Osteoporosis

Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. Men as well as women are affected by osteoporosis, a disease that can be prevented and treated. In the United States, more than 40 million people either already have osteoporosis or are at high risk due to low bone mass.

Risk Factors

Certain risk factors are linked to the development of osteoporosis and contribute to an individual’s likelihood of developing the disease. Many people with osteoporosis have several risk factors, but others who develop the disease have no known risk factors. Some risk factors cannot be changed, but you can change others.

Risk factors you cannot change:

  • Gender. Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone faster than men because of the changes that happen with menopause.
  • Age. The older you are, the greater your risk of osteoporosis. Your bones become thinner and weaker as you age.
  • Body size. Small, thin-boned women are at greater risk.
  • Ethnicity. Caucasian and Asian women are at highest risk. African American and Hispanic women have a lower but significant risk.
  • Family history. Fracture risk may be due, in part, to heredity. People whose parents have a history of fractures also seem to have reduced bone mass and may be at risk for fractures.

Risk factors you can change:

  • Sex hormones. Abnormal absence of menstrual periods (amenorrhea), low estrogen level (menopause), and low testosterone level in men can bring on osteoporosis.
  • Anorexia nervosa. Characterized by an irrational fear of weight gain, this eating disorder increases your risk for osteoporosis.
  • Calcium and vitamin D intake. A lifetime diet low in calcium and vitamin D makes you more prone to bone loss.
  • Medication use. Long-term use of certain medications, such as glucocorticoids and some anticonvulsants can lead to loss of bone density and fractures.
  • Lifestyle. An inactive lifestyle or extended bed rest tends to weaken bones.
  • Cigarette smoking. Smoking is bad for bones as well as the heart and lungs.
  • Alcohol intake. Excessive consumption of alcohol increases the risk of bone loss and fractures.

Prevention

To reach optimal peak bone mass and continue building new bone tissue as you age, you should consider several factors.

Calcium: An inadequate supply of calcium over a lifetime contributes to the development of osteoporosis. Many published studies show that low calcium intake appears to be associated with low bone mass, rapid bone loss, and high fracture rates. National nutrition surveys show that many people consume less than half the amount of calcium recommended to build and maintain healthy bones. Food sources of calcium include low-fat dairy products, such as milk, yogurt, cheese, and ice cream; dark green, leafy vegetables, such as broccoli, collard greens, bok choy, and spinach; sardines and salmon with bones; tofu; almonds; and foods fortified with calcium, such as orange juice, cereals, and breads. Depending on how much calcium you get each day from food, you may need to take a calcium supplement.

Calcium needs change during one’s lifetime. The body’s demand for calcium is greater during childhood and adolescence, when the skeleton is growing rapidly, and during pregnancy and breastfeeding. Postmenopausal women and older men also need to consume more calcium. Also, as you age, your body becomes less efficient at absorbing calcium and other nutrients. Older adults also are more likely to have chronic medical problems and to use medications that may impair calcium absorption.

Vitamin D: Vitamin D plays an important role in calcium absorption and bone health. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Many people obtain enough vitamin D naturally; however, studies show that vitamin D production decreases in the elderly, in people who are housebound, and for people in general during the winter. Adults should have vitamin D intakes of 600 IU (International Units) daily up to age 70. Men and women over age 70 should increase their uptake to 800 IU daily.

Exercise: Like muscle, bone is living tissue that responds to exercise by becoming stronger. Weight-bearing exercise is the best for your bones because it forces you to work against gravity. Examples include walking, hiking, jogging, climbing stairs, weight training, tennis, and dancing.

Smoking: Smoking is bad for your bones as well as your heart and lungs. Women who smoke have lower levels of estrogen compared with nonsmokers, and they often go through menopause earlier. Smokers also may absorb less calcium from their diets.

Alcohol: Regular consumption of 2 to 3 ounces a day of alcohol may be damaging to the skeleton, even in young women and men. Those who drink heavily are more prone to bone loss and fracture, because of both poor nutrition and increased risk of falling.

Medications that cause bone loss: Several medications can contribute to bone loss. For example, the long-term use of glucocorticoids (medications prescribed for a wide range of diseases, including arthritis, asthma, Crohn’s disease, lupus, and other diseases of the lungs, kidneys, and liver) can lead to a loss of bone density and fracture. Bone loss also can result from long-term treatment with certain antiseizure drugs, such as phenytoin (Dilantin)1 and barbiturates; gonadotropin-releasing hormone (GnRH) drugs used to treat endometriosis; excessive use of aluminum-containing antacids; certain cancer treatments; and excessive thyroid hormone. It is important to discuss the use of these drugs with your doctor and not to stop or change your medication dose on your own.

1 Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health, any other Government agency, Princeton Endocrinology Associates, LLC. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

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