Osteoporosis

Osteoporosis is a disease of the bones that causes bones to become weak and break easily. Osteoporosis affects mostly older women, but prevention starts when you are younger. No matter your age, you can take steps to build bone mass and prevent bone loss. Broken bones from osteoporosis cause serious health problems and disability in older women.

What is osteoporosis?

Osteoporosis is a disease of the bones. People with osteoporosis have bones that are weak and break easily.

Osteoporosis is called a “silent” disease. You may have bone loss for many years without any symptoms until you break a bone. A broken bone can cause severe pain and disability. It can make it harder to do daily tasks on your own, such as walking.

What is bone loss?

Bone loss is the amount of minerals, such as calcium, that your body absorbs (takes) from your bones.

Bone loss can happen for several reasons. Some of the most common reasons include:

• You do not get enough calcium from food. Your body uses calcium to build healthy bones and teeth and stores calcium in your bones. Your body also uses calcium to send messages through your nervous system, help your muscles contract, and regulate your heart’s rhythm. But your body does not make calcium. You have to get all the calcium your body needs from the foods you eat and drink (or from supplements). If you don’t get enough calcium each day, your body will take the calcium it needs from your bones.
• You are past menopause. As you get older, your bones don’t make new bone fast enough to keep up with your body’s needs. The calcium taken from your bones causes you to lose bone density. Bone loss also speeds up after menopause and can lead to weak, brittle bones.

Who gets osteoporosis?

Osteoporosis affects more women than men. Of the estimated 10 million Americans with osteoporosis, more than 8 million (or 80%) are women.

Women are more likely to get osteoporosis because:

• Women usually have smaller, thinner, less dense bones than men.
• Women often live longer than men. Bone loss happens naturally as we age.
• Women also lose more bone mass after menopause with very low levels of the hormone estrogen. Higher estrogen levels before menopause helps protect bone density.

Osteoporosis is most common in older women. In the United States, osteoporosis affects one in four women 65 or older. But younger women can get osteoporosis. And girls and women of all ages need to take steps to protect their bones.

Are some women more at risk for osteoporosis?

Yes. Your risk for osteoporosis is higher if you:

• Are past menopause. After menopause, your ovaries make very little of the hormone estrogen. Estrogen helps protect bone density. Some women lose up to 25% of bone mass in the first 10 years after menopause.
• Have a small, thin body (weigh less than 127 pounds)
• Have a family history of osteoporosis
• Are Mexican-American or white. One in four Mexican-American women and about one in six white women over 50 years old have osteoporosis Asian-American women also have a higher risk for osteoporosis because they are usually smaller and thinner than other women and therefore may have less bone density.
• Do not get enough calcium and vitamin D. Calcium and vitamin D work together to build and maintain strong bones.
• Do not get enough physical activity. Women of all ages need to get regular weight-bearing physical activity, such as walking, dancing, or playing tennis, to help build and maintain bone density.
• Have not gotten your menstrual period for three months in a row (called amenorrhea). If you have amenorrhea and you are not pregnant, breastfeeding, or taking a medicine that stops your periods, talk to your doctor or nurse. Not getting your period means your ovaries may have stopped making estrogen.
• Have an eating disorder. Eating disorders, especially anorexia nervosa and bulimia nervosa, can weaken your bones. Anorexia can also lead to amenorrhea.
• Smoke. Women who smoke have lower bone density and often go through menopause earlier than nonsmokers. Studies also suggest that smoking raises your risk for broken bones, and this risk goes up the longer you smoke and the more cigarettes you smoke.
• Have a health problem that raises your risk of getting osteoporosis. These include diabetes, premature ovarian failure, celiac disease and inflammatory bowel disease, and depression.
• Take certain medicines to treat long-term health problems, such as arthritis, asthma, lupus, or thyroid disease.
• Drink too much alcohol. For women, experts recommend no more than one alcoholic drink a day if you choose to drink alcohol. Long-term, heavy drinking can cause many health problems, including bone loss, heart disease, and stroke.

What are the symptoms of osteoporosis?

You may not have any symptoms of osteoporosis until you break (fracture) a bone. A fracture can happen in any bone of the body. But fractures are most common in the hip, wrist, and spine (vertebrae). Vertebrae support your body, helping you to stand and sit up. See the picture.

Osteoporosis in the vertebrae can cause serious problems for women. A fracture in this area can happen during day-to-day activities like climbing stairs, lifting objects, or bending forward when you have osteoporosis.

Fractures in the vertebrae can cause it to collapse and bend forward. If this happens, you may get any or all of these symptoms:

• Sloping shoulders
• Curve in the back
• Height loss
• Back pain
• Hunched posture

What causes osteoporosis?

Osteoporosis is caused by bone loss. Most often, the reason for bone loss is very low levels of the hormone estrogen. Estrogen plays an important role in building and maintaining your bones.

The most common cause of low estrogen levels is menopause. After menopause, your ovaries make very little estrogen.

Also, your risk for developing osteoporosis is higher if you did not develop strong bones when you were young. Girls develop 90% of bone mass by age 18. If an eating disorder, poor eating, lack of physical activity, or another health problem prevents you from building bone mass early in life, you will have less bone mass to draw on later in life.

How is osteoporosis diagnosed?

Your doctor will do a bone density test to see how strong or weak your bones are. A common test is a central dual-energy x-ray absorptiometry (DXA). A DXA is a special type of x-ray of your bones. This test uses a very low amount of radiation.

Your doctor may also use other screening tools to predict your risk of having low bone density or breaking a bone.

Do I need to be tested for osteoporosis?

Your doctor may suggest a bone density test for osteoporosis if:

• You are 65 or older
• You are younger than 65 and have risk factors for osteoporosis. Bone density testing is recommended for older women whose risk of breaking a bone is the same or greater than that of a 65‑year‑old white woman with no risk factors other than age. Ask your doctor or nurse whether you need a bone density test before age 65.

How can I get free or low-cost osteoporosis screening tests?

Screening for osteoporosis is covered by most insurance plans, including Medicare Part B. Depending on your insurance plan, you may be able to get screenings at no cost to you.

• If you have insurance, check with your insurance provider to find out what’s included in your plan.
• If you have Medicare, find out about Medicare coverage for bone density tests.
• If you have Medicaid, the benefits covered are different in each state, but certain benefits must be covered. Check with your state’s Medicaid program to find out what’s covered.
• If you don’t have insurance, you may be able to get a no-cost or low-cost bone density test.

How is osteoporosis treated?

If you have osteoporosis, your doctor may prescribe medicine to prevent more bone loss or build new bone mass. The most common types of medicine to prevent or treat osteoporosis include:

• Bisphosphonates. Bisphosphonates help treat bone loss. They may also help build bone mass.
• Selective estrogen receptor modulators (SERMs). SERMs may help slow the rate of bone loss after menopause.
• Denosumab. This injectable drug may help reduce bone loss and improve bone strength if you are past menopause and at higher risk for broken bones from osteoporosis.
• Calcitonin. Calcitonin is a hormone made by your thyroid gland that helps regulate calcium levels in your body and build bone mass. Taking calcitonin can help slow the rate of bone loss.
• Menopausal hormone therapy. Often used to treat menopausal symptoms, menopausal hormone therapy may also help prevent bone loss. The Food and Drug Administration recommends taking menopausal hormone therapy at the lowest dose that works for your menopause symptoms for the shortest time needed.
• Parathyroid hormone or teriparatide. Teriparatide is an injectable form of human parathyroid hormone. It helps the body build up new bone faster than the old bone is broken down.

Your doctor may also suggest getting more calcium, vitamin D, and physical activity.

All medicines have risks. For example, menopausal hormone therapy may raise your risk of a blood clot, heart attack, stroke, breast cancer, or gallbladder disease. Talk to your doctor or nurse about the benefits and risks of all medicines.

How can I prevent osteoporosis?

One of the best ways to prevent weak bones is to work on building strong ones. Building strong bones during childhood and the teen years is important to help prevent osteoporosis later.

As you get older, your bones don’t make new bone fast enough to keep up with the bone loss. And after menopause, bone loss happens even more quickly. But you can take steps to slow the natural bone loss with aging and to prevent your bones from becoming weak and brittle.

• Get enough calcium and vitamin D each day.
• Get active. Choose weight-bearing physical activities like running or dancing to build and strengthen your bones.
• Don’t smoke. Smoking raises your risk for broken bones.
• If you drink alcohol, drink in moderation (for women, this is one drink a day at most). Too much alcohol can harm your bones. Also, too much at one time or mixed with certain medicines can affect your balance and lead to falls.
• Talk to your doctor about whether you need medicine to prevent bone loss.

How does calcium help prevent osteoporosis?

Calcium is found in your bones and teeth. It helps build bones and keep them healthy. Your body also uses calcium to help your blood clot and your muscles contract. If you don’t get enough calcium each day from the foods you eat, your body will take the calcium it needs from your bones, making your bones weak.

You can get calcium through food or calcium supplements.

How much calcium do women need each day?

How much calcium you need depends on your age:

• 9–18 years: 1,300 mg per day
• 19–50 years: 1,000 mg per day
• 51 and older: 1,200 mg per day

Pregnant or nursing women need the same amount of calcium as other women of the same age.

You can get the calcium you need each day from food and/or calcium supplements.

What foods contain calcium?

Calcium is found naturally in some foods:

• Milk
• Cheese
• Yogurt
• Leafy green vegetables, such as broccoli, kale, and mustard greens

Calcium is sometimes added to certain foods, such as:

• Breakfast cereals (some have up to 100% of the recommended daily value — or 1,000 milligrams — of calcium in each ¾ cup serving)
• Orange juice
• Tofu
• Soymilk
• Breads and pastas

What if dairy foods make me sick or I don’t like to eat them? How can I get enough calcium?

If you have problems eating foods with dairy or don’t like to eat them, try the following tips to make sure you get enough calcium:

• Try lactose-reduced or lactose-free products, such as milk or yogurt.
• Take a lactose supplement (in pill or liquid form) before eating dairy foods to help you digest them.
• Choose other food sources of calcium. Other good sources of calcium include tofu or orange juice with calcium added, and vegetables such as bok choy, kale, collard greens, mustard greens, and broccoli.
• Ask your doctor or nurse if you need to take calcium supplements.

Should I take a calcium supplement?

The answer depends on how much calcium you need each day and how much calcium you get from the foods you eat.

It’s best to get the calcium your body needs from food. But if you don’t get enough calcium from the foods you eat, you may want to consider taking a calcium supplement.

You can get calcium supplements at the grocery store or drug store. Talk with your doctor or nurse before taking calcium supplements to see which kind is best for you and how much you need to take.

How does vitamin D help prevent osteoporosis?

Vitamin D helps your body absorb calcium from the food you eat. Just eating foods with calcium is not enough. You also need to get enough vitamin D to help your body use the calcium it gets.

Your skin makes vitamin D when it is exposed to sunlight. In general, you need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a week to make enough vitamin D. The amount of time depends on how sensitive your skin is to light. It also depends on your use of sunscreen, your skin color, the season, the latitude (how far north or south) where you live, and the amount of pollution in the air.

You can also get vitamin D from foods such as milk or from vitamin supplements. The vitamin D you get from food or supplements is measured in international units (IU).

How much vitamin D do women need each day?

How much vitamin D you need each day depends on your age:

• Women up to age 70: 600 international units (IU)
• Women 71 and older: 800 IU each day

Pregnant and breastfeeding women need the same amount of vitamin D (600 IU) as other women of the same age.

What foods contain vitamin D?

Although it’s hard to get enough vitamin D through food alone, foods with vitamin D include:

• Salmon
• Tuna fish
• Egg yolks

Vitamin D is often added to certain foods, including:

• Breakfast cereals
• Milk
• Orange juice

What types of physical activity help prevent osteoporosis?

Regular physical activity of any type can help slow bone loss, improve muscle strength, and help your balance. But weight-bearing physical activity is especially important to build bone and help prevent bone loss. Weight-bearing physical activity is any activity in which your body works against gravity.

Weight-bearing activities you can try include:

• Dancing
• Gardening
• Lifting weights
• Tennis
• Tai chi
• Yoga
• Running
• Walking

What can happen if osteoporosis is not treated?

Osteoporosis that is not treated can lead to serious bone breaks (fractures), especially in the hip and spine. One in three women is likely to have a fracture caused by osteoporosis in her lifetime.¹⁸

• Hip fractures can cause serious pain and disability and require surgery.
• Spinal fractures can cause you to lose height or get a stooped back. They often cause serious pain and require surgery.

Fractures can happen after minor falls, stumbles, or bumps into furniture. Falls are the leading cause of injuries in older adults over age 65.

Does pregnancy affect bone density?

Maybe. Your unborn baby needs calcium to help his or her bones grow. While in the womb, babies get calcium from what you eat (or the supplements you take). If you don’t get enough calcium from food or supplements, your baby will use the calcium in your bones.

You can lose some bone density during pregnancy, but any bone mass lost is usually restored after childbirth (or after breastfeeding). Also, during pregnancy, you absorb calcium from food and supplements (like prenatal vitamins) better than women who are not pregnant. Your body also makes more of the hormone estrogen, which protects bone.

Does breastfeeding affect bone density?

Yes, women often lose some bone density during breastfeeding. But this loss is temporary. Several studies have shown that when women lose bone mass during breastfeeding, they recover full bone density within six months after breastfeeding stops.