Osteoporosis can sneak up on you. In fact, most people don’t even know they have it until they break a bone. Knowing you’re prone to osteoporosis is one of the best ways to catch the condition before something snaps — or even prevent it from developing in the first place. Bone up on the biggest osteoporosis risk factors.
We tapped into some of the best bone experts for the most up-to-date information possible.
Stephen Honig, M.D.Rheumatologist and Director
Kendall Moseley, M.D.Medical Director
Mary Jane Minkin, M.D.Clinical Professor of Obstetrics, Gynecology, and Reproductive Services
What Exactly Is Osteoporosis?
Osteoporosis fittingly translates to porous bones. It’s a condition that can occur when you have low bone density; when you lose too much of the minerals that make your bones strong (mainly calcium), your bones become spongy and brittle on the inside, causing them to weaken as bone hollows out. Once that happens, they may fracture (the medical term for break) from very little impact or trauma (like a stumble or even coughing too hard).
How do bones become fragile? Bone development begins in utero, but it’s when you’re a kid — running, jumping, skipping and drinking your milk like Mom asked — that you’re building the bulk of your bone mass. By age 30, you’ll reach what’s called your peak bone mass: the maximum amount of bone you’ll have in your lifetime. You’ll continue to make new bone and lose some bone (a process called remodeling), but your overall bone density should remain fairly stable.
As you enter your 50s, you start losing bone mass more rapidly. Why? With age, osteoblasts (cells that form new bone) slow down and osteoclasts (cells that break down old bone and release calcium into your blood) rev up. If you didn’t have a great peak bone mass to begin with, or you’re losing more bone than you can replace, you may wind up with weak bones and what’s known as senile osteoporosis, an age-related form of the bone disease.
The other main type is postmenopausal osteoporosis, which occurs when bone loss accelerates after menopause (more on that below). Osteoporosis typically strikes older adults, but it can affect children and teens, usually due to underlying health conditions and medications.
Experts typically split risk factors into two categories: the ones you can’t control and the factors you can control.
The Risk Factors You Can’t Control
About 80 percent of your peak bone mass is determined by genetics. If you’ve had relatives diagnosed with low bone density or osteoporosis of the spine or hip, you’re more likely to develop it too.
Knowing your family history is key, but we may be getting close to a clinical genetic test: Researchers from Stanford University School of Medicine recently developed a genetic screening based on almost 900 genes associated with low bone density, 613 of which have never been identified before. People considered at risk because of these genes were 117 times more likely to develop osteoporosis and twice as likely to suffer a fracture in their lifetime than those not at risk.
Osteoporosis affects both sexes, but more so females. Of the 10 million Americans who have osteoporosis, eight million are women. By nature, females have smaller, thinner bones than men, so their peak bone mass isn’t as high. Ethnicity seems to play a role as well. Osteoporosis is more commonly seen in Caucasian and Asian-American women; 20 percent of women in these groups over the age of 50 have the brittle bone condition. Latina and African American women have the lowest rates of osteoporosis: just 10 and five percent over age 50 respectively.
Menopause also puts women at risk, due to a swift decline in estrogen. When estrogen diminishes, bone mass tends to ebb as well. It’s estimated that women can lose up to 20 percent of their bone mass in the first five to seven years after menopause. That means if you start menopause with a low peak bone mass, you’re at greater risk of developing osteoporosis. Men, of course, don’t have to contend with estrogen-related osteoporosis, but they can develop brittle bones due to low levels of androgens, aka male hormones.
While your weight may fluctuate (more on that below), your frame doesn’t change. That whole “big-boned” or “small-boned” thing is real. Someone who is small framed has smaller, thinner bones, and therefore, a lower peak bone mass to begin with, so when they start losing more bone mass with age, there’s less to take from, putting their bones at risk for osteoporosis.
There’s no way around it: loss of bone mass comes with age, laying the groundwork for low bone density and the potential of osteoporosis. We typically lose bone mass starting at age 40 and one in two women and one in four men over the age of 50 will fracture a bone at some point.
Certain medical conditions can affect how fast or slow you build and lose bone mass and lead to what’s called secondary osteoporosis. This list includes: kidney failure, rheumatoid arthritis, untreated celiac disease, multiple sclerosis, Cushing’s disease, scurvy, hyperparathyroidism, hyperthyroidism, diabetes, lupus, inflammatory bowel disease, Parkinson’s disease, and cancers including multiple myeloma, leukemia, and metastatic bone diseases. Getting treatment for these conditions may help reduce your risk of osteoporosis and your doctor may also prescribe a preventative osteoporosis drug.
Prescription medications can have side effects and in some cases, this includes low bone density. A few drugs that impact bone loss are:
Corticosteroids: These drugs, such as prednisone, are thought to reduce bone growth and speed up bone loss. Being on a long term course of corticosteroids may place you at high risk for osteoporosis.
Anti-seizure meds and blood thinners such as heparin
Drugs for hormonal breast cancer and prostate cancers: They are designed to alter hormone levels, which can affect bone health.
Antacids for heartburn: Prevacid, Nexium, and similar others may decrease calcium absorption, which can then reduce bone density.
Diuretics can also interfere with calcium levels. These are called loop diuretics and the most used one is furosemide (simply put: you pee out the supplement). Hydrochlorothiazide does not increase urinary excretion of calcium.
Multiple studies have linked air pollution and low bone density and osteoporosis. One in Lancet Planet Health found that osteoporotic bone fractures were higher in areas with higher levels of particulate matter in the air (teeny-tiny particles of dust, soot, smoke, and chemicals).
The Risk Factors You Can Control
Bone is mostly made of calcium, which means this mineral is vital for building healthy bone early on. Calcium is also important for:
If you’re not getting enough calcium, your body will take it from your bones (breaking down bone to release calcium into your blood). Having a calcium deficiency at a young age can lead to a lower peak bone mass and if you’re not getting enough of the mineral with age, you’ll lose bone mass faster than someone with adequate levels.
How Much Is Enough?
1,000 mg a day for women under 50 and men under 70
1,200 mg for women over 50 and men over 70
Ideally, calcium should come from foods. To add more calcium to your diet, the best sources are:
Calcium rich veggies such as broccoli
Fatty fish including sardines
A supplement can close the gap, but our bodies can’t absorb large doses of calcium, so it's better to take smaller doses (500 mg) once or twice a day, rather than one megadose. Talk to your doctor before starting a supplement.
Vitamin D is also essential for bone health because it helps the body absorb calcium. You can get D through:
Sunlight (but the risk of skin cancer makes moderation key)
Fortified foods such as milk
Fatty fish including mackerel and salmon
If your levels still fall short (which a doctor can check with a blood test), you can supplement with vitamin D2 or D3. The recommended vitamin D levels are:
400 to 800 international units (IU) for men and women under 50
800 to 1,000 IUs for those over age 50
Beyond calcium and vitamins, an eating approach that plays favorites with lean proteins, fruit, vegetables and omega fatty acids seems to help bone health. Those who have had eating disorders such as anorexia nervosa or bulimia, as well as those who have undergone bariatric surgery are also at risk due to vitamin deficiency and fluctuating hormone levels.
Weight-bearing exercise (those that require you to support your body weight, like walking or jogging) helps build strong bones. A bit of stress on your bones stimulates new bone growth, so if you had a health condition as a child that kept you from running and jumping, you may end up with a lower peak bone mass.
As an adult, weight-bearing exercise can boost your bone density and help keep it stable as you naturally lose bone mass with age. Aim for 30 minutes of weight-bearing exercise most days of the week, suggests the National Osteoporosis Foundation. If you don’t do weight-bearing exercise (say, you swim for exercise) or are sedentary, you’re at risk of developing disuse osteoporosis, which stems from not putting that good pressure or stress on your bones.
Chronic stress is linked to low bone density. Studies have shown those with PTSD have a higher chance of developing osteoporosis later in life than those without the condition. Likewise, stress in postmenopausal women is tied to low bone density, according to a study in a recent study in the Journal of Epidemiology & Community Health. The connection isn’t well understood yet, but researchers suspect that the increased inflammation that comes along with stress can affect the cells that boost and break down bone.
It seems you need some meat on your bones to ward off osteoporosis as weighing less than 127 pounds or having a BMI of less than 21 seems to increase your risk. Women who are naturally thin can have low bone mass; it’s not just extreme dieting or an eating disorder that leads to the condition, according to a study in the Journal of Clinical Endocrinology and Metabolism. On the flip side, being extremely overweight puts you at risk for diseases such as diabetes, which can lead to lower bone density and fractures, research has shown.
Experts know smoking is bad for your bones but they’re not exactly sure why. What we do know: Smoking reduces blood circulation to the bones (among other organs) and may also inhibit osteoblasts (those critical bone-building cells), affect calcium absorption, and reduce your hormone levels — all of which can weaken bone density. Plus, smoking can slow down the healing process when you do have a bone fracture. Bottom line: Quit!
A glass or two of alcohol a day isn’t going to hurt you — and may even protect bone health, according to studies, but research has shown that chronic, heavy drinking (more than two drinks per day) can lower your bone density. What you drink may matter too. Men who had more than two drinks of liquor per day had lower bone mineral density in their hips and spine as opposed to those who drank wine and beer, a study in the American Journal of Clinical Nutrition showed.
Lack of sleep has been linked to bone health, according to a study in The Journal of Bone and Mineral Research. Scientists reviewed the data on 11,000 postmenopausal women from the Women’s Health Initiative (a long-term national study focused on women’s health) and found that short sleep duration was associated with lower bone mineral density and a higher risk of osteoporosis. This is yet another reason to prioritize getting seven to eight hours nightly.
Take a closer look at your own circumstances and daily habits. What does your level of risk look like, and what small shifts can you make to keep your bones strong? Asking these questions — and acting on the answers — is vital to staying strong, healthy, and injury-free for the long haul.
The majority of your peak bone mass — the most amount of bone mass you’ll reach in your lifetime — is determined by genetics. Meaning, low bone density can simply run in your family — putting you at risk for developing osteoporosis. If one or both of your parents have fractured a bone from little impact, you may consider a bone density screening to see how strong (or weak) your bones are. Screenings are typically done after menopause for at-risk women, or by age 65 for the general population, and after age 70 for men.
What causes osteoporosis?
Osteoporosis is spurred by low bone density, or bones that are low in minerals — primarily calcium — which is found in the hard part of bones. When you start to lose bone density, bones get brittle, porous and can break from the slightest impact. Low bone density has many possible causes, including lack of hormones (estrogen in women and androgens in men), your natural bone structure, underlying medical conditions, medications, poor nutrition, a sedentary lifestyle, and more.
What are the signs of osteoporosis?
The condition is typically not detected until you have a fracture, but a nagging backache can be a sign of osteoporosis pain, and more specifically, collapsed vertebrae (a common complication of the disease). Other telltale signs can include shrinking in height. Because there are rarely symptoms, it’s important to know if you’re at risk so you can take steps to boost your bone health.
Can I prevent osteoporosis?
Yes, you can. You can’t do much about your gender, bone size, and the natural aging process, so preventing osteoporosis comes down to changing the risk factors you do have influence over. Eating a diet that includes bone-boosting calcium and vitamin D, refraining from smoking, keeping drinking in check, maintaining a healthy weight, and doing weight-bearing exercise regularly may prevent your bone density from getting dangerously low.
Social Stress and Women:Journal of Epidemiology & Community Health. (2019). “Psychosocial Stress and Bone Lose Among Postmenopausal Women: Results from Women’s Health Initiative.” jech.bmj.com/content/73/9/888
Bone Density and Types of Alcohol:American Journal of Clinical Nutrition. (2009).“The Effects of Beer, Wine, and Liquor on Bone Mineral Density in Older Men and Women.” ncbi.nlm.nih.gov/pubmed/19244365
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