- High alcohol intake
- Low testosterone in men
- Rapid weight loss
- Certain medical conditions (some examples):
Type 1 or 2 diabetes
Autoimmune conditions like lupus, celiac disease, and rheumatoid arthritis
Digestive conditions like irritable bowel syndrome (IBS)
Inflammatory bowel disease (IBD) like Crohn’s disease
High thyroid hormone (hyperthyroidism)
- Certain medications (some examples):
Long-term use of systemic corticosteroids
Proton-pump inhibitors
Some seizure or cancer medications
There are other factors not listed here. It’s important to talk with your clinician about your personal risk so you know how best to protect your bones.
➡️ How osteoporosis is diagnosed
Osteoporosis is considered a “silent disease” since many people have no noticeable signs or symptoms until they have a fragility fracture [archived link] — a bone break that occurs from a low trauma or fall from standing. Sometimes, a twist or pull can cause a weakened bone to break.
That being said, there are some clues that can sometimes show up with osteoporosis, including:
- Back pain
- Loss of height
- Stooped or hunched posture (kyphosis)
- Change in balance or gait (how you walk)
- Tooth loss [archived link]
Sometimes, an osteoporosis diagnosis comes after a bone break. Other times, osteoporosis is discovered during a routine screening test or assessment.
✨ Check out this TNG post, Should I be screened for osteoporosis?, written by Dr. Megan Madsen, a primary care physician and TNG contributing writer.
The DEXA scan (or DXA) [archived link] is a dual-energy X-ray absorptiometry test that measures bone mineral density, or BMD — a measure of the amount of minerals packed into each area of bone. A higher BMD means bones contain more minerals (mainly calcium and phosphorus). It also means they tend to be stronger and less likely to break. But keep in mind, the DEXA scan is only one part of assessing your fracture risk.
An initial DEXA screening is recommended for all women 65 or older [archived link] and some men over 70 [archived link]. Earlier testing is recommended if you have a higher risk of osteoporosis or fractures. Because there are MANY factors that could increase your risk of osteoporosis, it’s a good idea to talk to your clinician earlier, especially in the years leading up to menopause or if you have any significant health history, such as cancer or an autoimmune condition.
In addition to osteoporosis, the DEXA scan is also used to diagnose and monitor osteopenia (a less severe form of bone loss which can lead to osteoporosis). Both are assessed by comparing your BMD number to the typical peak BMD of a young adult. This comparison is called a “T score” [archived link]. The T-score is usually a negative number since DEXA scans are mostly done on older adults. The more negative the number, the more bone loss.
💡Research finds women who are Black, Hispanic, or Native American are less likely to be adequately screened [archived link]. Men are also more likely to be overlooked when it comes to osteoporosis screening. It’s important to know that osteoporosis occurs in women and men of all racial and ethnic backgrounds.
Catching bone loss in earlier stages allows for treatment, monitoring, and lifestyle changes that may prevent fractures.
➡️ Osteoporosis is a serious, lifelong condition. But it’s also treatable.
Maybe you broke a bone sometime in life. I broke my wrist rough-housing with my brothers when I was eight. At 33, I broke my foot when I stepped on uneven ground while giving my eight-year-old daughter a piggyback ride. Both times, my bones quickly healed. But I’m 50 now, and I know that if I break a bone now, I might not be so lucky.
Not only are bones more likely to break if you have osteoporosis, but they don’t heal as well either. Osteoporosis-related fractures can cause significant pain, loss of mobility, and changes in posture and daily functioning. My grandma broke her hip in her mid-70s. It was a traumatic experience. Thankfully, she fully recovered. But that’s not the case for many people after breaking a hip [archived link].
The good news is that osteoporosis and osteopenia are treatable with lifestyle changes and medications. Fractures can be prevented.
Stay tuned: In an upcoming post, we’ll discuss treatment options.
Stay strong. Stay supported. And stay osteo aware!
Further reading:
Vitamin D Fact Sheet for Consumers
Calcium Fact Sheet for Consumers
Worried About Osteoporosis? 4 Ways to Help Prevent the Disease
Fight osteoporosis with diet, exercise and facts
A type of Mediterranean diet may support weight loss and bone health
What The Updated Osteoporosis Screening Guidelines Means For You
