Let’s hear about a silent disease today—osteoporosis. It’s a condition that doesn’t show symptoms until it’s often too late, usually surfacing only after a screening in our fifties or sixties, or, in worst cases, only apparent after we break a bone in a harmless, surprisingly minimal impact.
Osteoporosis (and its precursor osteopenia) reflects the gradual loss of bone density with age. Bones are constantly turning over and rebuilding, remodeling – but over time, this slows down and becomes a bit haphazard.
It’s common: According to the CDC, about 10 million adults in the US have osteoporosis. Additionally, 44% of adults in the US have osteopenia, meaning almost half of us face reduced bone density as we age.
In this post, we’ll cover the main risk factors, testing methods, and ways to prevent and manage osteoporosis.
Risk Factors for Osteoporosis
Osteoporosis generally appears later in life as our bones’ natural rebuilding processes slow. Here’s what else increases our risk:
- Gender: Women are more susceptible, particularly after menopause, due to the drop in estrogen. Hormones like estrogen and testosterone tell our bones to remodel – if we lose the hormones, our bone health declines. Although men’s testosterone levels decline too, they tend to more slowly than estrogen’s fall in menopause and thus face less risk.
- Family History: A parent’s history of fractures from minimal impact suggests a genetic predisposition. Hip fractures particularly are HIGH risk factors if our parents had one!
- Body Type: Small frames and lower body weight can increase vulnerability compared to larger frames.
- Certain Medications: Long-term steroid use and some acid blockers (PPIs like Prilosec or Nexium) can weaken bones.
- Lifestyle Factors: Smoking and excessive alcohol intake negatively affect bone density.
- Chronic Conditions: Diseases like rheumatoid arthritis and inflammatory bowel disease can contribute to bone loss.
Symptoms and Diagnosis
Osteoporosis remains symptomless until a fracture occurs, often from minimal trauma—like a simple stumble or even a gentle bump. Fractures can cause significant pain and may require lengthy recovery. We use a DEXA (dual-energy X-ray absorptiometry) scan to measure bone density, starting around age 50 for those with risk factors and routinely for all women over 65 and men over 70. Typically, DEXA scans are repeated every two years.
Prevention
While osteoporosis is driven by age and hormones, we can slow its progression through:
- Calcium and Vitamin D: Aim for about 1200 mg of calcium daily and maintain a vitamin D level above 40 ng/dL, with 800 IU of daily supplementation as a general guide. This is person-to-person, the exact dosing should be guided by your physician since it depends so much on each person’s health status.
- Physical Activity: Weight-bearing exercises strengthen bones by encouraging remodeling. Even walking can make a difference!
- Avoiding Risk Factors: Minimize smoking and excessive alcohol intake.
- Screening: Follow your doctor’s screening recommendations for timely intervention.
Emerging research suggests vitamin K2 supplementation (90-100 mcg daily) may reduce spine fractures, a guideline likely to gain traction in future updates. I recommend this for my patients particularly when we’re trying to avoid medication for as long as possible.
Treatment
When osteoporosis progresses to a certain point, we consider prescription medications that can stabilize the bone and even grow the bone thicker. Usually, we drop someone’s fracture risk by HALF with even the oldest options we have in our toolbelt.
Options include oral and injectable therapies like bisphosphonates (e.g., Fosamax, Actonel), Prolia (denosumab), and Evenity (romosuzumab). There’s huge upside to using these when appropriate but require monitoring for potential risks and carry some side effects.
Summary
In summary, osteoporosis is a silent disease that can lead to fractures under seemingly trivial circumstances. Although we can’t completely halt bone loss, we have effective methods to slow it down and even strengthen bones in some cases. Discuss your risk factors and prevention or treatment options with your doctor. If you’re over 50 and have risk factors, ask about screening—your primary care provider or a specialist (endocrinologists or rheumatologists, most commonly) can help manage this silent but significant threat to bone health.
American Association of Clinical Endocrinology guidelines: https://pro.aace.com/clinical-guidance/2020-clinical-practice-guidelines-diagnosis-and-treatment-postmenopausal
American College of Rheumatology Glucocorticoid-induced osteoporosis guidelines: https://rheumatology.org/glucocorticoid-induced-osteoporosis-guideline