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Bone Health and Osteoporosis

6 months, 2 weeks ago

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Posted on Jan 08, 2024, 11 a.m.

Strong bones begin in childhood. With good habits and medical attention when needed, we can have strong bones throughout our lives. People who have weak bones are at higher risk for fractures.

You can improve your bone health by getting enough calcium, vitamin D, and physical activity. If you have osteoporosis or another bone disease, your doctor can detect and treat it. This can help prevent painful fractures.

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).

Osteoporosis is a “silent” disease because you typically do not have symptoms, and you may not even know you have the disease until you break a bone. Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Fractures can occur in any bone but happen most often in bones of the hip, vertebrae in the spine, and wrist.

However, you can take steps to help prevent the disease and fractures by:

  • Staying physically active by participating in weight-bearing exercises such as walking.
  • Drinking alcohol in moderation.
  • Quitting smoking, or not starting if you don’t smoke.
  • Taking your medications, if prescribed, which can help prevent fractures in people who have osteoporosis.
  • Eating a nutritious diet rich in calcium and vitamin D to help maintain good bone health.

Who Gets Osteoporosis?

Osteoporosis affects women and men of all races and ethnic groups. Osteoporosis can occur at any age, although the risk for developing the disease increases as you get older. For many women, the disease begins to develop a year or two before menopause. Other factors to consider include:

  • Osteoporosis is most common in non-Hispanic white women and Asian women.
  • African American and Hispanic women have a lower risk of developing osteoporosis, but they are still at significant risk.
  • Among men, osteoporosis is more common in non-Hispanic whites.

Certain medications, such as some cancer medications and glucocorticoid steroids, may increase the risk of developing osteoporosis.

Because more women get osteoporosis than men, many men think they are not at risk for the disease. However, both older men and women from all backgrounds are at risk for osteoporosis.

Some children and teens develop a rare form of idiopathic juvenile osteoporosis. Doctors do not know the cause; however, most children recover without treatment.

Symptoms of Osteoporosis

Osteoporosis is called a “silent” disease” because there are typically no symptoms until a bone is broken. Symptoms of vertebral (spine) fracture include severe back pain, loss of height, or spine malformations such as a stooped or hunched posture (kyphosis).

Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of:

  • Minor falls, such as a fall from standing height that would not normally cause a break in a healthy bone.
  • Normal stresses such as bending, lifting, or even coughing.

Causes of Osteoporosis

Osteoporosis occurs when too much bone mass is lost, and changes occur in the structure of bone tissue. Certain risk factors may lead to the development of osteoporosis or can increase the likelihood that you will develop the disease.

Many people with osteoporosis have several risk factors, but others who develop osteoporosis may not have any specific risk factors. There are some risk factors that you cannot change, and others that you may be able to change. However, by understanding these factors, you may be able to prevent the disease and fractures.

Factors that may increase your risk for osteoporosis include:

  • Sex. Your chances of developing osteoporosis are greater if you are a woman. Women have lower peak bone mass and smaller bones than men. However, men are still at risk, especially after the age of 70.
  • Age. As you age, bone loss happens more quickly, and new bone growth is slower. Over time, your bones can weaken and your risk for osteoporosis increases.
  • Body size. Slender, thin-boned women and men are at greater risk to develop osteoporosis because they have less bone to lose compared to larger-boned women and men.
  • Race. White and Asian women are at highest risk. African American and Mexican American women have a lower risk. White men are at higher risk than African American and Mexican American men.
  • Family history. Researchers are finding that your risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis or hip fracture.
  • Changes to hormones. Low levels of certain hormones can increase your chances of developing osteoporosis. For example:
    • Low estrogen levels in women after menopause.
    • Low levels of estrogen from the abnormal absence of menstrual periods in premenopausal women due to hormone disorders or extreme levels of physical activity.
    • Low levels of testosterone in men. Men with conditions that cause low testosterone are at risk for osteoporosis. However, the gradual decrease of testosterone with aging is probably not a major reason for loss of bone.
  • Diet. Beginning in childhood and into old age, a diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures. Excessive dieting or poor protein intake may increase your risk for bone loss and osteoporosis.
  • Other medical conditions. Some medical conditions that you may be able to treat or manage can increase the risk of osteoporosis, such as other endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa.
  • Medications. Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis, such as:
    • Glucocorticoids and adrenocorticotropic hormone, which treat various conditions, such as asthma and rheumatoid arthritis.
    • Antiepileptic medicines, which treat seizures and other neurological disorders.
    • Cancer medications, which use hormones to treat breast and prostate cancer.
    • Proton pump inhibitors, which lower stomach acid.
    • Selective serotonin reuptake inhibitors, which treat depression and anxiety.
    • Thiazolidinediones, which treat type II diabetes.
  • Lifestyle. A healthy lifestyle can be important for keeping bones strong. Factors that contribute to bone loss include:
    • Low levels of physical activity and prolonged periods of inactivity can contribute to an increased rate of bone loss. They also leave you in poor physical condition, which can increase your risk of falling and breaking a bone.
    • Chronic heavy drinking of alcohol is a significant risk factor for osteoporosis.
    • Studies indicate that smoking is a risk factor for osteoporosis and fracture. Researchers are still studying if the impact of smoking on bone health is from tobacco use alone or if people who smoke have more risk factors for osteoporosis.

Why Healthy Bones Are Important to You

Strong bones support us and allow us to move. They protect our heart, lungs, and brain from injury. Our bones are also a storehouse for vital minerals we need to live. Weak bones break easily, causing terrible pain. You might lose your ability to stand or walk. And as bones weaken, you might lose height.

Silently and without warning, bones may begin to weaken early in life if you do not have a healthy diet and the right kinds of physical activity. Many people already have weak bones and don’t know it. Others are making choices that will weaken their bones later.

There are several kinds of bone disease. The most common is osteoporosis. In this disease, bones lose minerals like calcium. They become fragile and break easily. With osteoporosis, your body’s frame becomes like the frame of a house damaged by termites. Termites weaken your house like osteoporosis weakens your bones. If you have severe fractures from osteoporosis, you risk never walking again. Weak bones can break easily. This can be fatal.

Fragile bones are not painful at first. Unfortunately, most people don’t realize they have weakened bones until one breaks. By that time, it is hard to make your bones strong again.

The good news is that you are never too old or too young to improve your bone health. There are many things you can do to keep bones strong and prevent fractures. At all ages, a diet with enough calcium and vitamin D, together with weight-bearing and resistance exercises, can help prevent problems later. You can work with your doctor to check out warning signs or risk factors. When you are older, you can have your bones tested and take medicine to strengthen them.

Don’t Risk Your Bones

Many things weaken bones. Some are outside your control. If you have a family member who has bone problems, you could also be at risk. Some medical conditions can also make you prone to bone disease.

There are some things you can control:

  • Get enough calcium and vitamin D in your diet at every age.
  • Be physically active.
  • Reduce hazards in your home that could increase your risk of falling and breaking bones.
  • Talk with your doctor about medicines you are taking that could weaken bones, like medicine for thyroid problems or arthritis. Also talk about ways to take medicines that are safe for bones. Discuss ways to protect bones while treating other problems.
  • Maintain a healthy weight. Being underweight raises the risk of fracture and bone loss.
  • Don’t smoke. Smoking can reduce bone mass and increase your risks for a broken bone.
  • Limit alcohol use. Heavy alcohol use reduces bone mass and increases your risk for broken bones.

Bones Are Not What You Think They Are

When you think of bones, you might imagine a hard, brittle skeleton. In reality, your bones are living organs. They are alive with cells and flowing body fluids. Bones are constantly renewed and grow stronger with a good diet and physical activity.

After your mid-30s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause, but it happens to men too.

The amount of calcium that makes up your bones is the measure of how strong they are. But your muscles and nerves must also have calcium and phosphorus to work. If these are in short supply from foods you eat, your body simply takes them from your bones.

Each day calcium is deposited and withdrawn from your bones. If you don’t get enough calcium, you could be withdrawing more than you’re depositing. Our bodies build up calcium in our bones efficiently until we are about 30 years old. Then our bodies stop adding new bone. But healthy habits can help us keep the bone we have.

When Bones Break

There is some natural bone loss as women and men age. As we grow older, bones can break or weaken if we don’t take steps to keep them strong. The most common breaks in weak bones are in the wrist, spine, and hip.

Broken bones in your spine can be painful and very slow to heal. People with weak bones in their spine gradually lose height and their posture becomes hunched over. Over time a bent spine can make it hard to walk or even sit up.

Broken hips are a very serious problem as we age. They greatly increase the risk of death, especially during the year after they break.

People who break a hip might not recover for months or even years. Because they often cannot care for themselves, they are more likely to have to live in a nursing home.

Tips for keeping your bones strong:

  • Calcium is found in foods like milk, leafy green vegetables, and soybeans. Enjoy snacks of yogurt and cheese to increase your calcium. You can also take calcium supplements or eat food specially fortified with calcium.
  • Your body needs vitamin D to absorb calcium. Make sure you get enough vitamin D from your diet, sunshine, or supplements.
  • Like muscle, bone is living tissue that responds to exercise by becoming stronger. Even simple activities like walking and stair climbing can help strengthen your bones.

You Could Be at Risk

Too many of us assume we are not at risk for bone loss or fractures. We believe that if we haven’t had any signs of bone damage, then our bones are strong. Because there are no obvious warning signs, even doctors often miss signs of the problem. Most of us have our blood pressure and cholesterol checked for heart health. Testing bone density is an important way to check for bone health.

The risk of osteoporosis is highest among women. It is also higher for whites and Asians than other groups. However, it’s important to remember that it is a real risk for older men and women of all backgrounds.

Here are some clues that you are at risk:

  • Your older relatives have had fractures.
  • You have had illnesses or have been on medications that might weaken bones.
  • You are underweight.

That’s why it is important to know the risks for poor bone health at all ages. There are many “red flags” that are signs that you are at risk for weak bones. In addition, your calcium and vitamin D intake, level of physical activity, and medications should all be evaluated.

Why being active makes your bones strong

Get up and move. Being active helps to make your bones strong. When you jump, run, or lift a weight, it puts stress on your bones. This sends a signal to your body that your bones need to be made stronger. New cells are added to strengthen your bones. If you are right-handed, the bones in your right arm are slightly larger and stronger from the extra use. Children and teens should get at least an hour of physical activity every day. Adults should get at least 2 hours and 30 minutes each week. The Office of Disease Prevention and Health Promotion provides guidance to help Americans maintain or improve their health through physical activity.

Bone Up On Your Diet

Calcium: To keep your bones strong, eat foods rich in calcium. Some people have trouble digesting the lactose found in milk and other dairy foods, including cheese and yogurt. Most supermarkets sell lactose-reduced dairy foods. Many nondairy foods are also calcium-rich.

Vitamin D: Vitamin D helps your body absorb calcium. As you grow older, your need for vitamin D goes up. Vitamin D is made by your skin when you are in the sun. For many, especially seniors, getting enough vitamin D from sunlight is not practical. Almost all milk and some other foods are fortified with vitamin D. If you are not getting enough calcium and vitamin D in your diet, supplements can be bone savers.

People of all ages need to know what they can do to have strong bones. You are never too old or too young to improve your bone health.

Protect Your Bones at Every Age

Babies: Bone growth starts before babies are born. Premature and low-birth-weight infants often need extra calcium, phosphorus, and protein to help them catch up on the nutrients they need for strong bones. Breastfed babies get the calcium and nutrients they need for good bone health from their mothers. That’s why mothers who breastfeed need extra vitamin D. Most baby formula contains calcium and vitamin D.

Children: Good bone health starts early in life with good habits. While children and young adults rarely get bone diseases, kids can develop habits that endanger their health and bones. Parents can help by encouraging kids to eat healthful food and get at least an hour of physical activity every day. Jumping rope, running, and sports are fun activities that are great for building strong bones. Children need the amount of calcium equal to 3 servings of low-fat milk each day. If your child doesn’t drink enough milk, try low-fat cheese, yogurt, or other foods that are high in calcium. If your child is allergic to milk or lactose intolerant, talk to your pediatrician about milk substitutes.

Teens: Teens are especially at risk for not developing strong bones because their bones are growing so rapidly. Boys and girls from ages 9 to 18 need 1,300 milligrams of calcium each day, more than any other age group. Parents can help teens by making sure they eat 4 servings of calcium-rich and vitamin D-fortified foods a day. At least 1 hour a day of physical activities—like running, skateboarding, sports, and dance—is also critical. But take note: extreme physical exercise, when combined with undereating, can weaken teens’ bones. In young women, this situation can lead to a damaging lack of menstrual periods. Teens who miss adding bone to their skeletons during these critical years may never make it up.

Adults: Adulthood is a time when we need to look carefully at our bone health. As adults, we need 1,000 to 1,200 milligrams of calcium, depending on our age, and at least 2 hours and 30 minutes per week of moderate-intensity physical activity. Activity that puts some stress on your bones is very important.

Adults can take steps to keep their bones strong with physical activity.

  • Physical activity at least 2 hours and 30 minutes each week
  • Muscle training activities on 2 days a week
  • Older adults should do exercises that maintain or improve balance if they are at risk of falling

Women: Many women over age 50 are at risk for bone disease, but few know it. At menopause, which usually happens in women over age 50, a woman’s hormone production drops sharply. Because hormones help protect bones, menopause can lead to bone loss. Hormone therapy was widely used to prevent this loss, but now it is known to increase other risks. Your doctor can help advise you on protecting bone health around menopause.

Seniors: Seniors can take steps to help prevent bone problems. Physical activity and diet are vital to bone health in older adults. Calcium, together with vitamin D, helps reduce bone loss. Activities that put stress on bones keep them strong. Find time for activities like walking, dancing, and gardening. Strengthening your body helps prevent falls. Protecting yourself against falls is key to avoiding a broken hip or wrist. All women over age 65 should have a bone density test.

Seniors should also know that recent studies conclude that anyone over age 50 should increase his or her vitamin D intake to 600 International Units (IU) per day. After age 70, 800 IU per day are needed.

Live Well, Live Strong, Live Long

The average American eats too little calcium. And nearly half of us do not get enough physical activity to strengthen our bones.

The same healthy lifestyle that strengthens your bones strengthens your whole body. You might not hear as much about bone health as other health concerns. But healthy habits are good for all your organs, including your bones.

  • Be physically active every day—at least 60 minutes for children and teens, and 2 hours and 30 minutes each week for adults. Do strength-building and weight-bearing and resistance exercises to build strong bones.
  • Eat a healthy diet. Educate yourself on proper nutrition. Be aware that certain foods are naturally rich in calcium and vitamin D. Get the recommended amounts of calcium and vitamin D daily.
  • Reduce your risks of falling. Check your home for loose rugs, poor lighting, etc. Take classes that increase balance and strength—like Tai Chi or yoga. Make stretching a part of your workout.

Even people who know better don’t always do what’s good for their bones. Make yourself an exception. Be aware of your risks and work to reduce them. Get help from your family and friends and your doctor, nurse, pharmacist, or other health care professional. Building healthy bones begins at birth and lasts your whole life.

Your Doctor Can Help Protect Your Bones

Talk to your doctor about bone health. Together you can evaluate your risks. Some things to discuss include your current health, your diet and physical activity levels, and your family background.

Your doctor can look at your age, weight, height, and medical history. From that he or she can determine if you need a bone density test. Broken bones are a “red flag” for your doctor. If you break a bone after the age of 50, talk to your doctor about measuring your bone density. Even if you broke a bone in an accident, you might have weak bones. It is worth checking.

Your doctor might recommend a medical test called a bone mineral density test. These tests are quick (5 to 10 minutes), safe, and painless. They will give you and your doctor an idea of how healthy your bones are. All women over age 65 should have a bone density test. Women who are younger than age 65 and at high risk for fractures should also have a bone density test.

Your doctor might also want to do a blood test to check for a vitamin D deficiency or abnormal calcium levels.

If your doctor finds that your bones are becoming weaker, there are things you can do to make them stronger. You can be more physically active, change your diet, and take calcium and vitamin D supplements. If your bones are already weak, there are medicines that stop bone loss. They can even build new bone and make it less likely that you will suffer a broken bone.

Your doctor might suggest medications to help you build stronger bones. To reduce the chance that you might fall, have your vision checked. When you speak to your doctor, be prepared with a list of questions and concerns. 

This public document was originally prepared by the U.S. Department of Health and Human Services under the direction of the Office of the Surgeon General to make information in The Surgeon General’s Report on Bone Health and Osteoporosis available in plain language to improve health literacy on this topic. Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement. These statements have not been evaluated by the Food and Drug Administration. 

Content may be edited for style and length.

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This content was created by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) with contributions from:

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