Guide to Osteoporosis and Bone Health

What is Osteoporosis?

Osteoporosis is a disease that causes bones to become weak and brittle. This can be the result of the body losing too much bone, making too little bone, or both.

Strong bones are essential to your overall health because they help protect vital organs from injury, store crucial nutrients and support movement. In healthy bones, new bone tissue is created quicker than old bone tissue deteriorates, resulting in strong, dense bones that are hard to break.

According to the National Osteoporosis Foundation, “Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone.”

Causes of Osteoporosis

Osteoporosis has several causes and can affect people of all ages and genders. One common cause of osteoporosis is vitamin D deficiency.

Vitamin D helps the body absorb calcium, a mineral that helps build bone strength and maintain muscle function.

• Vitamin D deficiency occurs when the body is not getting enough vitamin D, either through food, dietary supplements or sunlight.
• Too little vitamin D can trigger the release of parathyroid hormone, which causes bones to release calcium constantly into the bloodstream. This can cause bones to break down and lose their density, leading to osteoporosis.
• Low amounts of vitamin D have also been associated with cancer, cognitive impairment in older adults, asthma in children and an increased risk of death from cardiovascular disease.
• The symptoms of vitamin D deficiency are usually subtle, but may include muscle weakness and bone pain.

Vitamin D deficiency is not the only cause of osteoporosis. Other causes include:

• Slow bone growth during childhood. People who start out with lower reserves of bone are more likely to develop osteoporosis later in life.
• Menopause. The reduction of estrogen production that occurs during menopause can lead to osteoporosis in older women. This decrease in estrogen speeds up the rate of bone loss, especially during the first few years after menopause.
• Some diseases and medical conditions. Alcoholism, anorexia nervosa, kidney disease, hyperthyroidism and certain gastrointestinal disorders have been linked to osteoporosis.
• Certain medications. Long-term use of certain anticonvulsants and anti-inflammatory drugs can lead to osteoporosis.

Symptoms and Risks

Osteoporosis has no symptoms until a bone breaks. However, a bone density test can help evaluate how strong your bones are and determine whether or not you have osteoporosis. A bone density test can also identify how likely you are to break a bone.

Typically, your doctor will order a bone density test if he or she feels you are likely to develop osteoporosis.

Risks for Women and Older Adults

Age and Gender both play key roles in whether someone is at risk of developing osteoporosis.

After age 30, bone deposits occur at a slower rate than bone withdrawals, leading to decreased bone density. Also, reduced calcium absorption and vitamin D deficiency are common in older adults.

Although osteoporosis can occur in men and women at any age, it is most common in older women. According to Harvard Health Publications, osteoporosis starts earlier in women and gets worse faster because of midlife hormonal shifts.

Other risk factors include:

• Weight. People who are below their recommended body weight are more likely to get osteoporosis than people who are normal weight or overweight.
• Family history. People with one or more family members with osteoporosis may have an increased risk of developing the disease.
• Ethnicity. According to the National Institute of Health, Caucasian women and Asian women are most likely to get osteoporosis.
• Smoking. There is a direct correlation between tobacco use and decreased bone density.
• Inactivity. A lack of exercise or physical activity can increase the rate of bone loss.
• Certain medical conditions. Some autoimmune disorders, gastrointestinal disorders and cancers can increase the likelihood of osteoporosis 
• Some medical procedures. People who have had gastrointestinal bypass procedures may have an increased risk of developing osteoporosis.

Treatment and Prevention

The following tips can help strengthen bones and prevent fractures caused by osteoporosis.

1. Eat a Diet Rich In Calcium

A well-balanced diet is important at any age, but is especially important for people with osteoporosis.

Foods that are good sources of calcium include:

• Dairy products such as milk, cheese and yogurt
• Calcium-fortified soy milk
• Broccoli
• Tofu
• Kale
• Sardines and canned salmon
• Beans
• Almonds

Recommended Daily Calcium Intake

Source: National Institutes of Health Office of Dietary Supplements

Note: People between the ages of 19 and 50 should not consume more than 2,500 mg of calcium because it can cause kidney stones and other health problems.

2. Eat a Diet Rich In Vitamin D

Generally, the body absorbs vitamin D from sunlight and from certain foods, including egg yolks, liver and fish. People who are deficient in vitamin D may also take vitamin D supplements. There are two types of vitamin D supplements: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol).

The chart below show how much vitamin D is recommended for people of different ages and genders.

Recommended Daily Vitamin D Intake

Source: National Institutes of Health Office of Dietary Supplements

Foods Rich in Vitamin D

Source: National Institutes of Health Office of Dietary Supplements

3. Get Enough Exercise

Physical activity is necessary to build bone mass and maintain bone health through adulthood. Strength and resistance training exercises are especially beneficial and can reduce age-related bone loss when paired with adequate vitamin D and calcium intake.

Some low-impact exercises to try include:

• Water aerobics
• Walking
• Hiking (beginner to intermediate trails only)
• Stair climbing
• Dancing
• Tai chi

High-impact exercises such as running and activities that require you to bend at the waist should be avoided. This includes tennis, some yoga poses, golf and bowling.

4. Prevent Falls

According to the National Osteoporosis Foundation, “Each year about one-third of all people over age 65 will fall.” Falls can cause serious injuries, especially in people with osteoporosis because they are more likely to break a bone.

To limit your risk of fall:

• Make updates to your home that include:
  • Securing rugs with double-sided tape
  • Repairing loose flooring
  • Using sticky mats in the bathtub to prevent slipping
  • Moving coffee tables and other objects from high-trafficked areas 
• Swap out uncomfortable shoes with shoes that provide plenty of support
• Stay active. In addition to keeping bones healthy and strong, a bit of daily exercise can help improve coordination and balance, which can help prevent falls
• Make a doctor’s appointment. During the visit, be sure to disclose any medications you’re taking, as some medications cause side effects that can increase the risk of fall. Your doctor may recommend a different medication with fewer side effects.
• Don’t ignore a fall when it happens. A fall can be a sign of a new medical problem that requires immediate attention. Additionally, older adults who have fallen are more likely to fall again. When it comes to fall prevention, being proactive is key.

Fall Prevention Resources

• National Center for Injury Prevention and Control (NCIPC)
• State Falls Prevention Coalition Contacts
• Falls prevention fact sheet

References and Additional Reading

For more information about bone health and osteoporosis, refer to the resources listed below.

• National Osteoporosis Foundation
• National Institutes of Health, Osteoporosis and Related Bone Diseases
• 2 Million 2 Many
• American Society for Bone and Mineral Research
• Fracture Prevention CENTRAL
• PB&J (Protect Your Bones and Joints) — public education program for adolescents
• United States Bone and Joint Initiative
• American Bone Health
• International Osteoporosis Foundation — See here for a list of recipes that promote bone health

*This content is not medical advice, nor is it a substitute for professional medical advice, diagnosis, or treatment.