Though they keep us upright and allow us to move through our daily lives, we don’t often think about our bones until we break one. However, awareness of our bone health only becomes more important as we get older.

In the U.S., an estimated 10.2 million men and women currently suffer from osteoporosis, a condition that causes bones to become weak, brittle and easily breakable. Another 44 million people have low bone density that puts them at risk.

Below, we’ll discuss osteoporosis symptoms, screenings and prevention tips to help you stay on top of your bone health.

What is osteoporosis?

Bones are living tissue that our bodies are constantly breaking down and rebuilding. The rate of this process fluctuates as we age, but renewal starts to slow after age 50. Some loss of bone mass is a natural part of the aging process – in other words, our bones decrease in density and strength as we get older.

But when our bones begin to lose more mass (and at a faster pace) than our bodies can keep up with, they become brittle and weak, breaking easily. This is osteoporosis, which is defined as “porous bone.”

Osteoporosis causes around two million fractures each year, and for most people, a fracture is the first indication that they might have the condition. This is why osteoporosis is sometimes called a “silent disease.” A bone that breaks too easily is often the first symptom that people experience.

Osteoporosis symptoms and what to look for

As mentioned, most people never experience any early symptoms of osteoporosis. The first sign is often a broken bone from something that wouldn’t ordinarily have caused one, like a minor fall from standing height, a jolt against a hard surface or even just a sneeze or cough. Osteoporosis fractures are most common in the wrists, hips and vertebrae.

Other symptoms of osteoporosis include:

  • Back pain
  • Changes in the way you walk
  • Changes to your posture, like a stooped or hunched spine
  • Gradual loss of height of 1.5 inches or more

Osteoporosis can cause pain in your bones that is typically more severe than the normal aches of getting older. Pain linked to osteoporosis is most common in the neck and back, the result of spinal compression fractures. This pain is worse while walking and standing but can ease slightly when lying down.

What causes osteoporosis?

Our bones are a repository, or holding space, for vitamins and minerals that the body can draw upon when needed.

Osteoporosis happens when the body takes vitamins and minerals – mainly calcium – from our bones faster than they can be replenished. Healthy bone is already porous, or full of tiny holes, but osteoporosis makes the holes bigger, causing the inner structure to weaken and become more prone to fracture.

Osteoporosis is a common condition among post-menopausal women because the hormone estrogen regulates the process of bone renewal. When women experience a sharp drop in estrogen levels during and after menopause, this process is disrupted. Men are also affected by osteoporosis, but in fewer numbers than women.

Who is most at risk for osteoporosis?

There are several risk factors that can make you more likely to develop osteoporosis.

Gender

Both men and women can be affected by osteoporosis, but women are more likely to develop it due to the decline in estrogen levels during and after menopause. Women also tend to have smaller bones with a lower bone mass compared to men, making them more vulnerable.

Genetics

You are more likely to develop osteoporosis if someone in your immediate family also has the condition, especially if they have suffered a hip fracture because of it.

Race

People of Caucasian and Asian descent have a higher chance of developing osteoporosis than those of other races.

Endocrine diseases

Conditions like diabetes, hyperthyroidism and hyperparathyroidism interfere with the levels of hormones in your body, specifically the hormones that regulate the minerals calcium and phosphorus, which affect the normal process of breaking down and rebuilding bones.

Sex hormone disorders

Estrogen and testosterone both play an important role in maintaining bone health. While estrogen is involved in bone density maintenance and renewal, testosterone contributes to muscle growth, which then encourages bone growth. Chronically low levels of estrogen and testosterone can cause rapid bone degeneration.

Additional medical conditions

Some diseases can increase your risk of osteoporosis, like COPD, HIV/AIDS, rheumatoid arthritis, inflammatory bowel disease (IBD), chronic kidney disease, and prostate and breast cancer.

Other risk factors include:

  • Chronic calcium and vitamin D deficiency
  • Being underweight with a BMI of 19 and below
  • A sedentary lifestyle
  • Heavy alcohol consumption and tobacco use
  • Long-term use of certain medication types, like steroids and anticonvulsants

How is osteoporosis diagnosed?

If one or more of the risk factors discussed above applies to you, your primary care clinician can start screening you for osteoporosis at age 50. If you have recently broken a bone and are older than 50, your doctor may also recommend an osteoporosis screening. Otherwise, regular osteoporosis screenings start at age 65 for women and age 70 for men.

Even if you’ve never had a fracture, it’s a good idea to understand the current health of your bones. Ask your primary care doctor if an osteoporosis screening is right for you. They may recommend a bone densitometry screening, which is the diagnostic tool for osteoporosis.

Bone densitometry screening (DXA scan)

A bone densitometry screening, also called a DXA scan or bone mineral density test, is a type of X-ray that measures the density of your bones. Using two X-ray beams of different strength, the DXA machine will measure how much of each beam is able to pass through your bones. This gives your doctor an idea of how thick your bones currently are.

The results of your bone density scan are then compared to those of healthy young adults (25-30 years old) and calculated into a T-score. Your doctor will use the T-score to assess your risk of fracture and diagnose you with osteoporosis or osteopenia.

Osteopenia is a precursor to osteoporosis. With osteopenia, your bone density is low, but not yet low enough to be considered osteoporosis.

After your bone densitometry screening, your doctor can use your T-score to complete a fracture risk assessment (FRAX). This is a tool that calculates your risk of an osteoporosis-related fracture over the next 10 years. It involves questions about your lifestyle, your family medical history and your other medical conditions.

An elderly woman laughs as she dries dishes in her kitchen.

Osteoporosis treatment

If you’ve been diagnosed with osteoporosis, there’s no need to panic. It’s possible to slow the loss of bone mass and maintain healthy function through treatment, which may include:

Medication

There are several medicines your doctor may prescribe to slow bone degeneration or increase the rate of bone renewal. They come in multiple forms, most commonly an oral pill or injection. The frequency with which these medicines are taken varies. Some must be taken every day while others are weekly or just once a year. Your doctor can determine which type is right for you and your lifestyle.

Exercise and physical therapy

Physical therapy meant to slow the progression of osteoporosis will focus on weight training, posture correction and balance improvement. Weight-bearing exercises, such as walking, jogging and dancing, can also improve and maintain bone health.

Dietary changes

With osteoporosis, you’ll want to include plenty of healthy sources of calcium and vitamin D in your diet. Milk, yogurt, almonds, oranges, kale and spinach are chock-full of calcium, and you can find large amounts of vitamin D in fatty fish like salmon and sardines. It’s recommended that you increase your levels of calcium through diet rather than supplements, because our bodies absorb calcium from food better than calcium from supplements.

Vitamin D supplements

Our bodies absorb calcium through the intestines, and vitamin D helps the intestines be more receptive to calcium. To increase the calcium in your diet, you can take vitamin D supplements. Regular exposure to sunlight is another way to elevate your vitamin D levels.

Hormone therapy

Your doctor may prescribe medications that help increase the levels of estrogen in your body. However, these can have adverse side effects like an increased risk of breast cancer.

Osteoporosis prevention

There are steps you can take to maintain healthy bones as you age and reduce your risk of osteoporosis.

Diet and sunlight

Most people who live in northern latitudes don’t get enough vitamin D from the sun, especially those with darker skin. Include plenty of calcium and vitamin D in your diet, and make sure you are getting enough sunlight, usually 10-30 minutes of midday exposure. Contrary to popular belief, wearing sunscreen won’t inhibit your body’s production of vitamin D from the sun. Many people who live in northern latitudes, like the Upper Midwest, should take vitamin D supplements year-round.

Exercise

Exercise, especially weight-bearing exercise, can be highly beneficial for strengthening and stabilizing your muscles and bones. Weight-bearing exercises involve putting your bones and muscles under minor stress in the act of fighting gravity. This activates the cells in your bones that are responsible for creating new tissue. Find weight-bearing activities you enjoy, like hiking, running, strength training and dancing. And it doesn’t have to be complicated – walking just one mile a day can help maintain bone density.

Lifestyle

Because alcohol and tobacco affect the overall health of your body, they impact your bone health as well. Smoking and heavy alcohol consumption can cause poor circulation, hormonal imbalances, and calcium and vitamin D deficiencies. There’s no safe amount of tobacco use, but it’s safe to drink alcohol in moderation, about 1-2 drinks per day.

Fall prevention

You can prevent falls at home by making sure carpets and rugs are firmly fixed to the floor without any sections that stick out or that may slide underneath you. You can also install grab bars in your bathroom, position electrical cords away from where you walk and keep objects like books, papers and clothes off the floor. When you’re out and about, wear nonslip footwear, hold onto handrails where available and use a cane or walker if necessary.

When to see a doctor about osteoporosis

When you maintain healthy bones, you can maintain mobility and independence as you age – things that help make your golden years truly golden. If you suspect you may have low bone density, it’s a good idea to make an appointment with your primary care doctor. They can help coordinate a bone density screening for you and determine the right treatments for your needs.