Throughout your life, you constantly lose old bone and form new bone. As a teenager and young adult, your body made more bone than you lost. But with age, bone production drops off and bone loss increases, putting you at risk for osteoporosis (porous bone, which fractures easily). According to the National Osteoporosis Foundation (NOF), roughly 10 million Americans have osteoporosis and 34 million have osteopenia (low bone mass). But osteoporosis and related fractures don't have to be inevitable. Here are 10 things you need to know to lower your risk.
A broken bone might mean you already have osteoporosis. A simple fall that results in a fracture is the most telling sign that you may have osteoporosis, says Connie Weaver, PhD, chairman of the department of nutrition science at Purdue University and a calcium researcher. "Many times, people just assume the fracture is due to the trauma and don't investigate if they need to be treated for osteoporosis," Weaver says. But it's possible that the fractured bone was already in a weakened condition due to osteoporosis before the fall. People who break a bone and have other risk factors for osteoporosis -- such as a small build or a family history of fracture and low body weight -- should be especially vigilant, she says.
Having diabetes can raise your risk for osteoporosis. People who have type 1 diabetes or type 2 diabetes are prone to weaker bones. "The quality of the bone they make isn't good," says Diane Schneider, MD, a geriatrician and the author of The Complete Book of Bone Health. "In people with type 1 diabetes, there is more bone breakdown, and in people with type 2 diabetes, the bones are more fragile." Medications for type 2 diabetes can also cause bones to be weaker. Even extra body weight doesn't help. "We're finding a growing connection between bone and fat," Schneider says. "Being overweight is not as protective as we once thought it was."
Being thin increases your chances for osteoporosis. Having a small frame and a slight build means you have bones that are less dense, making them more vulnerable to osteoporosis and fracture. Some studies show you may be especially prone to developing osteoporosis if you weigh 127 pounds or less, Schneider says. Since there isn't much you can do about the way you're built, women who are small-boned need to take charge of osteoporosis risk factors that they can control. "You have to pay special attention to what I call the ABCDs of bone health," Schneider says. "Activity, balance -- because you need core strength to prevent falls regardless of bone density -- calcium, and vitamin D."
Not getting enough calcium puts your bones at risk. Calcium is a mineral essential to bone strength, but a recent study showed that many Americans may not be getting enough of it in their diets. Before you reach for a bottle of supplements, new research suggests taking calcium supplements may raise your risk of heart attack and kidney stones. The fact remains that calcium is a necessary part of our diets. According to the Institute of Medicine, women need 1,000 mg of calcium each day up to age 50, and 1,200 mg of calcium a day after age 50. Schneider recommends getting the bulk of your calcium from food -- milk, yogurt, broccoli, turnip greens, and calcium-fortified foods -- and taking less than the recommended dose of calcium supplements.
A lack of vitamin D raises your risk for osteoporosis. Vitamin D is essential for bone health because it helps your body absorb calcium. Spending just 20 minutes a day in the sunshine -- without sunscreen -- during the summer months provides enough vitamin D to last you through the year, says Dana Simpler, MD, a physician in private practice in Baltimore, MD. "People with dark complexions may need up to an hour," she says. You can also get vitamin D from supplements and foods such as dark leafy greens, and vitamin-D fortified orange juice and soy milk. According to the Institute of Medicine, most people need 600 IUs of vitamin D a day. People aged 71 and over require 800 IUs of vitamin D daily, possibly more, depending on their health.
Some medications can hurt your bones. Certain medications -- among them antidepressants, corticosteroids and proton pump inhibitors -- can put your bones at greater risk for osteoporosis. Anti-seizure medications, certain cancer treatments, and diabetes drugs may also cause bone loss. In most cases, the risk of osteoporosis goes up the longer you take these meds and the higher the dose. Before going on any medication, ask your doctor about the impact on your bones. If you must take one of these drugs, work with your doctor to take the lowest dose possible, and discuss ways to lower your risk of osteoporosis.
After menopause, your risk for osteoporosis goes up. For women, menopause causes a steep drop in estrogen, a hormone essential for strong bones. The earlier you go into menopause, the higher your risk of osteoporosis. A recent Swedish study found that women who entered menopause before the age of 47 were nearly twice as likely to have osteoporosis later in life as those who entered menopause when they were older. "Women lose the most bone in the first three to five years of menopause," Weaver says. "They can lose as much bone as they gain during puberty." Menopause, says Weaver, is an important period to make lifestyle choices that protect against bone loss, namely with exercise and diet.
A bone density test can detect bone loss. Bone density is commonly measured with dual-energy x-ray absorptiometry (DXA), also known as a bone density test. This simple, painless test gauges bone strength by comparing your bone mass to those of young adults of the same gender at peak bone mass, using a T-score. A T-score of -2.5 or lower, means you have osteoporosis. A score between -1.0 and -2.5 means you have osteopenia, low bone mass. A T-score of -1.0 or higher means your bones are normal. "Women usually don't need a DXA scan until they're 65 and men until age 70," says Schneider. Talk to your doctor about when to get screened and about follow-up tests. The answer will depend on your age, osteoporosis risk factors, and previous bone density test results.
Being physically active protects you against osteoporosis. Weight-bearing exercises -- the kind that force your body to work against gravity, such as walking, running, dancing, and tennis -- are the best for keeping bones healthy. The key, Schneider says, is to simply be active. "It doesn't have to be exercise in the gym," she says. "You simply want to spend more time on your feet and move. You want to spend less time sitting."
Not everyone with osteoporosis needs medication. In recent years, some drugs used to treat osteoporosis have come under fire for potentially increasing the risk for breakage of the femur bone, esophageal cancer, and the death of bone tissue in the jaw. In reality, only women at high risk for a fracture need treatment, says Ruth Freeman, MD, a professor of obstetrics-gynecology at Montefiore Medical Center in the Bronx. "I always recommend lifestyle changes first," Freeman says. Women who have osteoporosis and other risk factors such as rheumatoid arthritis, low body weight, and a family history of fractures for instance, may want to take osteoporosis drugs. But women who have no other risk factors might consider opting out. Talk to your doctor about your best option.
