Osteoporosis is often dismissed as an inevitable part of aging.
While bone mass naturally peaks in the late 20s and declines with age, the belief that this metabolic bone disease is guaranteed for everyone is a dangerous assumption — especially because osteoporosis can become deadly serious.
That belief is also false: Osteoporosis is not inevitable, and there are steps people can take to prevent or slow bone loss.
Clinically classified as a “silent disease” because bone loss happens without any pain, aching or physical warning, osteoporosis can go undetected as bone density decreases and bone tissue deteriorates, making bones increasingly fragile.
Often, the first sign is a fracture caused by a minor fall or even a routine daily activity.
Here, I’m setting the record straight on who is most at risk (spoiler alert: It’s not just older women), the factors that can increase risk and what steps can be taken today to protect bone health.
A fracture can have serious ripple effects
Osteoporosis can have consequences that go far beyond a broken bone.
Vertebral fractures can lead to chronic pain, while hip fractures in older adults are associated with a substantial risk of complications and death. Mortality after a hip fracture can approach 30% within one year in some studies.
At the very least, a fracture can result in loss of mobility and independence, making it harder for someone to live on their own.
Physical health isn’t all that can be impacted. If people become afraid of falling, even normal daily activities can become difficult. They may exercise less, stop doing activities they enjoy and become socially isolated.
Not just an older woman’s disease
Postmenopausal women are among those at highest risk for osteoporosis, but men can develop the disease, too.
Having a previous fragility fracture — a fracture caused by a low-trauma event, such as a minor fall — also raises the risk of having another one.
People with low BMI or low body weight are at increased risk, as are those who have experienced significant weight loss. People who are smaller in stature may also have smaller bones and less bone mass to begin with.
Family history is another major factor, particularly when it comes to hip fractures. Having a parent who fractured their hip, for example, can significantly increase the risk of a hip fracture or other major osteoporotic fractures.
Certain diseases and medications increase risk
There are several endocrine disorders that can affect bone health, including hyperthyroidism. Women are known to be at increased risk during menopause because of declining estrogen levels, but low testosterone can also contribute to bone loss.
Cushing’s syndrome, which causes the body to produce too much cortisol, as well as rheumatoid arthritis and other inflammatory conditions, can also increase the risk.
Chronic diseases affecting the kidneys, liver and gastrointestinal tract can lead to osteoporosis and bone loss through different mechanisms.
Certain medications also affect bone health. Drugs that suppress estrogen or testosterone, as well as some seizure medications, may contribute to bone loss. That means breast cancer and prostate cancer patients, as well as people being treated for epilepsy, may need to have their bone health monitored.
Lifestyle factors matter, too. Smoking and heavy alcohol consumption (more than two drinks a day for men and one for women) can increase risk of bone loss.
Your diet matters more than you think
Not getting enough nutrition, including a balanced diet rich in calcium, vitamin D and protein, can undermine bone health.
Calcium is essential for building and maintaining strong bones. Adults generally need about 1,000 to 1,200 milligrams of calcium per day, which can come from foods such as dairy products and fortified foods.
Vitamin D can come from sunlight and foods including salmon, mackerel, egg yolks and dairy products. Other vitamins and minerals, including magnesium, potassium and vitamins K and C, also play roles in bone health.
Sitting too much (and skipping strength training) can hurt your bones
Being sedentary is another factor that can put bone health at risk.
Regular weight-bearing exercise and strength training are important for maintaining and strengthening bones.
Weight-bearing activities include brisk walking, hiking, running, dancing and aerobics, while resistance training includes exercises that challenge the muscles and bones against resistance.
While yoga, Pilates and tai chi are also valuable forms of exercise that can improve flexibility, core strength and balance — which can help reduce the risk of falls — they do not replace weight-bearing or resistance exercise when it comes to building and maintaining bone strength.
The goal is to build as much bone mass as possible during the early years of life and maintain it for as long as possible. While some bone loss is a normal part of aging, healthy habits can help preserve bone strength and reduce fracture risk later in life.
Dr. Susan Zweig is an endocrinologist, clinical professor and associate director of clinical affairs in the Holman Division of Endocrinology, Diabetes and Metabolism within the Department of Medicine at NYU Langone Health. She sees patients at NYU Langone Diabetes & Endocrine Associates, where she treats a range of hormonal and metabolic conditions, including diabetes, thyroid disorders, osteoporosis and menstrual and fertility disorders.
