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When most of us think of the "brittle bone disease" known as osteoporosis, we picture a frail older woman with a broken hip or stooped shoulders. But you can't tell if someone has osteoporosis just by looking at them. Doctors need to review your personal and family history, your habits, as well as a bone density test to find your personal risk.

"It could be an elderly lady, a man, or a younger woman who is fine, but is 5 feet tall and weighs 93 pounds," says Ethel S. Siris, MD, of Columbia University Medical Center in New York.

Osteoporosis develops when our bodies don't build new bone as quickly as they remove old bone. Bones become weak and brittle and are more likely to fracture or break.

Some fractures happen when you take a big fall, while others can follow something as harmless as a hug or just bending over. Fractures due to osteoporosis are most common in the spine and hip.

What Raises Your Risk for Osteoporosis?

  • Early menopause and no use of supplemental estrogen
  • Family history of a hip fracture or osteoporosis
  • History of anorexia nervosa, an eating disorder, or a low body weight
  • Hormone treatment for prostate cancer
  • Older age
  • Past bone fractures
  • Rheumatoid arthritis (RA), some digestive illnesses, and certain other diseases
  • Smoking
  • Steroid medicine use for a long time (for asthma or other conditions)
  • Three or more alcoholic drinks per day

"When an older woman or man has a fracture, we must see if they have low bone mass or osteoporosis," says Siris. This is the biggest red-flag warning that more fractures can follow.

When Do You Need a Bone Density Test?

A bone density test can diagnose osteoporosis before a broken bone occurs. The National Osteoporosis Foundation recommends this X-ray for:

  • All women 65 and older
  • Younger women who have risk factors for osteoporosis
  • Men 70 and older
  • Men 50-69 with risk factors for osteoporosis

Some doctors use the FRAX formula (Fracture Risk Assessment Tool) to estimate your chance of breaking a bone within the next 10 years. It adds up past fractures, gender, smoking, alcohol use, and sometimes bone density test results in the hip, as well as other factors.

"As we age, we lose bone mass, and this puts everybody at risk for fracture," says Silvina Levis-Dusseau, MD, of the University of Miami Miller School of Medicine.

But it doesn't have to be this way. People think osteoporosis is a part of aging that you can't avoid, but that is wrong, says Levis-Dusseau.

Protect yourself and your bones, she says. "Live a healthy lifestyle. Consume enough calcium and vitamin D, exercise regularly, don't smoke, and drink in moderation, and have a bone density test."

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