Postmenopausal women are more prone to fractures than premenopausal women primarily because

Osteoporosis Causes

Simply put, osteoporosis occurs when your body absorbs more bone than it produces. In other words, your bones lose density, become weak, and are prone to fractures. This process isn’t the sole cause of osteoporosis; there are other factors that contribute to and exacerbate the onset of the disease.

Diet
Your diet has a significant impact on the health of your bones. Certain foods and nutrients promote healthy bone growth, while others don’t.

Below are nutrients that are essential for healthy bones:

  • Calcium: This mineral is necessary for bone growth and maintenance.
  • Vitamin D: Vitamin D helps your body absorb calcium. You can read more about the importance of calcium and vitamin D.
  • Other vitamins and minerals: Magnesium, phosphorous, vitamin K, vitamin B, and vitamin B12 all support bone health. You’ll likely get enough of these nutrients from the food you eat, but if you don’t eat a balanced diet, you should take a multivitamin or supplement.

Below are nutrients that may harm your bones when taken in very large amounts. You don’t have to completely remove these foods and nutrients from your diet—in most cases, it wouldn’t be healthy—but you should consume them in moderation:

  • Protein: Protein is an essential part of a healthy diet, but a diet very high in animal protein may cause calcium loss.
  • Caffeine: High caffeine intake (more than four cups of coffee per day) inhibits calcium absorption and leads to calcium loss through the urine
  • Sodium: Consuming too much salt causes loss of calcium through the kidneys.

Exercise
Exercise is an essential defense against osteoporosis. Exercise builds and maintains strong bones, so if you are inactive, your bones are likely weaker than they should be. Weak bones are more susceptible to fractures than strong, conditioned bones.

Low Sex Hormones
When women reach menopause, their estrogen levels drop significantly. Estrogen is important to new bone production because it supports osteoblasts, which are bone-producing cells. Without estrogen, osteoblasts can’t produce enough new bone, and eventually, osteoclasts (bone-absorbing cells) overpower them. That’s why post-menopausal women are at a high risk for osteoporosis.

In men, testosterone protects bone. When testosterone levels drop, it can lead to bone loss.

Medical Conditions
There are medical problems that can lead to osteoporosis. Below are some of those conditions:

  • Intestinal problems: Celiac disease and inflammatory bowel disease, for example, can interfere with normal calcium and vitamin D absorption.
  • Kidney disease: This condition causes decreased activation of vitamin D.
  • Parathyroid and Thyroid problems: Hyperparathyroidism, which is caused by too much parathyroid hormone, can cause osteoporosis because the excess hormone extracts calcium from your bones.
    On that same note, hyperthyroidism, or an overproduction of thyroid hormone, may also lead to bone loss.

Medications
Certain medications may cause osteoporosis. You don’t need to avoid these medications—many are vital for their respective conditions—but you will need to take extra care to prevent bone loss while taking them.

Below are some medications that may contribute to bone loss:

  • Glucocorticoids: Including cortisone and prednisone, are strong medications to relieve inflammation.
  • Antiseizure medications
  • Aromatase inhibitors— these medications are used for breast cancer
  • Proton pump inhibitors (PPIs): These medications, such as Prilosec and Prevacid, are used for a variety of conditions, namely indigestion.
  • Coumadin—used for blood thinning.

Smoking and Alcohol
The chemicals found in cigarettes make it more difficult for your body to use calcium. They also impact estrogen’s ability to protect your bones.

Excessive alcohol consumption also negatively impacts your body’s ability to effectively use calcium.

Osteoporosis may be caused by many things—and there are also risk factors that will increase your chances of developing the disease. Fortunately, many of the causes of osteoporosis can be prevented.

Updated on: 05/04/17 Continue Reading Risk Factors for Osteoporosis View Sources

  • Mayo Clinic Osteoporosis Causes page. Mayo Clinic Health Information Web site. Available at: http://www.mayoclinic.com/health/osteoporosis/DS00128/DSECTION=causes. Accessed April 27, 2009.
  • Osteoporosis: What It Is and Who Is at Risk. In the National Osteoporosis Foundation’s Boning Up on Osteoporosis, Second Edition. 2008: 5-15.

Why Osteoporosis is More Common in Women

It may not be fair, but it’s true: If you’re a woman, you’re automatically at greater risk for osteoporosis than men. The International Osteoporosis Foundation estimates that osteoporosis affects about 200 million women worldwide.

Why the gender gap? Women start with lower bone density than their male peers and they lose bone mass more quickly as they age, which leads to osteoporosis in some women. Between the ages of 20 and 80, the average white woman loses one-third of her hip bone density, compared to a bone density loss of only one-fourth in men.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, osteoporosis statistics show a greater burden for women in the following ways:

  • 68 percent of the 44 million people at risk for osteoporosis are women.
  • One of every two women over age 50 will likely have an osteoporosis-related fracture in their lifetime. That’s twice the rate of fractures in men — one in four.
  • 75 percent of all cases of hip osteoporosis affect women.

Building Better Bones

Osteoporosis may have its roots in childhood and adolescence, which is the period when your body does the most bone building. Women reach their peak bone mass at about age 18 while men reach theirs at 20. After that, both women and men continue to build small amounts of bone mass, but men add more than women. By 30, your bones are fully stocked, and although your body will continue to replace old bone cells, there will be no increase in bone mass past that point.

Osteoporosis and Estrogen

Add osteoporosis to the long list of health issues, like mood swings and migraines, that you can blame on your hormones. Although there are other possible genetic and environmental factors behind bone loss, your body’s changing levels of estrogen remains the most culpable suspect.

Estrogen is a hormone that helps regulate a woman’s reproductive cycle. At the same time, it plays a role in keeping bones strong and healthy, in both men and women. While premenopausal women have more estrogen than men, they will experience dramatic drops in estrogen production due to menopause, and are more likely to experience bone loss and osteoporosis at that time.

Women are at increased osteoporosis risk related to estrogen levels if they:

  • Experience irregular or infrequent periods, or began having their periods at a later than normal age
  • Have had their ovaries removed (at any age)
  • Are going through menopause, with those undergoing menopause at an early age having an even higher risk

Women lose bone mass much more quickly in the years immediately after menopause than they do at any other time in their lives.

In contrast, data suggests that women who have more estrogen than their peers, such as women who began their menstrual cycles earlier than normal or who have used estrogen containing contraceptives, are likely to have higher bone density.

Osteoporosis: Underdiagnosed in Men

Because osteoporosis occurs more frequently in women than men, less attention is paid to bone health in men, and those who have osteoporosis may go undiagnosed and untreated. A study of 895 nursing home residents over age 50 revealed that doctors were less likely to consider osteoporosis diagnosis and treatment for men than women, even when the men had recently experienced a fracture, a widely recognized red flag for osteoporosis. The reality is that 80,000 men experience osteoporosis-related fractures every year, and close to 23,000 die as a result of fracture-related complications.

Bone loss is a normal part of aging in both men and women; by about age 75, men and women lose bone at the same rate and both genders are less able to absorb calcium. However, when men get osteoporosis, it is usually related to another health condition, a lifestyle choice (smoking or alcohol abuse), or medication that has bone loss as a side effect.

Osteoporosis risk is different for men and women, but the disease is dangerous for anyone who gets it. Talk to your doctor about getting an osteoporosis screening if you know you have risk factors.

How to Treat Osteopenia

Osteopenia occurs more among women than men, mainly because their bones are thinner to begin with and because hormonal changes during menopause tend to speed up bone loss. Also, after 30, bones begin to get thinner with age. Certain factors can lead to women with osteopenia being at the same risk for broken bones as women with osteoporosis. These factors include bone density measures, previous fractures, poor health, and poor mobility. It is extremely important for women at risk of bone fractures to seek treatments to help slow bone loss or help new bone form.

Adopting a healthy lifestyle is the best choice for those who are dealing with osteopenia. But this doesn’t just work for patients who have problems with their bones: even if a patient has strong bones, a healthy lifestyle helps keep them that way. For those who have osteopenia, the following habits can help reduce the risk of osteoporosis.
Exercise helps beat osteopenia by strengthening bones. Weight-bearing exercises that force the body to work against gravity are the best exercises for bones. Walking, dancing, working out with weights and stair climbing are all excellent suggestions for someone just beginning an exercise program. Diet is another important factor. One that is rich in calcium and vitamin D is most beneficial for bones. Foods that are high in calcium include cheese, ice cream, low-fat milk, yogurt, tofu, leafy greens, sardines, and salmon. Foods that are rich in vitamin D include cheese, egg yolks, beef liver, and fish liver oils (also remember that the body makes its own vitamin D when exposed to sunlight, so if a patient spends a lot of time outdoors and in the sunlight, they probably have most of the vitamin D they need). It’s also a good idea to not smoke or drink too much, along with cutting back on salt and caffeine, both of which may contribute to calcium and bone loss.

Certain situations of osteopenia may need prescription medication, especially if a patient already has a broken bone. Biophosphonates are typically used in the treatment of osteopenia and are medications that slow the natural process that breaks down bone (this sometimes results in an increase of bone density). Calcitonin helps prevent the breakdown of bone and is usually given by injection or nasal spray. Parathyroid hormone, known as Forteo, is when a portion of hormone made by the parathyroid glands stimulates the formation of new bones. It is given daily by a shot under the skin.

The advice and information contained in this article is for educational purposes only, and is not intended to replace or counter a physician’s advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.
©Medical Marketing Solutions, 2012

Being female puts you at risk of developing osteoporosis and broken bones. Here are some facts:

  • Of the estimated 10 million Americans with osteoporosis, about eight million or 80% are women.
  • Approximately one in two women over age 50 will break a bone because of osteoporosis.
  • A woman’s risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.

There are multiple reasons why women are more likely to get osteoporosis than men, including:

    • Women tend to have smaller, thinner bones than men.
    • Estrogen, a hormone in women that protects bones, decreases sharply when women reach menopause, which can cause bone loss. This is why the chance of developing osteoporosis increases as women reach menopause.

Now the good news:

People used to think that osteoporosis was an inevitable part of aging. Today we know a lot more about how to prevent, detect, and treat the disease. You are never too young or old to take care of your bones. Good lifestyle habits can help you protect your bones and decrease your chance of getting osteoporosis. And, if your healthcare provider hasn’t talked to you about your bone health, it’s time for you to bring it up!

What’s Your Risk?

Osteoporosis and bone health issues vary for girls and women of different ages and ethnic backgrounds. Caucasian women, and older women, are most at risk for osteoporosis; however, osteoporosis and low bone density are common among other groups as well. And not only are women at risk; men can develop osteoporosis as well.

Are you …
Caucasian Women
African-American Women
Asian-American Women
Latina Women

Caucasian Women

  • Twenty percent of Caucasian women age 50 and older are estimated to have osteoporosis.
  • More than half of all Caucasian women age 50 and older are estimated to have low bone mass, which means their bones are getting weaker but they don’t yet have osteoporosis.
  • Between the ages of 20 and 80, Caucasian women lose one-third of the bone mineral density in their hip.
  • About 15 percent of Caucasians are lactose intolerant, which can make it difficult to get enough calcium.

African-American Women

  • Five percent of African American women older than 50 are estimated to have osteoporosis.
  • Another 35 percent are estimated to have low bone mass, which means their bones are getting weaker but they don’t yet have osteoporosis.
  • Recent research shows that even among African American women who do have risk factors for osteoporosis, few are screened for the disease.
  • About 70 percent of African Americans are lactose intolerant, which can make it difficult to get enough calcium.
  • Many African American women don’t get enough vitamin D, which can make it hard for the body to absorb calcium.
    In the United States, African American women are more likely than many other racial or ethnic groups to have diseases that can lead to osteoporosis, such as lupus.

Asian-American Women

  • About 20 percent of Asian American women age 50 and older are estimated to have osteoporosis.
  • More than half of all Asian American women age 50 and older are estimated to have low bone density, which means their bones are getting weaker but they don’t yet have osteoporosis.
  • About 90 percent of Asian American adults are lactose intolerant, which can make it difficult to get enough calcium.

Latina Women

  • Ten percent of Latinas have osteoporosis.
  • Half of all Latinas older than 50 have low bone mass, which means their bones are getting weaker but they don’t yet have osteoporosis.
  • Many Latinas are lactose intolerant, which can make it difficult to get enough calcium.
  • Hip fractures among Latinas in the United States appear to be on the rise.

Menopause: A Time for Action

When a woman reaches menopause, her estrogen levels drop and can lead to bone loss. For some women, this bone loss is rapid and severe.

Two major factors that affect your chance of getting osteoporosis are:

  • The amount of bone you have when you reach menopause. The greater your bone density is to begin with, the lower your chance of developing osteoporosis. If you had low peak bone mass or other risk factors that caused you to lose bone, your chance of getting osteoporosis is greater.
  • How fast you lose bone after you reach menopause. For some women, bone loss happens faster than for others. In fact, a woman can lose up to 20% of her bone density during the five – seven years following menopause. If you lose bone quickly, you have a greater chance of developing osteoporosis.

What about taking estrogen?

If you have menopausal symptoms, such as hot flashes, your healthcare provider may prescribe estrogen therapy (ET) or estrogen with progesterone hormone therapy (HT). In addition to controlling your menopausal symptoms, these therapies can also help prevent bone loss. Some women are advised not to take ET or HT because of the possible risks that may include breast cancer, strokes, heart attacks, blood clots and cognitive (mental) decline. It’s important to discuss the risks and benefits of your treatment options with your healthcare provider.

For more comprehensive information, download NOF’s resource Hormones and Healthy Bones

Teens: What YOU Can Do Now

Osteoporosis is the disease that is most likely to cause weak bones. It is more common in older people, especially women. But it is doesn’t have to happen to YOU when you get older. That’s because, for many people, osteoporosis can be prevented.

Most people don’t have the opportunity that you have right now: YOU can actually build denser, stronger bones now in a way that isn’t possible later. This will make you healthier, and it will set you up to have stronger bones when you are older – when weak bones can be serious.

The recipe for bone health is simple:

  • Get enough calcium and vitamin D, and eat a well balanced diet. Read more about balancing your diet
  • Exercise – Read more about exercise
  • Don’t smoke or drink

Eating Disorders and Other Warning Signs

The eating disorders anorexia and bulimia can weaken your bones and increase your risk of osteoporosis when you are older. If you have anorexia you become very thin, but you don’t eat enough because you think you are fat. Bulimia involves periods of overeating followed by purging, sometimes through vomiting or using laxatives.

You should talk to a parent, doctor, or health professional immediately if you have one of these disorders or if you stop getting your period for more than three months in a row (and you are not pregnant). This is a condition called amenorrhea and it is also bad for your bones.

Young Adult Women

While osteoporosis is most common in older people, it sometimes affects young people, including premenopausal women in their 20s, 30s and 40s. The term “premenopausal” refers to women who are still having regular menstrual periods and have not yet reached menopause. While it is uncommon for premenopausal women to have osteoporosis, some young women have low bone density which increases their chance of getting osteoporosis later in life.

Low Bone Density and Osteoporosis in Young Adult Women

Young women who have low bone density, often caused by low peak bone mass, are at an increased risk of getting osteoporosis later in life.

Often, when premenopausal women have osteoporosis, it may be due to an underlying medical condition or a medicine that causes bone loss. Osteoporosis that is caused by a medical condition or a medicine is called secondary osteoporosis. Sometimes premenopausal women have osteoporosis for no known reason. This is called idiopathic osteoporosis. The term “idiopathic” just means that the osteoporosis is unexplained and we cannot find a cause for it.

Diagnosing Osteoporosis in Young Women

Diagnosing osteoporosis in premenopausal women is not straightforward and can be quite complicated. First of all, bone density tests (jump link to below) are not routinely recommended for young women. Here are some reasons why:

  • Most premenopausal women with low bone density do not have an increased risk of breaking a bone in the near future. Therefore, having information about their bone density may only cause unnecessary worry and expense.
  • Some premenopausal women have low bone density because their genes (family history) caused them to have low peak bone mass. Nothing can or should be done to change this.
  • DXA tests can underestimate bone density in women who are small and thin. Therefore, a DXA test may indicate that a small person has low bone density, but the bone density is actually normal for the person’s body size
  • Osteoporosis medicines are not approved or advised for most premenopausal women. Bone density tests are used to help guide decisions about treatment.

Diagnosing osteoporosis in young women usually involves several steps. While these steps may differ for each person, they may include:

  • Your medical history
  • Physical exam
  • Bone mineral density (bone density) testing
  • Lab tests
  • X-rays

Bone density testing. A bone density test shows the amount of bone a person has in the hip, spine or other bones. It is routinely recommended for postmenopausal women and men age 50 and older and is how osteoporosis is diagnosed in older people. Bone density tests are usually only done for premenopausal women if they break several bones easily or break bones that are unusual for their age, such as bones in the hip or spine. Also, if you have a condition or take a medicine that causes secondary osteoporosis, your healthcare provider may order a bone density test. This test should be done on a DXA machine. DXA stands for dual energy x-ray absorptiometry.

One or two years after an initial bone density test, a second bone density may be done and will determine if you have low peak bone mass that is staying the same or if you are losing bone. If your bone density drops significantly between the first and second test, you may be losing bone and further evaluation by a healthcare provider is needed.

Understanding your bone density test results

A bone density test result shows a Z-score and a T-score. T-scores are used to diagnose osteoporosis in postmenopausal women and men age 50 and older, but not in premenopausal women. A Z-score compares your bone density to what is normal for someone your age. While a Z-score alone is not used to diagnose osteoporosis in premenopausal women, it can provide important information. Read some tips to help you understand your Z-score.

  • If your Z-score is above -2.0, your bone density is considered within the ranges expected for your age or normal according to the International Society for Clinical Densitometry (ISCD). For example, a Z-score of +0.5, -0.5 and -1.5 is considered normal for most premenopausal women.
  • If your Z-score is -2.0 or lower, your bone density is considered below the expected range. Examples are -2.1, -2.3 and -2.5. If your Z-score is in this range, your healthcare provider will consider your health history and possible causes of bone loss, including secondary osteoporosis, before making a diagnosis of osteoporosis.
  • If your Z-score is normal, but you’ve broken one or more bones from a minor injury, your healthcare provider may diagnose you with osteoporosis because some people with normal bone density break bones easily. As mentioned above, a bone density test will also show a T-score. A T-score compares bone density to what is normal in a healthy 30-year-old adult.

Treating Osteoporosis in Young Women

Most of the osteoporosis medicines available at this time are not approved by the FDA for use in premenopausal women. But, for women who have taken steroid medicines for a long time, three osteoporosis medicines are approved for the prevention and treatment of osteoporosis. In very rare cases, a healthcare provider may recommend that a premenopausal woman consider taking an osteoporosis medicine for other reasons. Examples include when a woman breaks a bone because of low bone density or has severe bone loss due to a medical condition.

Expecting Women

If you are pregnant or breastfeeding, be sure to get enough calcium and vitamin D. Calcium and vitamin D are good for you and for your baby’s growing bones. If you don’t get enough of these nutrients, your baby’s calcium needs will be met by taking calcium from your bones.

Most studies show that while some bone loss may occur during pregnancy, a woman usually regains it after giving birth. In fact, studies show that having children, even as many as 10, does not increase a woman’s chance of getting osteoporosis later in life. Research even suggests that each additional pregnancy provides some protection from osteoporosis and broken bones.

Pregnancy-associated osteoporosis.

Some women develop a temporary type of osteoporosis during pregnancy. While we do not fully understand what causes this type of osteoporosis, it is extremely rare and usually goes away shortly after a woman gives birth.

Breast feeding.

Like pregnancy, breastfeeding may cause some temporary bone loss. However, bone density appears to recover over time and should not cause long-term harm to a woman’s bone health. All women who are pregnant or nursing need to get enough calcium, vitamin D and appropriate exercise to keep their bones healthy. If you’re breastfeeding exclusively, ask your child’s pediatrician if you need to give your baby supplemental vitamin D.

Risk factors

Osteoporosis affects women and men. Over 1 million people in Australia have osteoporosis.

More information on risk factors:

Both men and women may have certain ‘risk factors’ that can make them more likely to develop osteoporosis. People should discuss risk factors with their doctor, and anyone over 50 with risk factors may require a bone density scan.

Women are at a greater risk of developing osteoporosis because of the rapid decline in oestrogen levels during menopause. When oestrogen levels decrease, bones lose calcium and other minerals at a much faster rate. As a result a bone loss of approximately 2% per year occurs for several years after menopause.

Men also lose bone as they age, however testosterone levels in men decline more gradually so their bone mass remains adequate till later in life.

Your family history

Bone health can be strongly inherited so consider your family history of osteoporosis. It is important to note if anyone in your family (particularly parents or siblings) has ever been diagnosed with osteoporosis, broken a bone from a minor fall or rapidly lost height. These can indicate low bone density.

Your calcium and vitamin D levels

  • Low calcium intake – adults require 1,000 mg per day (preferably through diet) which increases to 1,300 mg per day for women over 50 and men over 70
  • Low vitamin D levels – a lack of sun exposure can mean you are not getting enough vitamin D which your body needs to absorb calcium

Your medical history

Certain conditions and medications can impact on your bone health.

  • Corticosteroids – commonly used for asthma, rheumatoid arthritis and other inflammatory conditions
  • Low hormone levels – in women: early menopause; in men: low testosterone
  • Thyroid conditions – over active thyroid or parathyroid
  • Conditions leading to malabsorption eg: coeliac disease, inflammatory bowel disease
  • Some chronic diseases eg: rheumatoid arthritis, chronic liver or kidney disease
  • Some medicines for breast cancer, prostate cancer, epilepsy and some antidepressants

Lifestyle factors

  • Low levels of physical activity
  • Smoking
  • Excessive alcohol intake
  • Weight – thin body build or excessive weight (recent studies suggest that hormones associated with obesity may impact bones)

Does Osteoporosis Run in Your Family?

If one of your parents has had a broken bone, especially a broken hip, you may need to be screened earlier for osteoporosis. This is a medical condition where bones become weak and are more likely to break. Share your family health history with your doctor. Your doctor can help you take steps to strengthen weak bones and prevent broken bones.

How can osteoporosis affect my health?

People with osteoporosis are more likely to break bones, most often in the hip, forearm, wrist, and spine. While most broken bones are caused by falls, osteoporosis can weaken bones to the point that a break can occur more easily, for example by coughing or bumping into something. As you get older, you are more likely to have osteoporosis and recovering from a broken bone becomes harder. Broken bones can have lasting effects including pain that does not go away. Osteoporosis can cause the bones in the spine to break and begin to collapse, so that some people with it get shorter and are not able to stand up straight. Broken hips are especially serious—afterward, many people are not able to live on their own and are more likely to die sooner.

How can I find out if I have osteoporosis?

Osteoporosis is more common in women. It affects about 25% (1 in 4) of women aged 65 and over and about 5% (1 in 20) of men aged 65 and over. Many people with osteoporosis do not know they have it until they break a bone. Screening is important to find these people before this happens, so they can take steps to decrease the effects of osteoporosis.

Currently, screening for osteoporosis is recommended for women who are 65 years old or older and for women who are 50 to 64 and have certain risk factors, which include having a parent who has broken a hip. You can use the FRAX Risk Assessment toolexternal iconexternal icon to learn if you should be screened. It uses several factors to determine how likely you are to have osteoporosis. Talk to your doctor if you have concerns about osteoporosis.

Screening for osteoporosis is commonly done using a type of low level x-rays called dual/energy x-ray absorptiometry (DXA). Screening also can show if you have low bone mass, meaning your bones are weaker than normal, and are likely to develop osteoporosis.

How can I improve my bone health if I have osteoporosis?

There are steps you can take to improve your bone health and strengthen weak bones:

  • Take medications to strengthen your bones and avoid medications that can make your bones weaker.
  • Eat a healthy diet that includes adequate amounts of calcium and vitamin D.
  • Perform weight-bearing exercises regularly.
  • Do not smoke.
  • Limit alcohol use.

Don’t wait until you have a broken bone to take steps to improve your bone health—you can start at any age! You can also take steps to prevent falls, including doing exercises to improve your leg strength and balance, having your eyes checked, and making your home safer.

Osteoporosis makes you more likely to break bones because you lose bone mass and density. You may not have any symptoms or pain. The first sign might be a bone fracture.

Things that make osteoporosis more likely include:

Age. Your bone density peaks around age 30. After that, you’ll begin to lose bone mass. So that’s all the more reason to do strength training and weight-bearing exercise — and make sure you get enough calcium and vitamin D from your diet — to keep your bones as strong as possible as you get older.

Gender. Women over the age of 50 are the most likely people to develop osteoporosis. The condition is 4 times as likely in women than men. Women’s lighter, thinner bones and longer life spans are part of the reason they have a higher risk. Men can get osteoporosis, too — it’s just less common.

Family history. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may be more likely to get it, too.

Bone structure and body weight. Petite and thin women have a greater chance of developing osteoporosis. One reason is that they have less bone to lose than women with more body weight and larger frames. Similarly, small-boned, thin men are at greater risk than men with larger frames and more body weight.

Broken bones. If you’ve had fractures before, your bones may not be as strong.

Ethnicity. Research shows that Caucasian and Asian women are more likely to develop osteoporosis than women of other ethnic backgrounds. Hip fractures are also twice as likely to happen in Caucasian women as in African-American women.

Certain diseases. Some diseases such as rheumatoid arthritis raise the odds that you’ll get osteoporosis.

Some medications. Certain prescription medications — for example, if you take steroids such as prednisone for a long time — can also boost your odds of getting osteoporosis.

Smoking. It’s bad for your bones. To lower your risk of osteoporosis and fractures — and many other health problems — work with your doctor to kick this habit ASAP.

Alcohol. Heavy drinking can lead to thinning of the bones and make fractures more likely.

Osteoporosis Risk Factors

Topic Overview

The risk of getting osteoporosis increases with age as bones naturally become thinner. After age 30, the rate at which your bone tissue dissolves and is absorbed by the body slowly increases, while the rate of bone building decreases. So overall you lose a small amount of bone each year after age 30.

In women, bone loss is more rapid and usually begins after monthly menstrual periods stop, when a woman’s production of the hormone estrogen slows down (usually between the ages of 45 and 55). A man’s bone thinning typically starts to develop gradually when his production of the hormone testosterone slows down, at about 45 to 50 years of age. Women typically have smaller and lighter bones than men. As a result, women develop osteoporosis far more often than men. Osteoporosis usually does not have a noticeable effect on people until they are 60 or older.

Whether a person develops osteoporosis depends on the thickness of the bones (bone density) in early life, as well as health, diet, and physical activity later in life. Factors that increase the risk for osteoporosis in both men and women include:

  • Having a family history of osteoporosis. If your mother, father, or a sibling has been diagnosed with osteoporosis or has experienced broken bones from a minor injury, you are more likely to develop osteoporosis.
  • Lifestyle factors. These include:
    • Smoking. People who smoke lose bone density faster than nonsmokers.
    • Alcohol use. Heavy alcohol use can decrease bone formation, and it increases the risk of falling. Heavy alcohol use is more than 2 drinks a day for men and more than 1 drink a day for women. See pictures of standard alcoholic drinks.
    • Getting little or no exercise. Weight-bearing exercises—such as walking, jogging, stair climbing, dancing, or lifting weights—keep bones strong and healthy by working the muscles and bones against gravity. Exercise may improve your balance and decrease your risk of falling.
    • Being small-framed or thin. Thin people and those with small frames are more likely to develop osteoporosis. But being overweight puts women at risk for other serious medical conditions, including type 2 diabetes, high blood pressure, and coronary artery disease (CAD). For more information, see the topic Weight Management.
    • A diet low in foods containing calcium and vitamin D.
  • Having certain medical conditions. Some medical conditions, such as hyperthyroidism or hyperparathyroidism, put you at greater risk for osteoporosis.
  • Taking certain medicines. Several medicines, such as corticosteroids used for long periods, cause bone thinning.
  • Having certain surgeries, such as having your ovaries removed before menopause.

Other risk factors for osteoporosis may include:

  • Being of European and Asian ancestry, the people most likely to have osteoporosis.
  • Being inactive or bedridden for long periods of time.
  • Excessive dieting or having an eating disorder, such as anorexia nervosa.
  • Being a female athlete, if you have infrequent menstrual cycles due to low body fat.

Women who have completed menopause have the greatest risk for osteoporosis because their levels of the estrogen hormone drop. Estrogen protects women from bone loss. Likewise, women who no longer have menstrual periods—either because their ovaries are not working properly or because their ovaries have been surgically removed—also can have lower estrogen levels.

Causes


Osteoporosis

Who’s at risk of osteoporosis

Osteoporosis can affect men and women. It’s more common in older people, but it can also affect younger people.

Women

Women are more at risk of developing osteoporosis than men because the hormone changes that happen at the menopause directly affect bone density.

The female hormone oestrogen is essential for healthy bones. After the menopause, oestrogen levels fall. This can lead to a rapid decrease in bone density.

Women are at even greater risk of developing osteoporosis if they have:

  • an early menopause (before the age of 45)
  • a hysterectomy (removal of the womb) before the age of 45, particularly when the ovaries are also removed
  • absent periods for more than 6 months as a result of overexercising or too much dieting

Men

In most cases, the cause of osteoporosis in men is unknown. However, there’s a link to the male hormone testosterone, which helps keep the bones healthy.

Men continue producing testosterone into old age, but the risk of osteoporosis is increased in men with low levels of testosterone.

In around half of men, the exact cause of low testosterone levels is unknown, but known causes include:

  • taking certain medicines, such as steroid tablets
  • alcohol misuse
  • hypogonadism (a condition that causes abnormally low testosterone levels)

Osteoporosis: Why It Affects More Women Than Men

Osteoporosis is a bone condition that causes bones to thin and weaken over time, making them easier to break. It affects both men and women. One in two women over 50 and one in four men will experience an osteoporosis related fracture in their lifetime. Also 2 million men have osteoporosis.

Yet it’s estimated that 80 percent of the 10 million Americans with osteoporosis are women. Women tend to have smaller, lighter bones than men. This makes women more susceptible to osteoporosis as there is less mass, and menopause has a greater effect on their bones. Plus, after menopause the body produces less estrogen and progesterone – two common female hormones that help keep bones strong. A lack of estrogen can cause bone loss in younger women too. These differences mean women tend to see faster bone loss than men. Early menopause can cause early bone loss and disease well before the age of 65. Women lose more than 30% of their bone mass within five years after menopause.

So what can women do to fight against osteoporosis? It starts with understanding human bones.

Bones and How They Work

Bone is constantly being built, torn down and rebuilt in the body. As the body digests nutrients like calcium, vitamin D and potassium, it creates bone mass. Exercises like walking or jogging also help to strengthen bones.

Strengthening of bones typically continues until people are in their mid-30s. Then bones begin to lose their density. The hard minerals in bone are replaced by empty honey-comb like tissue. Lighter and more fragile, they break more easily when you fall or have an accident.

Risk Factors

Beyond gender, risk factors for osteoporosis include:

  • Early menopause
  • Race white, Asian
  • Smoker
  • Thin frame
  • Steroid use
  • Exposure to breast cancer drugs
  • Age
  • Prior fracture as adult
  • Parental history of hip fracture
  • Vitamin D deficiencies

In Americans over age 50, osteoporosis is most common in women of European or Asian descent. Nearly half have low bone density levels, also known as osteopenia. Asian women have the lowest bone density but are less likely to break bones than white or Hispanic women.

In young women, anorexia, bulimia and lack of periods can elevate your chances of the condition over time. This is common with athletes who may have eating disorders or too little body weight because of high activity levels.

Additionally, inadequate physical activity (weight bearing exercise), smoking and drinking too much alcohol increase your risk.

How Can I Prevent Osteoporosis?

All adults should take steps to strengthen their bones. Start right now, no matter your age. Start by looking at your lifestyle habits.

  • Quit smoking.
  • Limit alcohol consumption.
  • Eat a healthy diet rich in calcium and vitamin D. Vitamin D is essential to absorbing calcium. You’ll find it in cooked salmon; dairy products and greens including broccoli, bok choy and kale.
  • Get at least 30 minutes a day of weight-bearing physical activity. Jogging, walking and hiking are great activities to strengthen your bones. Dancing, yoga and tai chi can also build up your density levels while improving your balance.
  • Get outdoors in the sun. Sunshine helps your body process vitamin D, which is essential to calcium absorption. Exercise outdoors and get a double benefit!
  • Get your vitamin D and calcium levels checked by your health care provider if you are over the age of 50 or post menopause.

The Takeaways

Where do you go from here? Don’t wait until you break a wrist or leg to find out you have osteoporosis.

During regular check-ups with your health care provider, ask if you’re at risk. Your provider can work with you to evaluate all your risk factors.

The best way to check your bone-density level is a bone-mineral X-ray test. Generally, your provider will recommend you have your first bone-mineral density screening if you:

  • Are age 65 or older, also during early menopause without estrogen replacement.
  • Have broken a bone after age 50.
  • Have other risk factors such as family history, history of smoking, heavy alcohol use, currently on steroids, treated with Arimidex for breast cancer, thin frame.

Talk to your health care provider about the appropriate screening intervals after your first bone density screening.

Treatment for osteoporosis starts with changes to your diet and lifestyle. You need to get enough calcium and vitamin D. Your doctor will want you to increase your physical activity. This helps to strengthen your bones and increase your bone mass. Examples of weight-bearing exercises include walking, jogging, and climbing steps. You also should stop smoking and limit alcohol.

If you’re at risk for falls, reduce your risk by getting rid of tripping hazards in your home. For example, remove rugs, avoid slick surfaces, and move electrical cords. You can install grab bars in certain places, such as your bathroom and shower. The bars can help you move around more easily and safely.

Your doctor may prescribe medicine(s) to help treat osteoporosis. There are several types and forms.

Biophosphonates. This type helps reduce your risk of breaks and fractures. It also increases bone density. It comes in oral (pill) form or intravenous (IV or injection) form. Side effects can include nausea or stomach pain. You may have irritation of the esophagus (the tube that connects your mouth and stomach). Some people cannot take biophosphonates. This includes people who have kidney disease or low levels of calcium in their blood, and women who are pregnant or nursing. Examples of biophosphonates include:

  • Alendronate and risedronate.These medicines are used to help prevent and treat osteoporosis. They help reduce your risk of fractures by decreasing the rate of bone loss. They are available in pill form. Their most common side effect is an upset stomach.
  • This medicine helps to slow bone loss and increase bone density. It is available as a pill or injection. You have 2 options for the pill. You can take it daily or monthly. For the injection, your doctor or nurse will give you a shot every 3 months. Side effects may include lower back or side pain, shortness of breath, tightness in your chest, and bloody or cloudy urine.
  • Zoledronic acid.This medicine is given through IV once a year.

Calcitonin. This is a hormone that helps slow down bone loss. It is available as an injection or nasal spray. Side effects of the injection include diarrhea, stomach pain, nausea, and vomiting. Side effects of the nose spray include headache and irritation of your nose lining.

Raloxifene. This medicine helps prevent and treat osteoporosis in women. It increases your bone density. It is not a hormone, but it mimics some of the effects of estrogen. Side effects may include hot flashes and a risk of blood clots.

Teriparatide. This medicine helps to grow new bones. It is a synthetic form of parathyroid hormone. Both women and men can use it. It is available as an injection. You inject it in your thigh or stomach once a day. Common side effects are nausea, stomach pain, headache, muscle weakness, fatigue, and loss of appetite.

Denosumab. This drug is used when other drugs don’t work or if you can’t tolerate other treatment options. Denosumab increases your bone density. It can be used by both women and men. It is given as an injection by your doctor. Side effects can include lower calcium levels, skin rash, or pain in the arms and legs.

Osteoporosis

What is osteoporosis?

Osteoporosis (“porous bone”) is a disease that weakens bones, putting them at greater risk for sudden and unexpected fractures. Osteoporosis results in an increased loss of bone mass and strength. The disease often develops without any symptoms or pain, and it is usually not discovered until the weakened bones cause painful fractures. Most of these are fractures of the hip, wrist, and spine.

Although osteoporosis occurs in both men and women, women are four times more likely to develop the disease than men. After age 50, one in two white women, and one in four white men, will have an osteoporosis-related fracture in their lifetimes. Another 30 percent have low bone density that puts them at risk of developing osteoporosis (including African-Americans).

Osteoporosis is responsible for more than 2 million fractures each year, and this number continues to grow. There are steps you can take to prevent osteoporosis from ever occurring. Treatments can also slow the rate of bone loss if you do have osteoporosis.

Who is at risk for developing osteoporosis?

There are many risk factors that increase your chance of developing osteoporosis:

  • Gender: Women over the age of 50 or postmenopausal women have the greatest risk of developing osteoporosis. Women undergo rapid bone loss in the first 10 years after entering menopause, because menopause slows the production of estrogen, a hormone that protects against excessive bone loss.
  • Age: Your risk for osteoporosis fractures increases as you age.
  • Race: Caucasian and Asian women are more likely to develop osteoporosis. However, African-American and Hispanic women are still at risk. In fact, African-American women are more likely than white women to die after a hip fracture.
  • Bone structure and body weigh: Petite and thin people have a greater risk of developing osteoporosis because they have less bone to lose than people with more body weight and larger frames.
  • Family history: If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may have a greater risk of developing the disease.
  • Nutrition: You are more likely to develop osteoporosis if your body doesn’t have enough calcium and vitamin D.
  • Lifestyle: People who lead sedentary (inactive) lifestyles have a higher risk of osteoporosis.
  • Medications: Certain medications cause side effects that may damage bone and lead to osteoporosis. These include steroids, treatments for breast cancer, and medications for treating seizures.
  • Smoking: Smoking increases the risk of fractures.
  • Alcohol use: Having one to two drinks a day (or more) increases the risk of osteoporosis.
  • Medical conditions: People who have had the following should consider earlier screening for osteoporosis (this is not a complete list):
    • Overactive thyroid, parathyroid, or adrenal glands
    • History of bariatric (weight loss) surgery
    • Hormone treatment for breast or prostate cancer
    • Eating disorders (bulimia, anorexia)
    • Organ transplant
    • Celiac disease
    • Inflammatory bowel disease
    • Missed periods
    • Blood diseases such as multiple myeloma

What causes osteoporosis?

Though the exact cause of osteoporosis is unknown, we do understand how the disease develops. Your bones are made of living, growing tissue. The inside of healthy bone looks like a sponge; this area is called trabecular bone. An outer shell of dense bone wraps around the trabecular, or spongy bone. This hard shell is called cortical bone. When osteoporosis occurs, the “holes” in the “sponge” grow larger and more numerous, which weakens the inside of the bone.

In addition to supporting the body and protecting vital organs, bones store calcium and other minerals. When the body needs calcium, it breaks down and rebuilds bone. This process, called “bone remodeling,” supplies the body with needed calcium while keeping the bones strong.

Up until about age 30, a person normally builds more bone than he or she loses. After age 35, bone breakdown occurs faster than bone buildup, which causes a gradual loss of bone mass. A person who has osteoporosis loses bone mass at a greater rate. After menopause, the rate of bone breakdown occurs even more quickly.

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