Osteoporosis is a common disease that makes bones thinner, which makes them more likely to break. These fractures can lead to different health problems, like pain, stooped posture, or trouble moving around.
Many people lose bone gradually over many years. There are no symptoms that tell you it’s happening. But it is possible to treat osteoporosis with medications and healthy lifestyle choices. If you make those good habits part of your life early on, you can prevent bone loss and lower the chances you’ll break a bone.
What Causes Osteoporosis?
We don't know a lot about what causes the condition, but we do know how it progresses throughout a person’s life.
Your body constantly breaks down old bone and rebuilds it. This process is called remodeling. As you grow up, your body builds more bone than it removes. During childhood, your bones become larger and stronger. Peak bone mass happens when you have the most bone you will ever have, usually in your early to mid-30s.
At a certain age, the bone remodeling process changes. New bone comes in at a slower rate. This slowdown leads to a drop in the amount of bone you have.
When bone loss becomes more severe, you have osteoporosis.
Osteoporosis usually doesn’t cause any symptoms. But after many years, you may notice signs like back pain, a loss of height, or a stooped posture. For some people, the first sign they have of the disease is a broken bone, usually in the spine or hip.
If osteoporosis becomes severe, the normal stress on bones from sitting, standing, coughing, or even hugging can cause painful fractures. After the first fracture, you’re more likely to get more.
For some people, the pain from a fracture may get better as the bone heals. But others will have long-lasting pain. You may feel stiff and have trouble being active.
Will I Get Osteoporosis?
The things that raise your chances of getting osteoporosis include:
- Family history: Osteoporosis seems to run in families. If your mother had a hip or spine fracture, chances are you’re more likely to get the disease.
- Sex: Women are four times more likely than men to get osteoporosis.
- Age: Though anyone can have osteoporosis, your chances go up with age. Women over 50 are most likely to get it. The older you are, the more likely you are to have fractures.
- Bone structure and body weight: Petite and thin women have higher chances for the disease, too. Weight loss after age 50 in women also seems to raise the chance of hip fractures, while weight gain lowers it. Small-boned, thin men have a greater chance of getting osteoporosis than men with larger frames and more body weight.
- History of fractures: Having one fracture means you’re likely to get more.
- Smoking: Studies show that cigarette smokers (past or current) have lower bone mass and higher fracture risks. Women who smoke have lower levels of the hormone estrogen -- a key part of bone health.
- Medications: Some medications may make you more likely to have the disease. These include long-term use of steroids (prednisone), thyroid drugs, anti-seizure medicine, antacids, and other drugs.
Osteoporosis and Menopause
At menopause, there's a major drop in a woman’s levels of the hormone estrogen. That slows the bone remodeling process and makes the body lose bone faster. This continues for about 10 years after menopause. Eventually, the rate of bone loss goes back to what it was before menopause. But the pace of making new bone does not. That lowers overall bone mass and gives postmenopausal women a much greater chance of having a fracture.
Early menopause (before age 40) also raises the chance of osteoporosis and fractures. So do long periods of time when hormone levels are low or absent, which can happen to women who do a lot of intense exercise.
How Do I Know if I Have Osteoporosis?
First, find out how likely you are to get the disease. Talk to your doctor about your chances and ask if you need a bone density test. These scans use very small amounts of radiation to see how strong your bones are. They’re the only way to know for sure if you have osteoporosis.
Treatments for Osteoporosis
Many osteoporosis treatments stop bone loss and lower your chances of fractures. You may start with changes to your diet and lifestyle, such as quitting smoking, adding more calcium and vitamin D to your diet, and getting more exercise. But some people may need medications to slow bone loss or build new bone, such as:
- Drugs called bisphosphonates, such as alendronate (Binosto, Fosamax), ibandronate (Boniva), risedronate (Actonel, Atelvia), and zoledronic acid (Reclast, Zometa)
- Abaloparatide (Tymlos)
- Calcitonin (Fortical, Miacalcin)
- Raloxifene (Evista)
- Injectable teriparatide (Forteo) or PTH to rebuild bone in women who have higher chances of fractures
- Injectable denosumab (Prolia) for women with higher chances of fractures
How Can I Prevent It?
A focus on these good health habits can help prevent osteoporosis and fractures:
Exercise. It makes bones and muscles stronger. Weight-bearing exercises, such as walking, jogging, playing tennis, and dancing, are best for preventing osteoporosis. Do them at least three to four times per week.
In addition, strength and balance exercises build stronger muscles and may help you avoid falls. That lowers the chances you’ll break a bone.
Add calcium to your diet. Experts recommend 1,000 milligrams each day for women before menopause and 1,200 milligrams a day for those who’ve been through it.
Good sources of calcium include:
- Milk and dairy products
- Canned fish with bones, such as salmon and sardines
- Dark green, leafy vegetables, such as kale, collards, and broccoli
- Foods that have calcium added in, such as orange juice
You can get the recommended amounts of calcium by having four servings of calcium-rich foods each day.
Supplement your diet. It’s best to get calcium through the food you eat. But if you don't get enough, ask your doctor if you should take calcium supplements. Some studies have shown that these pills might make some people more likely to have a heart attack, though we need more research to know for sure. You and your doctor should talk about your risks and decide what’s best for you.
Get plenty of vitamin D. Your body needs it to absorb calcium. You can get some of what you need by spending time in the sun, which prompts your body to make vitamin D. But don’t get too much -- that raises your chances for skin cancer. You can also get vitamin D from foods, such as:
Adults need 600 to 800 international units (IU) of vitamin D each day.