Worried About Osteoporosis? 4 Ways to Help Prevent the Disease

Osteoporosis, a serious condition that weakens and thins your bones, mainly affects older women. But there are key steps anyone can take to help prevent it—or lessen further bone loss if they already have the condition.

Preventing or mitigating the effects of osteoporosis is important because it is considered a silent disease—sometimes, the first sign is a fracture from a minor slip or fall. A broken bone, especially if it’s the hip, can have serious consequences, including loss of mobility, independence, and even death, for an older person.

Although osteoporosis affects an estimated 10 million Americans, women account for 80% of those affected. Women tend to have bones that are less dense than men, and low bone density increases the risk of bone breakage. What’s more, estrogen helps to preserve bone density, which is why women are particularly susceptible to osteoporosis after the loss of ovarian estrogen production due to menopause.

There is no cure for osteoporosis, but bone loss can be slowed down. We spoke with Clemens Bergwitz, MD, a Yale Medicine endocrinologist, who shared his advice on how to prevent and manage osteoporosis.

Bones are living tissues that are continually “remodeling.” This involves the resorption, or breakdown, of old bone and the formation of new bone.

As kids and young adults, our bones typically grow faster than they break down. By ages 25 to 30, our bones will reach peak mass—or the greatest amount of bone tissue an individual can produce. Bone mass plateaus from around ages 30 to 50. After age 50, our bones begin to break down quicker than they regenerate, leading to an aging-related loss of bone mass. As bone mass decreases, bone structure changes, too—leading to less dense, thinner, and more fragile bones.

“Osteoporosis is defined as bone loss beyond a threshold that quadruples the fracture risk compared to a healthy 35-year-old woman," says Dr. Bergwitz.

For people with severe osteoporosis, simple actions, such as bending over, coughing, or bumping into furniture, can lead to a broken bone. Wrist, hip, and spine fractures are among the most commonly affected areas, but fractures can occur anywhere in the body.

Doctors can measure bone density with tests called dual-energy X-ray absorptiometry (DEXA) scans. DEXA scans use low-energy X-rays to measure how tightly minerals are packed in a bone segment. Health care providers recommend routine DEXA scans starting at age 65 for women and age 70 for men. The test is repeated every few years or more often if necessary. If patients have additional risk factors, physicians may suggest beginning DEXA scans earlier.

Some of those risk factors include smoking, excessive alcohol consumption, having an inflammatory disease, such as rheumatoid arthritis (the drugs—steroids—often used to treat it can also weaken bones), using hormone blockers to treat breast or prostate cancer, having low testosterone (in men), and being thin (because fat protects bones from injury).

The DEXA scans can also detect osteopenia, a condition in which your bone density is lower than normal but not severe enough to be considered osteoporotic.

DEXA scan results are presented as "T-scores" and "Z-scores." T-scores, which are used for postmenopausal women and men ages 50 and older, compare a patient's bone mineral density to that of a healthy 35-year-old woman.

T-score results can fit into one of several categories:

• Normal bone density: +1 to -1
• Low bone mass (osteopenia): -1 to -2.5
• Osteoporosis: -2.5 or lower

Z-scores are used for children, young adults, premenopausal women, and men younger than 50. These scores compare patients' bone density to the average bone density of healthy people of the same age, ethnicity, and sex. Z-scores of –2.0 or lower indicate a low bone density—essentially, you may have lost bone more rapidly than others your age.

While DEXA scans can show bone strength, they are only one factor that predicts the likelihood of a fracture. Health care providers may use the Fracture Risk Assessment Tool—or FRAX—to calculate the 10-year probability of bone fracture in a patient and include other risk factors (more on that below).