Osteoporosis: Are You at Risk?
Things that make
osteoporosis more likely include:
Age. Your
bone density peaks around age 30. After that, you’ll begin to lose bone mass.
So that’s all the more reason to do strength training and weight-bearing exercise -- and make sure you get enough calcium and vitamin D from your diet -- to
keep your bones as strong as possible as you get older.
Gender. Women over the age of 50 are the most likely people to
develop osteoporosis. The condition is 4 times as likely in women than men.
Women's lighter, thinner bones and longer life spans are part of the reason
they have a higher risk. Men can get osteoporosis, too -- it’s just less
common.
Family history. If your parents or grandparents have had any signs of osteoporosis,
such as a fractured hip after a minor fall, you may be more likely to get it,
too.
Bone structure and body weight. Petite and thin women have a greater chance of
developing osteoporosis. One reason is that they have less bone to lose than
women with more body weight and larger frames. Similarly, small-boned, thin men
are at greater risk than men with larger frames and more body weight.
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Ethnicity. Research shows that Caucasian and Asian women are more
likely to develop osteoporosis than women of other ethnic backgrounds. Hip
fractures are also twice as likely to happen in Caucasian women as in
African-American women.
Certain diseases. Some diseases such as rheumatoid arthritis raise the odds that you’ll get osteoporosis.
Some medications. Certain prescription medications -- for example, if
you take steroids such as prednisone for a long time -- can also boost your odds of getting
osteoporosis.
Smoking. It’s bad for your bones. To lower your risk of
osteoporosis and fractures -- and many other health problems -- work with your
doctor to kick this habit ASAP.
Sources
© 2016
WebMD, LLC.
Although
osteoporosis runs in her family, Roe says she found out her diagnosis was
likely also caused by medication she was taking. "I had been on a very
high dose of prednisone for almost 2 years to treat an autoimmune
disease," she says. Those steroid treatments, along with her age, gender,
and family history, put Roe at high risk of getting the disease -- and breaking
bones.
Osteoporosis
happens when your body starts losing bone, doesn't make enough bone, or both.
It causes weak bones that break easily, especially after a fall.
"There's
often nothing wrong with the bone -- there's just too little of it," says
Susan L. Greenspan, MD, director of the Osteoporosis Prevention and Treatment
Center and the Bone Health Program at the University of Pittsburgh Medical
Center. "Imagine a stool that only has two legs instead of four. It's much
easier to break."
You lose bone as
you age, so the older you are, the more likely you are to get osteoporosis,
especially if you're a woman. "After age 50, one out of every two women
and one out of five men will fracture a bone," Greenspan says.
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Much Sweating?
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And once you've
broken a bone, you're much more likely to break another one in the future.
Roe's fractures didn't stop with her broken vertebrae. "I've had another
vertebral fracture, a hip broken in two places, and broken bones in my hand and
both feet," she says.
Besides your
age, gender, and past broken bones, there are other things that raise your risk
of getting osteoporosis, like:
- Family history of the disease, or a mother or father with a hip
fracture
- Conditions like overactive thyroid condition, rheumatoid
arthritis, diabetes, lung diseases, and Parkinson's disease
- Medications like steroids, heartburn medicine, seizure drugs, or
breast and prostate cancer medications
- Early menopause
- Lack of exercise
- Too thin
- Not enough calcium or vitamin D
- Don't eat enough fruits and veggies
- Smoking
- Have too much protein, sodium, caffeine, or alcohol
Even if one or more of these things are true for you, it doesn't mean you'll
get the disease. But it does mean you should keep a close eye on your bone
health and take steps to keep your bones strong.
"The good
news is there are lifestyle changes and medications that reduce the risk of
fractures and keep you active and standing tall," Greenspan says.
Your doctor has
several tools to help monitor how your bones are doing. In addition to your
medical history and an exam, she can also use certain tests to measure the
density of your bones. Most commonly, doctors use a bone density test, or DEXA.
"The bone
density lets the health care provider know if the bone is normal, on the way to
osteoporosis, or osteoporotic," Greenspan says. "It's easy,
comfortable, and low radiation."
Doctors
recommend regular bone density scans for women starting at age 65, and for men
starting at age 70. Or you may have one sooner if you have things that may
raise your chances of osteoporosis, such as:
- Breaking a bone after age 50
- Back pain
- Height loss of 1/2 inch in a year
- Height loss of 1 and 1/2 inches from your original height
If you're on
medication for osteoporosis, your doctor will likely recommend you have a bone
density test every 1 to 2 years.
Once your doctor
has your bone density information, she can use it to do an osteoporosis risk
assessment test, or FRAX. The test scores can help you learn how likely it is
you'll break a bone in the next 10 years.
Are You At
Risk?
There are a variety of factors – both
controllable and uncontrollable – that put you at risk for developing
osteoporosis. It is important to talk with your healthcare provider about your
risk factors for osteoporosis and together you can develop a plan to protect
your bones.
A woman’s risk of
breaking a hip due to osteoporosis is equal to her risk of breast, ovarian and
uterine cancer combined. And a man age 50 or older is more likely to break a
bone due to osteoporosis than he is to get prostate cancer.
Uncontrollable
Risk Factors
·
Being over age
50.
·
Being female.
·
Menopause.
·
Family history of
osteoporosis.
·
Low body
weight/being small and thin.
·
Broken bones or
height loss.
Controllable
Risk Factors
·
Not getting
enough calcium and vitamin D.
·
Not eating enough
fruits and vegetables.
·
Getting too much
protein, sodium and caffeine.
·
Having an
inactive lifestyle.
·
Smoking.
·
Drinking too much
alcohol.
·
Losing weight.
What Women
Need to Know
Being female puts you at risk of
developing osteoporosis and broken bones. Here are some facts:
·
Of the estimated
10 million Americans with osteoporosis, about eight million or 80% are women.
·
Approximately one
in two women over age 50 will break a bone because of osteoporosis.
·
A woman’s risk of
breaking a hip is equal to her combined risk of breast, uterine and ovarian
cancer.
There are multiple
reasons why women are more likely to get osteoporosis than men, including:
o
Women tend to
have smaller, thinner bones than men.
o
Estrogen, a
hormone in women that protects bones, decreases sharply when women reach menopause,
which can cause bone loss. This is why the chance of developing osteoporosis
increases as women reach menopause.
Now the good news:
People used to think
that osteoporosis was an inevitable part of aging. Today we know a lot more
about how to prevent, detect, and treat the disease. You are never too young or
old to take care of your bones. Good lifestyle habits can help you protect your
bones and decrease your chance of getting osteoporosis. And, if your healthcare
provider hasn’t talked to you about your bone health, it’s time for you to
bring it up!
What’s Your Risk?
Osteoporosis and bone health issues vary for girls and women of different ages and ethnic backgrounds. Caucasian women, and older women, are most at risk for osteoporosis; however, osteoporosis and low bone density are common among other groups as well. And not only are women at risk; men can develop osteoporosis as well.
Caucasian Women
·
Twenty percent of
Caucasian women age 50 and older are estimated to have osteoporosis.
·
More than half of
all Caucasian women age 50 and older are estimated to have low bone mass, which
means their bones are getting weaker but they don’t yet have osteoporosis.
·
Between the ages
of 20 and 80, Caucasian women lose one-third of the bone mineral density in
their hip.
·
About 15 percent
of Caucasians are lactose intolerant, which can make it difficult to get
enough calcium.
African-American
Women
·
Another 35 percent
are estimated to have low bone mass, which means their bones are getting weaker
but they don’t yet have osteoporosis.
·
Recent research
shows that even among African American women who do have risk factors for
osteoporosis, few are screened for the disease.
·
About 70 percent
of African Americans are lactose intolerant, which can make it difficult to get
enough calcium.
·
Many African
American women don’t get enough vitamin D, which can make it hard for the body
to absorb calcium.
In the United States, African American women are more likely than many other racial or ethnic groups to have diseases that can lead to osteoporosis, such as lupus.
In the United States, African American women are more likely than many other racial or ethnic groups to have diseases that can lead to osteoporosis, such as lupus.
Asian-American Women
·
About 20 percent
of Asian American women age 50 and older are estimated to have osteoporosis.
·
More than half of
all Asian American women age 50 and older are estimated to have low bone
density, which means their bones are getting weaker but they don’t yet have
osteoporosis.
·
About 90 percent
of Asian American adults are lactose intolerant, which can make it difficult to
get enough calcium.
Latina Women
·
Ten percent of
Latinas have osteoporosis.
·
Half of all
Latinas older than 50 have low bone mass, which means their bones are getting
weaker but they don’t yet have osteoporosis.
·
Many Latinas are
lactose intolerant, which can make it difficult to get enough calcium.
·
Hip fractures
among Latinas in the United States appear to be on the rise.
Menopause: A Time
for Action
When a woman reaches
menopause, her estrogen levels drop and can lead to bone loss. For some women,
this bone loss is rapid and severe.
Two major factors that
affect your chance of getting osteoporosis are:
·
The amount of bone you have when you reach
menopause. The
greater your bone density is to begin with, the lower your chance of developing
osteoporosis. If you had low peak bone mass or other risk factors that caused
you to lose bone, your chance of getting osteoporosis is greater.
·
How fast you lose bone after you reach
menopause. For
some women, bone loss happens faster than for others. In fact, a woman can lose
up to 20% of her bone density during the five – seven years following
menopause. If you lose bone quickly, you have a greater chance of developing
osteoporosis.
What about taking
estrogen?
If you have menopausal
symptoms, such as hot flashes, your healthcare provider may prescribe estrogen
therapy (ET) or estrogen with progesterone hormone therapy (HT). In
addition to controlling your menopausal symptoms, these therapies can also help
prevent bone loss. Some women are advised not to take ET or HT because of the
possible risks that may include breast cancer, strokes, heart attacks, blood
clots and cognitive (mental) decline. It’s important to discuss the risks and
benefits of your treatment options with your healthcare provider.
For more comprehensive
information, download NOF’s resource Hormones and
Healthy Bones
Teens: What YOU Can
Do Now
Osteoporosis is the
disease that is most likely to cause weak bones. It is more common in older
people, especially women. But it is doesn’t have to happen to YOU when you get
older. That’s because, for many people, osteoporosis can be prevented.
Most people don’t have
the opportunity that you have right now: YOU can actually build denser,
stronger bones now in a way that isn’t possible later. This will make you
healthier, and it will set you up to have stronger bones when you are older –
when weak bones can be serious.
The recipe for bone
health is simple:
·
Get enough
calcium and vitamin D, and eat a well balanced diet. Read more about
balancing your diet
·
Exercise – Read more about
exercise
·
Don’t smoke or
drink
Eating Disorders
and Other Warning Signs
The eating disorders
anorexia and bulimia can weaken your bones and increase your risk of
osteoporosis when you are older. If you have anorexia you become very thin, but
you don’t eat enough because you think you are fat. Bulimia involves periods of
overeating followed by purging, sometimes through vomiting or using laxatives.
You should talk to a
parent, doctor, or health professional immediately if you have one of these
disorders or if you stop getting your period for more than three months in a
row (and you are not pregnant). This is a condition called amenorrhea and it is
also bad for your bones.
Young Adult Women
While osteoporosis is
most common in older people, it sometimes affects young people, including
premenopausal women in their 20s, 30s and 40s. The term “premenopausal” refers
to women who are still having regular menstrual periods and have not yet
reached menopause. While it is uncommon for premenopausal women to have
osteoporosis, some young women have low bone density which increases their
chance of getting osteoporosis later in life.
Low Bone Density
and Osteoporosis in Young Adult Women
Young women who have low
bone density, often caused by low peak bone mass, are at an increased risk of
getting osteoporosis later in life.
Often, when
premenopausal women have osteoporosis, it may be due to an underlying medical
condition or a medicine that causes bone loss. Osteoporosis that is caused by a
medical condition or a medicine is called secondary osteoporosis. Sometimes
premenopausal women have osteoporosis for no known reason. This is called
idiopathic osteoporosis. The term “idiopathic” just means that the osteoporosis
is unexplained and we cannot find a cause for it.
Diagnosing
Osteoporosis in Young Women
Diagnosing osteoporosis
in premenopausal women is not straightforward and can be quite complicated.
First of all, bone density tests (jump link to below) are not routinely
recommended for young women. Here are some reasons why:
·
Most
premenopausal women with low bone density do not have an increased risk of
breaking a bone in the near future. Therefore, having information about their
bone density may only cause unnecessary worry and expense.
·
Some
premenopausal women have low bone density because their genes (family history)
caused them to have low peak bone mass. Nothing can or should be done to change
this.
·
DXA tests can
underestimate bone density in women who are small and thin. Therefore, a DXA
test may indicate that a small person has low bone density, but the bone
density is actually normal for the person’s body size
·
Osteoporosis
medicines are not approved or advised for most premenopausal women. Bone
density tests are used to help guide decisions about treatment.
Diagnosing osteoporosis
in young women usually involves several steps. While these steps may differ for
each person, they may include:
·
Your medical
history
·
Physical exam
·
Bone mineral
density (bone density) testing
·
Lab tests
·
X-rays
Bone density testing. A bone density test shows the amount of bone a
person has in the hip, spine or other bones. It is routinely recommended for
postmenopausal women and men age 50 and older and is how osteoporosis is
diagnosed in older people. Bone density tests are usually only done for
premenopausal women if they break several bones easily or break bones that are
unusual for their age, such as bones in the hip or spine. Also, if you have a
condition or take a medicine that causes secondary osteoporosis, your
healthcare provider may order a bone density test. This test should be done on
a DXA machine. DXA stands for dual energy x-ray absorptiometry.
One or two years after
an initial bone density test, a second bone density may be done and
will determine if you have low peak bone mass that is staying the same or if
you are losing bone. If your bone density drops significantly between the first
and second test, you may be losing bone and further evaluation by a healthcare
provider is needed.
Understanding your
bone density test results
A bone density test
result shows a Z-score and a T-score. T-scores are used to diagnose
osteoporosis in postmenopausal women and men age 50 and older, but not in premenopausal women. A
Z-score compares your bone density to what is normal for someone your age.
While a Z-score alone is not used to diagnose osteoporosis in premenopausal
women, it can provide important information. Read some tips to help you
understand your Z-score.
·
If your Z-score
is above -2.0, your bone density is considered within the ranges expected for
your age or normal according to the International Society for Clinical
Densitometry (ISCD). For example, a Z-score of +0.5, -0.5 and -1.5 is
considered normal for most premenopausal women.
·
If your Z-score
is -2.0 or lower, your bone density is considered below the expected range.
Examples are -2.1, -2.3 and -2.5. If your Z-score is in this range, your
healthcare provider will consider your health history and possible causes of
bone loss, including secondary osteoporosis, before making a diagnosis of
osteoporosis.
·
If your Z-score
is normal, but you’ve broken one or more bones from a minor injury, your
healthcare provider may diagnose you with osteoporosis because some people with
normal bone density break bones easily. As mentioned above, a bone density test
will also show a T-score. A T-score compares bone density to what is normal in
a healthy 30-year-old adult.
Treating
Osteoporosis in Young Women
Most of the osteoporosis
medicines available at this time are not approved by the FDA for use in
premenopausal women. But, for women who have taken steroid medicines for a long
time, three osteoporosis medicines are approved for the prevention and
treatment of osteoporosis. In very rare cases, a healthcare provider may
recommend that a premenopausal woman consider taking an osteoporosis medicine
for other reasons. Examples include when a woman breaks a bone because of low
bone density or has severe bone loss due to a medical condition.
Expecting Women
If you are pregnant or
breastfeeding, be sure to get enough calcium and vitamin D.
Calcium and vitamin D are good for you and for your baby’s growing bones. If
you don’t get enough of these nutrients, your baby’s calcium needs will be met
by taking calcium from your bones.
Most studies show that
while some bone loss may occur during pregnancy, a woman usually regains it
after giving birth. In fact, studies show that having children, even as many as
10, does not increase a woman’s chance of getting osteoporosis later in life.
Research even suggests that each additional pregnancy provides some protection
from osteoporosis and broken bones.
Pregnancy-associated
osteoporosis.
Some women develop a
temporary type of osteoporosis during pregnancy. While we do not fully
understand what causes this type of osteoporosis, it is extremely rare and
usually goes away shortly after a woman gives birth.
Breast
feeding.
Like pregnancy,
breastfeeding may cause some temporary bone loss. However, bone density appears
to recover over time and should not cause long-term harm to a woman’s bone
health. All women who are pregnant or nursing need to get enough calcium, vitamin D and
appropriate exercise to
keep their bones healthy. If you’re breastfeeding exclusively, ask your child’s
pediatrician if you need to give your baby supplemental vitamin D.
Osteoporosis
Overview
Osteoporosis
causes bones to become weak and brittle — so brittle that a fall or even mild
stresses such as bending over or coughing can cause a fracture.
Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.
Bone
is living tissue that is constantly being broken down and replaced.
Osteoporosis occurs when the creation of new bone doesn't keep up with the
removal of old bone.
Osteoporosis
affects men and women of all races. But white and Asian women — especially
older women who are past menopause — are at highest risk. Medications, healthy
diet and weight-bearing exercise can help prevent bone loss or strengthen
already weak bones.
Symptoms
There
typically are no symptoms in the early stages of bone loss. But once your bones
have been weakened by osteoporosis, you may have signs and symptoms that
include:
·
Back
pain, caused by a fractured or collapsed vertebra
·
Loss
of height over time
·
A
stooped posture
·
A
bone fracture that occurs much more easily than expected
When to see a doctor
You
may want to talk to your doctor about osteoporosis if you went through early
menopause or took corticosteroids for several months at a time, or if either of
your parents had hip fractures.
·
Osteoporosis
weakens bone
Your
bones are in a constant state of renewal — new bone is made and old bone is
broken down. When you're young, your body makes new bone faster than it breaks
down old bone and your bone mass increases. Most people reach their peak bone
mass by their early 20s. As people age, bone mass is lost faster than it's
created.
How
likely you are to develop osteoporosis depends partly on how much bone mass you
attained in your youth. The higher your peak bone mass, the more bone you have
"in the bank" and the less likely you are to develop osteoporosis as
you age.
Risk factors
A
number of factors can increase the likelihood that you'll develop osteoporosis
— including your age, race, lifestyle choices, and medical conditions and
treatments.
Unchangeable risks
Some
risk factors for osteoporosis are out of your control, including:
·
Your sex. Women are much
more likely to develop osteoporosis than are men.
·
Age. The older you
get, the greater your risk of osteoporosis.
·
Race. You're at
greatest risk of osteoporosis if you're white or of Asian descent.
·
Family history. Having a parent
or sibling with osteoporosis puts you at greater risk, especially if your
mother or father experienced a hip fracture.
·
Body frame size. Men and women who
have small body frames tend to have a higher risk because they may have less
bone mass to draw from as they age.
Hormone levels
Osteoporosis
is more common in people who have too much or too little of certain hormones in
their bodies. Examples include:
·
Sex hormones. Lowered sex
hormone levels tend to weaken bone. The reduction of estrogen levels in women
at menopause is one of the strongest risk factors for developing osteoporosis.
Men experience a gradual reduction in testosterone levels as they age.
Treatments for prostate cancer that reduce testosterone levels in men and
treatments for breast cancer that reduce estrogen levels in women are likely to
accelerate bone loss.
·
Thyroid problems. Too much thyroid
hormone can cause bone loss. This can occur if your thyroid is overactive or if
you take too much thyroid hormone medication to treat an underactive thyroid.
·
Other glands. Osteoporosis has
also been associated with overactive parathyroid and adrenal glands.
Dietary factors
Osteoporosis
is more likely to occur in people who have:
·
Low calcium intake. A lifelong lack
of calcium plays a role in the development of osteoporosis. Low calcium intake
contributes to diminished bone density, early bone loss and an increased risk
of fractures.
·
Eating disorders. Severely
restricting food intake and being underweight weakens bone in both men and
women.
·
Gastrointestinal surgery. Surgery to reduce
the size of your stomach or to remove part of the intestine limits the amount
of surface area available to absorb nutrients, including calcium.
Steroids
and other medications
Long-term
use of oral or injected corticosteroid medications, such as prednisone and
cortisone, interferes with the bone-rebuilding process. Osteoporosis has also
been associated with medications used to combat or prevent:
·
Seizures
·
Gastric
reflux
·
Cancer
·
Transplant
rejection
Medical conditions
The
risk of osteoporosis is higher in people who have certain medical problems,
including:
·
Celiac
disease
·
Inflammatory
bowel disease
·
Kidney
or liver disease
·
Cancer
·
Lupus
·
Multiple
myeloma
·
Rheumatoid
arthritis
Lifestyle
choices
Some
bad habits can increase your risk of osteoporosis. Examples include:
·
Sedentary lifestyle. People who spend
a lot of time sitting have a higher risk of osteoporosis than do those who are
more active. Any weight-bearing exercise and activities that promote balance
and good posture are beneficial for your bones, but walking, running, jumping,
dancing and weightlifting seem particularly helpful.
·
Excessive alcohol consumption. Regular
consumption of more than two alcoholic drinks a day increases your risk of
osteoporosis.
·
Tobacco use. The exact role
tobacco plays in osteoporosis isn't clearly understood, but it has been shown
that tobacco use contributes to weak bones.
Complications
·
Compression
fractures
Bone
fractures, particularly in the spine or hip, are the most serious complication
of osteoporosis. Hip fractures often are caused by a fall and can result in
disability and even an increased risk of death within the first year after the
injury.
In
some cases, spinal fractures can occur even if you haven't fallen. The bones
that make up your spine (vertebrae) can weaken to the point that they may
crumple, which can result in back pain, lost height and a hunched forward
posture.
Prevention
Good
nutrition and regular exercise are essential for keeping your bones healthy
throughout your life.
Protein
Protein
is one of the building blocks of bone. And while most people get plenty of
protein in their diets, some do not. Vegetarians and vegans can get enough protein
in the diet if they intentionally seek suitable sources, such as soy, nuts,
legumes, and dairy and eggs if allowed. Older adults may also eat less protein
for various reasons. Protein supplementation is an option.
Body weight
Being
underweight increases the chance of bone loss and fractures. Excess weight is
now known to increase the risk of fractures in your arm and wrist. As such,
maintaining an appropriate body weight is good for bones just as it is for
health in general.
Calcium
Men
and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day.
This daily amount increases to 1,200 milligrams when women turn 50 and men turn
70. Good sources of calcium include:
·
Low-fat
dairy products
·
Dark
green leafy vegetables
·
Canned
salmon or sardines with bones
·
Soy
products, such as tofu
·
Calcium-fortified
cereals and orange juice
If
you find it difficult to get enough calcium from your diet, consider taking
calcium supplements. However, too much calcium has been linked to kidney
stones. Although yet unclear, some experts suggest that too much calcium
especially in supplements can increase the risk of heart disease. The Institute
of Medicine recommends that total calcium intake, from supplements and diet
combined, should be no more than 2,000 milligrams daily for people older than
50.
Vitamin D
Vitamin
D improves your body's ability to absorb calcium and improves bone health in
other ways. People can get adequate amounts of vitamin D from sunlight, but
this may not be a good source if you live in a high latitude, if you're
housebound, or if you regularly use sunscreen or avoid the sun entirely because
of the risk of skin cancer.
Scientists
don't yet know the optimal daily dose of vitamin D for each person. A good
starting point for adults is 600 to 800 international units (IU)
a day, through food or supplements. For people without other sources of vitamin
D and especially with limited sun exposure, a supplement may be needed. Most
multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for
most people.
Exercise
Exercise
can help you build strong bones and slow bone loss. Exercise will benefit your
bones no matter when you start, but you'll gain the most benefits if you start
exercising regularly when you're young and continue to exercise throughout your
life.
Combine
strength training exercises with weight-bearing and balance exercises. Strength
training helps strengthen muscles and bones in your arms and upper spine, and
weight-bearing exercises — such as walking, jogging, running, stair climbing,
skipping rope, skiing and impact-producing sports — affect mainly the bones in
your legs, hips and lower spine. Balance exercises such as tai chi can reduce
your risk of falling especially as you get older.
Swimming,
cycling and exercising on machines such as elliptical trainers can provide a
good cardiovascular workout, but they're not as helpful for improving bone
health.
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