Osteoporosis, which means “porous bones,” is a disease that thins and weakens your bones, making them fragile and more likely to break. It is sometimes called a “silent disease” because it can develop gradually over many years without causing any symptoms. You may be able to reduce or delay Bone loss and you can treat osteoporosis, but you may not be able to prevent it.

The National Osteoporosis Foundation (NOF) estimates as many as 54 million Americans have osteoporosis and low bone mass. Research shows about half of women and one-quarter of men will break a bone due to osteoporosis.

Although men can suffer from osteoporosis, the vast majority of individuals affected by osteoporosis are women. In fact, the annual number of osteoporotic fractures in women is greater than the number of heart attacks, strokes and cases of breast cancer combined. Women are four times more likely to develop osteoporosis than men.

Although the disease can strike at any age, women are at greatest Risk for osteoporosis after menopause. More than 50 percent of non-Hispanic Caucasian and Asian women age 50 years and older have low bone mass, increasing their risk for osteoporosis. A major reason for this is that women’s bodies produce less estrogen after menopause, and estrogen plays an important role in helping to prevent bone loss.

Although the average age for menopause in the United States is 51, some women experience menopause earlier due to natural causes or following surgery, illness or treatments that destroy the ovaries. For example, a total hysterectomy in which the ovaries and uterus are removed will immediately trigger menopause. When you have not had a menstrual period for more than 12 consecutive months, without another medical reason for the absence of your periods, you are postmenopausal.

The good news is that osteoporosis can be prevented and treated and bone health can be maintained. It is never too late to learn how to maintain and keep your bones healthy.

Bone Basics

Your bones are complex living tissue. They provide structure and support for your muscles, protect your organs and store 99 percent of the calcium used by the soft tissues of your body for their various functions.

Healthy bone is strong and dense with many interconnecting pieces. Bone affected by osteoporosis is porous, fragile and weak.

Bone is made mostly of collagen, a protein that provides a soft framework, and hydroxyapatite, a complex of calcium and phosphate, minerals that add strength and harden the framework. This combination of collagen and calcium makes bone strong yet flexible to withstand stress.

Bone changes regularly through a process called remodeling, in which the body breaks down old bone and replaces it with new, strong bone. This process continues throughout life, but varies significantly as you age.

From birth to age 25 or 30, the body builds more new bone than it breaks down. By age 30, your bones become the strongest they will ever be. This phase of bone development is called peak bone mass. The level of bone mass achieved at the peak is determined largely by genetics, but also by nutrition, exercise and menstrual function. Having healthy, strong bones at younger ages can be a critical factor in protecting against osteoporosis in the future.

After about age 30, your body breaks down old bone faster than it builds new bone. This process speeds up dramatically as menopause approaches and for several years after. In the first five to seven years following menopause, you can lose up to 20 percent of bone mass.

Bone loss continues at a slower pace throughout the remainder of your life and may accelerate again in your older years, usually after age 70. Rates of bone loss vary among individuals, but even slow rates of loss may be dangerous, especially in women who start with low bone mass prior to menopause. Often, the first symptom of osteoporosis is a broken bone, which is called a fracture. The common sites for these fractures are the hip, spine or wrist.

Diagnosis

Osteoporosis develops gradually, usually without symptoms. A broken bone that occurs with minor trauma, such as a slight blow to the wrist, for example, is typically the first symptom. Approximately one in two women and one in four men over age 50 will have an osteoporosis-related fracture in their remaining lifetime.

Both hip and spine fractures are associated with an increased risk of death. Spine fractures, also known as vertebrae compression fractures, occur when weakened vertebrae suffer the impact of a strain, bump or fall. They can lead to loss of height, severe and sometimes chronic pain, crowding of internal organs and stooped posture (called kyphosis or “dowager’s hump”). They can also result in prolonged disability and increased mortality.

Hip fractures are another common consequence of osteoporosis, accounting for one-quarter of osteoporosis-related breaks. A hip fracture can lead to a downward spiral of declining health, decreased mobility and increased frailty. They almost always require hospitalization and major surgery and may require long-term nursing home care.

For some, this injury may cause prolonged or permanent disability or even death. The number of fractures due to osteoporosis is expected to rise to more than three million by 2025, according to the National Osteoporosis Foundation.

Your health care professional can make a diagnosis of osteoporosis based on your medical history with an assessment of your risk factors; a physical examination and laboratory tests; and a bone mineral density (BMD) test, a noninvasive test that measures your bone mass.

Common risk factors for osteoporosis are:

• Small, thin frame (weighing less than 127 pounds)
• Personal and/or family history of broken bones or stooped posture in adulthood
• Previous history of osteoporotic fractures of the spine, hip or wrist
• Low lifetime intake of calcium
• Excessive thinness
• Smoking
• Excessive alcohol consumption (“Moderate drinking” for women and older people is defined by the National Institute on Alcohol Abuse and Alcoholism as one drink per day—one drink equals: a 12-ounce bottle of beer (5 percent alcohol) , one 5-ounce glass of wine (12 percent alcohol), or 1.5 ounces of 80-proof distilled spirits. Moderate drinking is considered safe.)
• Inactive lifestyle
• Estrogen deficiency caused by menopause and certain medical conditions such as athletic amenorrhea, anorexia nervosa and treatment with medications that lower estrogen levels
• Absence of menstrual periods or irregular menses as a young woman
• Long-term use of some anticonvulsants and corticosteroids
• Caucasian or Asian ethnic backgrounds, but African-Americans and Hispanic Americans are also at significant risk.
• Certain chronic medical conditions including diabetes, hyperthyroidism, hyperparathyroidism, some bowel diseases and rheumatoid arthritis
• Depression. People with serious depression have increased rates of bone loss, as do people who take selective serotonin reuptake inhibitor (SSRI) antidepressants. More research is necessary to better understand the associations between depression and SSRIs and bone loss.
• Use of proton pump inhibitors. The Food and Drug Administration (FDA) requires safety information on the labels of prescription and over-the-counter labels for proton pump inhibitors about a possible increased risk of fractures to the hip, wrist and spine for people using these medications. Proton pump inhibitors are used to treat a variety of gastrointestinal disorders. They are generally prescribed for a two-week course and are not to be used more than six weeks in a year. In observational studies, the risk rises with prolonged use and high doses of proton pump inhibitors. Further study is needed to verify any increased risk of fractures.

Next Steps

After discussing your individual concerns about osteoporosis with your health care professional, a series of laboratory tests may be recommended. These tests will help identify or rule out conditions other than menopause that may be causing low bone density.

They include:

• Complete blood cell count

• Blood and urine calcium levels

• Thyroid function tests

• Parathyroid hormone levels

• 25-hydroxyvitamin D test to determine if the body has enough vitamin D

• Biochemical marker tests, such as CTX and NT

If your medical history or physical findings suggest causes of bone loss other than menopause and age, then additional laboratory tests may be conducted.

The U.S. Preventive Services Task Force recommends that women age 65 and older be routinely screened for osteoporosis. It also recommends screening younger women who have a fracture risk equal to or greater than that of a 65-year-old white woman. In addition, the National Osteoporosis Foundation and the International Society for Clinical Densitometry recommend DXA screening in postmenopausal women and men 50 to 70 who have risk factors for the disease.

It is recommended to have your BMD performed at a hospital or osteoporosis center that does bone density testing regularly.

There are several types of BMD tests, including the following:

• DEXA (Dual Energy X-ray Absorptiometry) measures bone density at the spine, hip or total body
• QCT (Quantitative Computed Tomography) may be used to measure the spine as an alternative to DXA. This test is rarely used, however, because it is expensive and requires a higher dose of radiation. The International Society for Clinical Densitometry (ISCD) recommends DXA as the preferred method for diagnosis or treatment decisions. QCT may be used when DXA is not available, but results are hard to compare with those from DXA.
• Ultrasound uses sound waves to measure bone density. It is most often used in community screening programs to identify individuals who need more definitive testing with DXA bone mineral density testing. The ICSD doesn’t recommend use of ultrasound for diagnosis or treatment decisions. Because most of those who have risk for osteoporosis have insurance coverage for DXA testing, paying extra for health screening with ultrasound is rarely necessary.

Results of BMD tests done on postmenopausal women and older men are usually expressed as “T-scores,” a measure of how far your bone density deviates above or below the average bone density value for a young, healthy, Caucasian woman. For children and young women and men, the better comparison is with individuals of the same age.

• A T-score between +1 and -1 indicates normal bone density.
• A T-score between -1 and -2.5 usually signals low bone density.
• A T-score at or below -2.5 usually signals osteoporosis.

Your bone density is also compared to an “age matched” standard. The age-matched reading (Z-score) compares your bone density to the “norm” for your age, sex and size.

Your T-score will help your health care professional determine whether you are at risk for a fracture. Generally, the lower your bone density, the higher your risk for fracture. However, your health care professional will consider your BMD score along with your personal health history, osteoporosis risks and lifestyle, including whether you exercise and are getting adequate calcium.

Your health care professional may also use FRAX, which stands for “Fracture Risk Assessment Tool.” Your FRAX score, which is based on your age, weight, height, medical history and other risk factors, as well as your bone mineral density score, determines your risk of having a hip or vertebral fracture in the next 10 years. By weighing all of these factors, your health care professional can determine if osteoporosis poses a significant threat for you now or in the years ahead.

Some tests for osteoporosis risk, such as those available at community health fairs, provide a starting point for assessing your bone health—but definitely require follow-up. If you have one of these types of tests, be sure to discuss the results with your health care professional, especially if your results indicate low bone density.

Medicare and most commercial insurers pay for BMD testing for all women over the age of 65 and for other individuals at risk or already suffering from osteoporosis.

Treatment

The primary goal of osteoporosis therapy is to reduce the risk of fractures. A comprehensive osteoporosis treatment program focuses on nutrition, exercise and safety precautions to prevent falls that may result in fractures and, if necessary, medication to slow or stop bone loss, increase bone density and reduce fracture risk.

If you are at risk for or have osteoporosis, your health care professional may recommend several treatment and preventive measures, including:

• Adequate amounts of calcium and vitamin D, either from diet or supplementation
• Regular weight-bearing exercise
• Avoiding smoking and excessive alcohol consumption (“Moderate drinking” for women and older people is defined by the National Institute on Alcohol Abuse and Alcoholism as one drink per day—one drink equals: 12-ounce bottle of beer (5 percent alcohol) , one 5-ounce glass of wine (12 percent alcohol) or 1.5 ounces of 80-proof distilled spirits. Moderate drinking is considered safe).
• Medications to stop or slow bone loss, improve bone density and prevent fractures.
• Surgery to repair fractured bones that result from osteoporosis. For example, patients with an acute vertebral fracture and pain that does not respond to standard treatment approaches—medication, increased calcium intake and back-strengthening exercises to improve muscle support—may be candidates for balloon kyphoplasty.
• Balloon kyphoplasty is similar to a technique known as vertebroplasty, in which acrylic cement is injected into the fractured vertebral bone to stabilize it and relieve pain. During balloon kyphoplasty, however, a small orthopedic balloon is inserted into the vertebrae and inflated with liquid. The balloon is then deflated and removed, creating a cavity into which bone cement may be applied.
• Hip protectors or pads, especially if you are thin or have fallen before.

Medical Approaches to Treating Osteoporosis

The U.S. Food and Drug Administration (FDA) has approved several medications for postmenopausal women to help slow or stop bone loss, build bone and reduce the risk of fractures. These medications work well, but only when they are taken regularly. Plus, as with any medication therapy, there are certain risks and side effects.

• Menopausal Estrogen Therapy and Combination Estrogen-Progestin TherapyAlthough not approved by the Food and Drug Administration (FDA) for the treatmentof osteoporosis, oral and transdermal forms of estrogen, called estrogen therapy (ET), and combined estrogen-progestin, called hormone therapy (HT), are approved for preventing bone loss in recently menopausal women who have risk factors for osteoporosis, such as low bone mass or a petite frame.Studies find that ET increases bone mass and reduces the incidence of vertebral, wrist and hip fractures. However, because of the long-term risks associated with hormone replacement therapy—risks identified within the last several years by the federal Women’s Health Initiative—the FDA recommends that women first consider other osteoporosis medications and warns that hormone therapies should be used at the lowest possible dose for the shortest possible time.
• Raloxifene (Evista)Available in pill form, this medication is approved for the prevention and treatment of osteoporosis in postmenopausal women. Raloxifene has positive estrogen-like effects on bone but not on the breast or lining of the uterus and may reduce the risk of estrogen-dependent breast cancer by 65 percent over eight years. Raloxifene is now FDA-approved to decrease the risk of breast cancer in women with osteoporosis and even in women without osteoporosis who are at high risk of breast cancer.It is part of a class of drugs called selective estrogen receptor modulators (SERMs) that appear to prevent bone loss at the spine, hip and other points in the body. Studies find that raloxifene reduces the risk of spinal fracture in women with osteoporosis, but there are no data confirming that it reduces the risk of any other fractures. Possible side effects include hot flashes, blood clots in the veins (similar to estrogen) and leg cramps. The pill is taken once a day, with or without meals.
• Alendronate (Fosamax and other brands, including generics)From the bisphosphonate class of drugs, this is a bone-specific medication approved by the FDA to treat and prevent osteoporosis. Studies find alendronate increases bone mass and reduces the risk of spine, hip, wrist and other fractures by up to 50 percent over two to four years in women with osteoporosis.Alendronate has also been approved for the treatment of glucocorticoid-induced osteoporosis and the treatment of osteoporosis in men. Alendronate tablets should be taken on an empty stomach in the morning and with eight ounces of water at least 30 minutes before the first food, beverage or medication of the day. To minimize side effects—which can include heartburn or irritation of the esophagus—remain upright for at least 30 minutes after taking this medication. Alendronate can be taken daily or as a weekly medicine regimen.Alendronate is also available in a pill together with 2,800 or 5,600 IU of vitamin D3, called Fosamax Plus D.
• Risedronate (Actonel, Atelvia)Another type of bisphosphonate drug, this medication is approved to treat and prevent osteoporosis in postmenopausal women and to prevent and treat glucocorticoid-induced osteoporosis in women and men. It can be taken once per day, once per week or once per month. Risendronate is also available with calcium.Studies find risedronate increases bone mass and reduce the risk of spinal, wrist, hip and other non-spinal fractures in women with osteoporosis.Take on an empty stomach in the morning with eight ounces of water, 30 minutes before eating or drinking. To minimize side effects—which can include heartburn or irritation of the esophagus—remain upright for at least 30 minutes after taking. Take any vitamins, calcium and antacids at least 30 minutes after you take risedronate.
• Ibandronate (Boniva)This is another bisphosphonate that has been approved by the FDA for prevention and treatment of osteoporosis in postmenopausal women. It reduces the incidence of vertebral fractures by about 50 percent and increases bone mineral density throughout the skeleton. Ibandronate also prevents bone loss in recent menopausal women but who do not yet have osteoporosis. Ibandronate must be taken once a month on an empty stomach, first thing in the morning, with eight ounces of water (no other liquid) at least 60 minutes before eating or drinking. Patients must remain upright for at least one hour after taking this medication. Ibandronate also may be given intravenously once every three months.
• Zoledronic acid (Reclast)A once-yearly infusion of Reclast was approved in 2007 to treat postmenopausal osteoporosis, and a 2009 approval allows it to also be used to prevent onset of osteoporosis in postmenopausal women with low bone mass. Reclast is another bisphosphonate medication that works by strengthening bones and protecting against osteoporosis-related fractures, including those of the spine and hip. In one major study, zoledronic acid reduced risk of hip fractures by 41 percent and spine fractures by 70 percent. Reclast is given only once a year or once every two years (depending on the diagnosis) as a 15-minute intravenous infusion. Side effects include transient fever, muscle pain, pain in the bones or joints, flu-like symptoms and headache. When these symptoms occur, they usually start within the first three days of receiving Reclast and generally go away within three to four days.
• Calcitonin (Miacalcin, Fortical)This is approved for the treatment of osteoporosis in women who are five years postmenopausal and cannot tolerate estrogen therapy. Studies find that this medication helps slow bone loss, increases spinal bone density and may relieve fracture pain. Because calcitonin is a protein, it cannot be taken orally, so it is taken as a nasal spray or, in some instances, an injection. Possible side effects include nasal irritation and inflammation, bloody nose, headache and backache. Injectable calcitonin may cause an allergic reaction and flushing of the face and hands, frequent urination, nausea and skin rash. Calcitonin isn’t as potent as other medications for osteoporosis, so it is usually reserved for people who can’t take other drugs.
• Teriparatide (Forteo)A form of parathyroid hormone, this is the first medication that stimulates bone formation instead of slowing the breakdown of bone. It is approved for postmenopausal women and for men at high risk for fractures. It increases bone mineral density and reduces spinal fractures and other fractures. The drug is administered by injection once a day (for up to 24 months). Side effects may include nausea, dizziness and leg cramps.
• Denosumab (Prolia)This injectable treatment, approved by the FDA in 2010, is a fully human monoclonal antibody. It offers another option for postmenopausal women with osteoporosis who are at high risk for fracture. It works to decrease the destruction of bone and increase bone mass and strength, and it decreases the risk of spine, hip, and other fractures. An injection is recommended every six months. Side effects may include back pain, pain in the extremities, musculoskeletal pain, high cholesterol levels and urinary bladder infections. Serious adverse reactions include low calcium levels in the blood, serious infections and skin reactions such as dermatitis, rashes and eczema.

There have been some concerns over osteonecrosis of the jaw (ONJ) and atypical fractures of the femur related to osteoporosis medications, particularly bisphosphonates and denosumab. Some reports suggest an increased risk of a certain type of thigh fracture in people with osteoporosis who take bisphosphonates for a long time. As such, the FDA ordered a warning about the link on the Warnings and Precautions section of the labels of all bisphosphonate drugs approved for the prevention and treatment of osteoporosis, and for denosumab.

Sometimes there is some warning pain in the thigh before an atypical fracture occurs, so if you have been taking an osteoporosis medication for several years and start to experience aching or pain in your hip or thigh, contact your health care provider.

Because bisphosphonates accumulate in bone, some patients who have taken these medications may be candidates for a “drug holiday” after 5 to 10 years of bisphosphonate treatment.

It is important to recognize that ONJ and atypical fractures are uncommon, and that the risk of a typical hip fracture is a much more serious threat to women with osteoporosis. Talk to your health care provider about the benefits and risks of taking osteoporosis medication, and discuss what treatment and prevention options are best for you, with your health history in mind.

Preventing Falls Is Key

Falls are one of the most common causes of hip, wrist and vertebral fracture in people over age 60.

Environmental hazards, such as slippery floors or loose carpeting, can increase your risk for falls. Physical issues such as impaired vision and/or balance; chronic diseases that impair mental or physical functioning; and certain medications may also put you at risk.

Consider making some of these changes to help eliminate environmental factors that could lead to falls:

• Indoors: Keep floor surfaces smooth but not slippery and clear of clutter and loose wires; wear supportive, low-heeled shoes even at home; avoid walking in socks, stockings or slippers; be sure stairwells are well lit and that stairs have handrails on both sides; install grab bars on bathroom walls near tub, shower and toilet; and use a rubber mat in the shower or tub.
• Outdoors: If necessary, use a cane or walker for added stability; wear rubber-soled shoes for traction; walk on grass when sidewalks are slippery; use caution on highly polished floors that are slick when wet. Use plastic or carpet runners when possible. Some older women at high risk of falls and hip fracture might want to consider hip protectors. These devices are thin shields that can be incorporated into underwear.

Prevention

The importance of beginning bone loss prevention at a very young age is now well understood. Bone health programs are being developed and implemented that target girls as young as nine to 12 years of age and their parents, focusing on promoting good nutritional choices and participating in regular physical activity.

Nearly one-third of bone loss can occur before a diagnosis of osteoporosis is made. However, you can prevent future bone loss caused by osteoporosis with early detection. Also, once you’ve had a fracture due to osteoporosis, your risk of future fractures is increased.

Thus, it is important to prevent the first fracture. Taking preventive steps and reviewing risk factors now are especially helpful approaches for women of all ages.

There are five simple steps to reduce your risk for osteoporosis:

• Increase the amount of calcium and vitamin D in your diet.
• Exercise regularly; bones and muscles respond to physical activity by becoming stronger. Weight-bearing exercises like walking and weight lifting are the most beneficial.
• Maintain a healthy body weight. Being underweight or losing weight increases your risk of bone loss and fracture, and ultimately, of developing osteoporosis.
• Quit smoking. Cigarette smoking (nicotine) can reduce bone mass and increase the risk of fracture, thus increasing your risk for osteoporosis. Ask your health care professional to recommend methods to help you quit.
• Drink alcohol in moderation, if you drink. Excessive consumption of alcohol increases your risk of osteoporosis and fractures from falls.

For some women, medication may also be helpful for preventing additional bone loss. Ask your health care professional what the best osteoporosis prevention strategy is for you.

Dietary Strategies for Osteoporosis Prevention

Many vitamins and minerals are important to maintaining healthy bones. That is why it is important to eat a well-balanced diet every day consisting of a variety of foods, including grains, fruits, vegetables, nonfat or low-fat dairy foods or other calcium-rich foods, as well as meat and beans.

Most Americans do not get enough calcium in their diets so adding calcium to your diet may be the easiest health-related change you can make. It’s an important one, too. Calcium may reduce fractures caused by osteoporosis by as much as 50 percent.

The National Osteoporosis Foundation recommends these calcium guidelines based on age:

• Girls ages nine to 18: 1,300 mg/calcium/daily
• The average woman age 19 to 50: 1,000 mg/calcium/daily
• Women 51 or older: 1,200 mg/calcium/daily.

If you have asthma, allergies, a thyroid condition or other chronic medical condition, you may need an even higher daily calcium intake. Your intake should not exceed 2,000 mg/day, however.

Good sources of calcium include:

• Low-fat or nonfat dairy products, such as milk, yogurt and cheese. Three eight-ounce glasses of milk plus calcium from a normal diet will meet daily calcium requirements.
• Dark green, leafy vegetables such as broccoli, collard greens, bok choy and spinach
• Sardines and salmon with bones
• Fortified tofu (a soybean product made from curdled soy milk)
• Soy milk
• Almonds
• Calcium-fortified foods and beverages such as orange juice, cereals and breads

Difficulty digesting milk, which is called lactose intolerance, and stomach upset caused by dairy products may be more common as you age. If that’s the case, yogurt with active cultures, buttermilk, and cheddar and Swiss cheeses are high in calcium but low in lactose, the sugar found in milk and milk products.

Many people mistakenly believe they are lactose intolerant when a simple sensitivity to dairy products or some other food substance is really the case. So check with your health care professional before you avoid dairy products. Products that don’t contain lactose (such as Lactaid) can help people with lactose intolerance to consume dairy products.

When your diet doesn’t provide enough calcium, you may wish to take calcium supplements. You shouldn’t take calcium supplements you do not need, however. Calcium supplements are available by prescription and over the counter. Always talk to your health care professional before you take any new supplement, including calcium.

To choose a calcium supplement, look for labels that have the United States Pharmacopeia symbol or state the supplements are purified. Also read the label to determine the amount of elemental calcium (which is the actual amount of calcium in the supplement), Keep in mind that your body best absorbs calcium in doses of 500 to 600 mg or less, so it may be better to take a few smaller doses throughout the day (called divided doses). Calcium supplements are best absorbed when taken with food.

Multivitamins generally do not provide enough calcium to meet the daily needs of a postmenopausal woman. In fact, calcium, which is a mineral, isn’t always included in a multivitamin preparation, so be sure to read the label if you are relying on your vitamin supplement to meet your calcium requirement.

Your diet should also be rich in vitamin D. This nutrient helps your body absorb calcium more efficiently and minimize bone loss. Although the use of dairy products fortified with vitamin D and adequate sun exposure have helped reduce the incidence of vitamin D deficiency, many Americans—particularly older Americans and Americans who live in certain parts of the country—do not get adequate sunlight and are therefore deficient in vitamin D.

This essential vitamin is found in fortified milk and cereals, as well as vitamin supplements. If your exposure to sunlight is limited due to use of sun block or the climate where you live, you may want to consider increasing your average intake of vitamin D. Eight hundred to 1,000 units (IU) of vitamin D daily is recommended for women ages 50, and some people may require more. Check with your health care provider to see how much you need.

Exercise Strategies

Bone and muscle respond to physical activity by becoming stronger. Although all exercise is beneficial to overall good health, two kinds of exercise are most effective for preventing osteoporosis: Weight-bearing, in which you work against gravity, and resistance exercises, such as weight lifting.

Weight-bearing exercise is any exercise in which your feet and legs bear your weight while you perform it, such as brisk walking, dancing, racket sports and aerobics. This creates high pressure on the bone that helps to build and maintain its strength.

Resistance exercises that strengthen muscle may also be beneficial, particularly for the large muscles of the shoulder, pelvis, hips, back and trunk. Because falls are the most common cause of fractures, balance-improving activities, such as tai chi and strength training, may also significantly reduce your risk for falls.

In a 2011 British study published in Osteoporosis International, researchers looked at the relationship between regular physical activity and hip fracture risk in middle-aged women. They found women who regularly walked or had moderate or high-frequency physical activities had lower rates of hip fractures compared to women who were sedentary.

The National Osteoporosis Foundation recommends a total of 30 minutes of weight-bearing physical activity on most days of the week, muscle strengthening exercises two to three times per week, and balance, posture and functional exercise every day or as often as needed. Bicycling and swimming are non-weight–bearing exercises and won’t maintain and build new bone, but they are still good for the cardiovascular system.

For muscle strengthening, you can use stationary weight machines at health clubs and gyms and free weights or elastic bands in the gym or at home. The important thing to remember is that you don’t have to lift heavy weights to benefit from strength training. You should start with a light weight and gradually increase your repetitions and/or resistance as your strength increases. The goal is to build bone strength—not muscle mass, which requires numerous lifts with heavy weights.

In a study whose results surprised even the researchers who conducted it, gardening went a long way to help reduce the risk for osteoporosis among the 3,310 women age 50 and older involved in the study. Gardening activities such as raking, thrusting a shovel into the ground and moving a wheelbarrow filled with dirt, weeds or mulch are all considered weight-bearing exercises. Be careful not to lift heavy pots or heavy bags of mulch or dirt.

Facts to Know

1. The National Osteoporosis Foundation estimates as many as 54 million Americans have osteoporosis and low bone mass. Research shows about half of women and one-quarter of men will break a bone due to osteoporosis.
2. Significant risk of osteoporosis has been reported in people of all ethnic backgrounds.
3. Osteoporosis contributes to 2 million fractures annually, including hip fractures, vertebral fractures, wrist fractures and fractures at other sites.
4. The number of people beyond age 65 years in the United States is expected to increase dramatically over the next few decades. This will drive up the national cost of osteoporosis, which is estimated at $19 billion per year, according to the National Osteoporosis Foundation. By 2025, the national cost may be as high as $25.3 billion.
5. Smoking, abusing alcohol and excessive thinness increase your risk for developing osteoporosis. Likewise, your risk for developing osteoporosis increases if you don’t exercise or if you exercise too much.
6. Bones that are calcium rich are less likely to break. Be sure your diet provides at least 1,000 to 1,200 mg of calcium and 400 to 1,000 IU of vitamin D daily, depending on your age, to help keep your bones strong. Drinking or eating three dairy products a day provides the recommended daily intake of calcium, but most women fall short of this requirement. If you are unable to get enough calcium and vitamin D from your diet, your health care professional may recommend a supplement.
7. Menopause increases your risk for developing osteoporosis because your body’s natural production of the hormone estrogen declines, and estrogen helps keep bones strong.
8. Several types of medications, including raloxifene (Evista), teriparatide (Forteo), denosumab (Prolia), teripartide (Forteo) and bisphosphonates (Actonel, Atelvia, Fosamax, Boniva, Reclast), are effective in preventing and/or treating osteoporosis. Reclast is a single infusion that prevents postmenopausal osteoporosis for two years or treats osteoporosis for a year.
9. Women lose the most bone mass—as much as 20 percent—in the first five to seven years after menopause. Because of declining estrogen levels after menopause, a woman’s ability to naturally maintain bone structure is seriously depleted. However, not everyone needs to seek treatment. Bone density testing helps target those at greatest risk for bone loss and osteoporosis.
10. A bone mineral density (BMD) test measures the strength of your bones to help assess your future risk of fractures. This test is not usually performed until after menopause, unless you have an unusual clinical situation or are at high risk for osteoporosis. It is quick, painless and noninvasive.
11. Bone loss rates can be slowed by regular weight-bearing and muscle-strengthening exercises. Activities such as walking, gardening, jogging and playing tennis help to strengthen bones and connective tissue.
12. There is no cure for osteoporosis. However, it is preventable and treatable. You can help prevent bone loss and fractures from osteoporosis with proper diet, exercise and medications, when necessary.

Key Q&A

1. Why is osteoporosis called a “silent disease”?Osteoporosis is sometimes called a “silent disease” because it can occur gradually over many years without your knowledge. Often, the very first symptom of osteoporosis is a broken bone, also called a fracture, which typically happens at the hip, spine or wrist. Osteoporosis thins and weakens your bones, making them fragile and more likely to break. However, the good news is that osteoporosis can be prevented and treated. Early detection is important; therefore, you should ask your health care professional for more information about osteoporosis.
2. Can’t I just take a multivitamin to prevent osteoporosis?No. Most multivitamins contain only minimal quantities of calcium. Calcium carbonate and calcium citrate are available over-the-counter as supplements if your diet is low in this essential mineral. Girls age nine to 18 need 1,300 mg/calcium/daily. The average woman age 19 to 49 needs 1,000 mg/calcium/daily, and women 50 and older should be getting 1,200 mg/calcium/daily. In addition, be sure your diet (or supplement) also provides between 400 IU (international units) and 1,000 IU of vitamin D (400 to 800 IU for adults under 50 and 800 to 1,000 IU for adults 50 and over), which helps your body absorb calcium. Taking the recommended daily amount of calcium and vitamin D can cut your risk of fracture by as much as 50 percent, particularly in older women. One cup (8 ounces) of fat-free milk contains 306 mg of calcium. Calcium is also found in other dairy products, such as yogurt, cheese and some soy products. Fortified orange and other juices, fortified grains, dark greens and some seafoods are other sources.
3. If I’ve already reached menopause, isn’t it too late to do anything about osteoporosis?It’s never too late to make lifestyle changes to improve your bone health and receive the appropriate treatment for osteoporosis, if you have it. Although you can’t restore all the bone that has already been lost, you can build some new bone and prevent bone loss with a diet rich in calcium and vitamin D, a program of weight-bearing exercise and, in some cases, medications.
4. Isn’t it true that we get shorter as we age?Substantial loss of height and a stooped posture are not normal results of growing older. Instead, they can be signs of multiple vertebral compression fractures in the spine. Height loss of one- to one-and-one-half inches may be due to degenerative disc disease, however, not necessarily osteoporosis. Frequently, you may not know you have osteoporosis until your bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse. It is these collapsed vertebra that lead to loss of height, stooped or rounded posture (called kyphosis, but also known as “dowager’s hump”) and other spinal deformities.
5. If I have one or more of the risk factors for osteoporosis, does that mean that I probably have the disease but don’t know it?Not necessarily. Your health care professional will take into account a number of factors in determining your likelihood of developing osteoporosis. These include your personal health history, your individual osteoporosis risks, your lifestyle—including whether you exercise and are getting adequate calcium—and the results of a bone mineral density (BMD) test.
6. Is the test for osteoporosis painful?No! A BMD test is safe, quick and painless. Simple measurements are usually taken of the bones in your hip, wrist and spine. You typically remain clothed during the procedure. There are several types of BMD tests; some may use a very small amount of radiation. Talk with your health care professional to learn more about the procedure and to further alleviate any fears you may have about this simple exam and be sure to ask your health care professional what your test results mean when you get them.
7. My health care professional recommended that I start working out with weights, but I’m afraid of lifting heavy weights. What should I do?Good news: You don’t have to lift heavy weights to benefit from strength training. You should lift a light amount of weight and gradually increase your threshold as your strength increases. The goal is to build bone and muscle strength—not muscle mass, which requires numerous lifts with heavy weights. So enjoy this important activity and work at your own pace. Just remember, if you do not routinely exercise, ask your health care professional to recommend a simple, safe program and start soon.
8. What medications are available to prevent and treat osteoporosis?There are several medications approved by the U.S. Food and Drug Administration for the prevention and/or treatment of osteoporosis. These medications may postpone or stop bone loss, but only when they are taken regularly. Medications currently available include menopausal hormone therapy and the drugs alendronate (Fosamax) adendronate plus vitamin D3 (Fosamax Plus D), raloxifene (Evista), risedronate (Actonel, Atelvia), risedronate with calcium (Actonel with calcium), ibandronate (Boniva), zoledronic acid (Reclast), teriparatide (Forteo), denosumab (Prolia) and calcitonin (Miacalcin). As with any medication therapy, there are risks and side effects associated with each of these medications, but for those with osteoporosis who are have a high risk for fracture, the reduction in fracture risk with treatment can outweigh the risks of treatment. Hormone therapy was once the mainstay of osteoporosis treatment, but it has, for the most part, been replaced with other therapies. Ask your health care professional for more information.

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