I’m a doctor — here’s how to keep your bones strong for a lifetime

It’s common to think of your bones as solid and unchanging, but they’re composed of living tissue constantly in flux. 

Consider: Every year, 15% of your spine and 5% of your hips are replaced with new bone through a process called remodeling. Every 10 years, your entire skeleton will have rebuilt itself. 

With aging and certain chronic diseases, however, you can gradually lose bone faster than it’s replaced, increasing the risk of low bone density and osteoporosis, which can lead to fractures of the hip, spine and wrist. 

But the good news? Osteoporosis is preventable and treatable. We spoke with Dr. Paula Rackoff, a rheumatologist at NYU Langone and clinical associate professor in the Department of Medicine at NYU Grossman School of Medicine, for steps you can take to keep your bones strong for a lifetime.

Who should worry about osteoporosis? 

Bone health should be on everyone’s radar, especially in midlife and beyond. An estimated 10.2 million people 50 and older have osteoporosis, and about 43.3 million more people have low bone mass, which puts you at high risk for osteoporosis. 

Women in perimenopause and menopause are particularly at risk due to naturally falling estrogen levels. Estrogen is a key hormone in the bone remodeling process. When estrogen levels fluctuate during perimenopause and then plummet after menopause, bone loss accelerates. 

People with hormonal disorders, such as hyperthyroidism and hyperparathyroidism, and the endocrine condition Cushing’s syndrome also have a greater chance of developing osteoporosis. 

But anyone who has a condition that’s rooted in chronic inflammation is at increased risk for osteoporosis and should also be screened. These conditions include multiple sclerosis, Parkinson’s disease, rheumatoid and psoriatic arthritis, inflammatory bowel disease, chronic lung disease and skin conditions, such as severe eczema and autoimmune diseases of the skin, such as psoriasis. 

Why is paying attention to bone health so important?

It’s important because your skeletal integrity often determines the quality of your life in your 70s, 80s and 90s. We’re seeing more and more people surviving strokes and even more than one cancer diagnosis. But once you start breaking bones, it can really impact your quality of life because it has the potential to cause you to lose your independence. 

What’s the connection between chronic inflammation and osteoporosis?

Treatment for inflammatory diseases, such as the long-term use of corticosteroid medication or certain anticonvulsant medication, can accelerate bone loss. But the inflammatory process itself can lead to bone loss, even before treatment begins.

Inflammatory diseases can potentially affect bone health because they produce an abundance of pro-inflammatory cytokines. These small proteins produced by the immune system increase the rate of bone-resorbing cells, which break down bone through the remodeling process. 

What’s a bone screening like?

A dual-energy X-ray absorptiometry (DEXA) scan is the gold standard for osteoporosis and low bone mass screening and diagnosis. It’s a painless, low-dose X-ray, generally of the hip and spine, to assess the mineral content of the bones that only takes about 20 minutes. A DEXA scan provides a T score, which is compared with the average bone density in a young, healthy male or female adult of the same race or ethnicity.

A bone density test is recommended for:

• Women 65 and older
• Men 70 and older
• Anyone who has broken a bone after 50
• Women 50 to 64 with risk factors
• Men 50 to 69 with risk factors 

Risk factors can include the long-term use of steroid medication, such as prednisone, having an inflammatory condition or a family history of osteoporosis. Your doctor will consider your T score along with your risk factors to determine whether you require treatment. 

Anyone who is at increased risk of falling should also have a bone density scan, such as those with Parkinson’s disease or other chronic conditions that affect your ability to be physically active. Anything that causes immobility increases the risk for osteoporosis. 

What happens if I’m diagnosed with osteoporosis or low bone density?

The great news is that there are plenty of treatments that can slow bone loss to increase bone density and improve bone strength and quality. If you have osteoporosis or low bone density, start treatment right away. There are so many options now. 

NYU Langone’s Osteoporosis Center, located at NYU Langone Orthopedic Hospital, specializes in the diagnosis and treatment of osteoporosis, providing complete support during diagnosis, initial treatment and beyond. The center gives patients access to physical therapists, psychologists, exercise experts and social workers after a comprehensive evaluation and state-of-the-art bone mineral density testing to measure bone strength. 

Any other strong bone strategies?

Yes. Be sure to focus on balance training to reduce your risk of falls and weight-bearing exercise, which can help maintain bone mass and slow bone loss at any age. The force exerted on bones during strength training stimulates bone-forming cells to build more bone, making bones denser and stronger. 

If you can get in two strength-training sessions per week like the CDC recommends, that’s great, but more could be even better. Evidence shows that if you aggressively exercise six days per week, you can maintain your bone density without medication. 

Dr. Paula Rackoff is a rheumatologist at NYU Langone and clinical associate professor in the Department of Medicine at NYU Grossman School of Medicine. She collaborates closely with Dr. Nicole Leung and Eileen Lydon, NP as part of our Osteoporosis & Bone Health Program.