Osteoporosis Explained: Who’s At Risk and What You Can Do About It
Osteoporosis Explained: Who’s At Risk and What You Can Do About It
Osteoporosis is a medical condition characterized by the weakening of bones, making them fragile and more susceptible to fractures. The word "osteoporosis" literally means "porous bones," which refers to the loss of bone density and the structural deterioration of bone tissue. In a healthy bone, the structure is dense and solid, allowing it to withstand normal stresses. In osteoporosis, however, bones become less dense, more brittle, and more likely to break, even from minor falls or bumps.
The condition develops over time, and often there are no symptoms in the early stages. It’s typically only detected when a fracture occurs, or through a bone density test (DEXA scan). Although osteoporosis can affect any bone in the body, it most commonly affects bones in the spine, hips, and wrists. These fractures can lead to significant pain, disability, and loss of independence.
Who Does Osteoporosis Commonly Affect?
Osteoporosis is often referred to as a "silent disease" because it develops slowly and doesn’t present clear symptoms until a bone fracture occurs. While anyone can develop osteoporosis, certain groups are at higher risk, especially as they age. The following populations are most commonly affected:
Postmenopausal Women
Hormonal Changes: One of the most significant risk factors for osteoporosis is low levels of estrogen, a hormone that plays a key role in maintaining bone density. After menopause, women experience a sharp decline in estrogen levels, which accelerates bone loss. This makes postmenopausal women particularly vulnerable to osteoporosis.
Age Factor: The risk of developing osteoporosis increases with age. Women over the age of 65 are at higher risk of osteoporosis-related fractures, but the condition can develop earlier, especially if they have other risk factors.
Older Adults (Men and Women)
As people age, bone density naturally decreases. Both men and women experience a gradual reduction in bone mass after the age of 30, but women are more affected due to the sharp drop in estrogen after menopause. Men, however, can also develop osteoporosis as they age, especially if they have low levels of testosterone, which is another hormone that helps maintain bone density.
Individuals with a Family History of Osteoporosis
Genetics play a role in the development of osteoporosis. If you have a parent or sibling with osteoporosis, especially a mother who had fractures due to osteoporosis, your risk is higher. A family history of fractures can indicate a genetic predisposition to weaker bones.
People with Certain Medical Conditions
Chronic diseases like rheumatoid arthritis, chronic kidney disease, and celiac disease can increase the risk of osteoporosis. Conditions that affect the absorption of nutrients, such as malabsorption syndromes, can also make it harder for the body to get the necessary vitamins and minerals for bone health.
Conditions like hyperthyroidism and certain metabolic disorders can also lead to bone loss.
People on Long-Term Medications
Long-term use of medications like corticosteroids (for conditions such as asthma, COPD, arthritis, or lupus) can interfere with bone health. These medications reduce bone formation and can lead to a loss of bone density. Other medications, such as proton pump inhibitors (PPIs), which are used to treat acid reflux, can also have an impact on calcium absorption.
Individuals with Low Body Weight or Poor Nutrition
People who are underweight or have low body mass index (BMI) are at higher risk of developing osteoporosis. Low body weight can indicate that there is less bone mass to start with. Additionally, individuals who have poor diets that lack adequate calcium and vitamin D intake are more likely to develop osteoporosis.
Smokers and Heavy Drinkers
Smoking reduces blood flow to the bones and interferes with bone cell activity, leading to weaker bones. Excessive alcohol consumption also disrupts the balance of calcium in the bones and can prevent the body from absorbing the nutrients it needs to maintain healthy bone mass.
Ethnic and Racial Differences
Osteoporosis is more common in Caucasians and Asians, especially among women. African American and Hispanic populations generally have denser bones and lower fracture rates, but they are not immune to osteoporosis, especially if they have other risk factors.
Prevention: Building Strong Bones From The Start
Adequate Nutrition: Calcium and Vitamin D
Calcium is the main building block of bone tissue. Consuming enough calcium in your diet is essential for maintaining bone density and preventing bone loss as you age. The recommended daily intake varies by age and sex, but adults generally need about 1,000 to 1,200 milligrams of calcium per day. Dairy products like milk, yogurt, and cheese, as well as fortified plant-based milk and leafy green vegetables, are excellent sources of calcium.
Vitamin D is necessary for calcium absorption and bone health. Without enough vitamin D, the body can't effectively absorb calcium, leading to weaker bones. Sunlight exposure is the most natural source of vitamin D, but it can also be obtained from fortified foods or supplements. Adults typically need about 600 to 800 IU of vitamin D daily, though some individuals may require higher doses, particularly those with limited sun exposure or absorption issues.
Physical Activity Weight-bearing exercises such as walking, jogging, dancing, and resistance training can help build and maintain strong bones. Activities that stimulate bone formation are essential, especially for people in their 20s and 30s. As people age, these activities help slow the loss of bone density and improve balance, which reduces the risk of falls and fractures.
Avoiding Smoking and Excessive Alcohol Consumption Smoking and heavy drinking are both detrimental to bone health. Smoking reduces blood flow to the bones and decreases bone formation, while excessive alcohol consumption can interfere with calcium absorption. Avoiding these habits is crucial for maintaining bone density over the long term.
Fall Prevention As we age, the risk of falls increases, and a fall can lead to a fracture, especially in individuals with osteoporosis. Primary care doctors can advise patients on fall prevention strategies, including modifying the home environment (e.g., removing tripping hazards), improving balance through exercise (e.g., tai chi), and wearing proper footwear.
Early Detection: Identifying Osteoporosis Before a Fracture Occurs
Osteoporosis is often asymptomatic in the early stages, which is why it’s important to assess the risk of developing this condition before a fracture happens.
Assessing Risk Factors The first step in identifying those at risk is understanding the individual’s risk factors for osteoporosis. Key risk factors include:
Age (women over 65 and men over 70 are at higher risk)
Family history of osteoporosis or fractures
Low body weight
Long-term use of medications such as corticosteroids or proton pump inhibitors
Hormonal changes (e.g., menopause in women, low testosterone in men)
Sedentary lifestyle
Poor diet (low calcium and vitamin D intake)
Bone Density Testing (DEXA Scan) Dual-energy X-ray absorptiometry (DEXA) is the gold standard for diagnosing osteoporosis. This non-invasive test measures bone mineral density (BMD) and provides a score that helps determine the risk of fractures. The test is typically recommended for women over the age of 65 and men over the age of 70, or earlier for individuals with risk factors for osteoporosis. A low BMD score (usually defined as a T-score of -2.5 or lower) indicates the presence of osteoporosis.
Treatment: Medications and Lifestyle Adjustments to Prevent Fractures
If osteoporosis is diagnosed, the goal of treatment is to prevent fractures by improving bone density and strength. In addition to the preventive measures discussed earlier, treatment options can include medications and lifestyle adjustments.
Medications to Improve Bone Density Several classes of medications are available to help manage osteoporosis.
Bisphosphonates (e.g., alendronate, risedronate) are the most commonly prescribed medications for osteoporosis. They work by inhibiting the cells that break down bone (osteoclasts), helping to maintain bone mass and reduce fracture risk. These medications can be taken orally or via injection.
Denosumab is a monoclonal antibody that works similarly to bisphosphonates by inhibiting bone resorption. It is typically administered as a subcutaneous injection every six months.
Selective Estrogen Receptor Modulators (SERMs) like raloxifene are used primarily in postmenopausal women. They mimic estrogen’s bone-protecting effects without some of its other side effects.
Teriparatide is a recombinant form of parathyroid hormone that stimulates new bone formation. It is usually reserved for those with severe osteoporosis and a high fracture risk.
Romosozumab is a newer medication that both inhibits bone resorption and promotes bone formation. It is given as a monthly injection for individuals at high risk of fractures.
Lifestyle Adjustments Even if medications are prescribed, making lifestyle changes is an important part of managing osteoporosis:
Continue weight-bearing exercises to maintain bone strength.
Ensure adequate calcium and vitamin D intake through diet or supplements, as needed.
Modify the home environment to reduce fall risk by adding grab bars, securing rugs, and ensuring good lighting.
Final Thoughts
Osteoporosis is a common but often under-recognized condition that affects millions of people, particularly postmenopausal women, older adults, and those with certain risk factors. Early detection and prevention are key to managing the condition, and individuals at higher risk should discuss bone health with their internal medicine doctor. While osteoporosis can be a serious condition, with proper lifestyle modifications, supplementation, and medical treatments, the risk of fractures can be minimized, and bone health can be preserved throughout life.
Florida Direct Primary Care
At Florida Direct Primary Care, we develop individualized treatment plans that promote overall health and wellness, tailored to each patient’s unique health needs and goals. If you’re in the St. Augustine area and looking for a primary care doctor, sports medicine or obesity medicine doctor, contact us to learn more about the practice. Visit FloridaDPC.com, email us at info@FloridaDPC.com, or call 904-650-2882.
This web site is provided for educational and informational purposes only and does not constitute the provision of medical advice or professional services. The information provided should not be used for diagnosing or treating individual health problems or diseases. Those seeking medical advice should consult with a licensed physician.Ready to become a Florida DPC member? Click here to register.
