Bone Health

Osteoporosis

Osteoporosis, which literally means “porous bone,” is one of the biggest health concerns for women: About one in two women (compared to one in four men) over the age of 50 will break a bone due to osteoporosis. Women have a greater risk then men because they have less bone tissue to begin with and tend to lose bone faster after menopause. While your risk for osteoporosis increases as you age, you’re never too young—or too old—to take crucial steps to protect your bones. When osteoporosis occurs, either because your body starts to make too little new bone cells, or you’re losing too many old bone cells (or a combination of both), your bones develop larger spaces or holes within this honeycomb pattern. That weakens your bones and makes them more prone to breakage. Even a simple bump or a minor fall can result in a fracture. People with osteoporosis most often break bones in their hip, spine or wrist.

If your bone density is lower than normal (but not low enough to be considered osteoporosis) you may have osteopenia. This condition puts you at a greater risk of a fracture in the future simply because you have less bone to lose.

What’s Happening in Your 20s, 30s and 40s

While osteoporosis is not very common in women who are pre-menopausal (meaning you still have regular menstrual periods and have not yet reached menopause), low bone density now will increase your chance of developing osteoporosis as your get older. You develop up to 90 percent of your bone mass by age 18, but you can keep building bone tissue until around age 30.

How to Stay Healthy

The more bone you can bank now, the lower your risk of fracture later.

  • Do weight-bearing exercise at least twice a week. Any exercise in which you work against your own body weight—walking, running, hiking, stair climbing, lifting weights, using resistance bands—can help build bone density.
  • Bank calcium and vitamin D. Aim to get your daily calcium needs (1,000 mg for women ages 19 to 50) through your daily diet. Good sources include low-fat dairy (milk, yogurt and cheese), dark leafy greens (spinach, broccoli and kale), tofu, almonds and foods fortified with calcium such as orange juice. Many dairy foods are also fortified with vitamin D, but talk to your doctor about testing your D levels to see if you need to take a supplement. Read more about the importance of Calcium here.
  • Avoid smoking. The chemicals in cigarette smoke aren’t just bad for your lungs, they can also significantly weaken your bones.

What’s Happening in Your 50s, 60s and Beyond

During the first few years after menopause, many women go through rapid bone loss as falling estrogen levels create a drop in bone tissue, although eventually this bone loss will level off.

How to Stay Healthy

Osteoporosis is not an inevitable part of aging: It’s true that the denser your bones are to begin with, the less bone you will lose as you get older. But lifestyle changes can play an important role.

  • Stay active. Regular weight-bearing exercise and strength training helps keep muscles strong and reduces bone loss. Even if you’re not a regular exerciser and have never lifted a free weight or used a resistance band, it’s not too late to start.
  • Up your calcium. Postmenopausal women are less efficient at absorbing calcium and other nutrients, so you may need to take in more to meet your body’s needs. The daily recommendation is 1,200 mg for women 51 and older. Aim to get more through your diet—continue to eat calcium-rich foods including low-fat dairy, dark leafy greens, tofu, almonds and fortified foods. If you suspect you’re not eating enough calcium and need to take a supplement, be sure to talk to your doctor first. Research has linked calcium supplements to an increased risk of heart disease in women. Read more about the importance of Calcium here.
  • Consider vitamin D supplements. Although your body can make vitamin D through exposure to sunlight, older people (especially those who do not go outside much or who live in northern climates) may need to take supplements of 600 IU per day (800 IU for those over age 70). Ask your doctor to check your D levels (it’s a simple blood test) so she can help you figure out if and how much you need to supplement.

Signs and Symptoms

Osteoporosis is often called the “silent disease” because you can be at risk without realizing it—you can’t feel bones becoming weaker. Often fracturing a bone is the first sign. However, if you have experienced a significant loss of height or a curvature in your spine, talk to your doctor about getting tested. The risk factors for osteoporosis are:

  • Age: Your bones become thinner and weaker as you get older.
  • Body size: Smaller, thin-boned women are at the highest risk.
  • Ethnicity: African American and Hispanic women have a lower risk than Caucasian and Asian women.
  • Family history: If your parents have a history of fractures, you may also have an increased risk.
  • Hormones: Low estrogen levels in women (either due to abnormal absence of menstrual periods or menopause) and low testosterone levels in men can boost your risk of osteoporosis.
  • Diet: Chronically low levels of vitamin D and calcium as well can bump your risk
  • Lifestyle: Smoking, excessive alcohol intake and inactivity can all weaken bones over time.
  • Medications: The long-term use of certain medications such as glucocorticoids and some anticonvulsants can also lower bone density

If you fall into one of these high-risk groups, talk to your health-care provider about getting a bone mineral density (BMD) test, which can help determine your bone density before there’s a fracture. The most widely used type is called a dual energy x-ray absorptiometry, or DXA test. The procedure is similar to an x-ray but without as much radiation exposure, and it measures bone density at the hip and spine. The results of these tests are typically given as a T-score. The lower the T-score, the lower your bone density.

  • 1.0 or above: Normal bone density
  • 1.0-2.5: Low bone density (osteopenia)
  • 2.5 or below: Osteoporosis

Blood and urine tests can also help identify possible causes of bone loss. These tests may measure calcium and vitamin D levels, thyroid function, and hormonal levels, among others. Biochemical marker tests (also taken through blood or urine) can help estimate how fast you are losing or making bones.

Your doctor may also give you something called your FRAX score, which uses information about bone density as well as other risk factors to estimate your risk of breaking a hip or other major bones (spine, shoulder, forearm) over the next 10 years.

Treatment options

Getting a diagnosis of either osteopenia or osteoporosis doesn’t mean you’re destined to break your hip or fracture another bone. There are a variety of treatments available to help you minimize your risk and keep your bones healthy for years to come.

Keep in mind:

  • Many medications are not recommended for women who have not yet gone through menopause. The severity of bone loss can also make a difference in what type of medication you receive.
  • Medications are available in pill, liquid or as a nasal spray or injection, and can be taken daily, weekly, monthly or even just once a year. Some estrogen-based medications are only available for women.
  • Talk to your health-care provider about possible side effects and treatment options that may work best for you.

How North Shore-LIJ Can Help

The North Shore-LIJ Orthopaedic Institute has a full range of services to treat illnesses and injuries affecting your bones, muscles, joints, ligaments and tendons. Our specialized services include:

  • Joint reconstruction and replacement
  • Neck, back, and spine-related treatments
  • Trauma and fracture care
  • Reconstructive orthopaedic surgery
  • Sports medicine
  • Pediatric orthopaedics
  • Shoulder, elbow, hand and wrist treatments
  • Foot and ankle care
  • Musculoskeletal tumors

Our clinical staff are knowledgeable about the orthopedic injuries and conditions that are more common in women, with a focus on wellness and prevention as well as treatment. Please click here for more information.

Additionally, the Division of Endocrinology, Diabetes and Metabolism offers consultative services and ongoing management of all aspects of endocrine disorders, including bone and mineral metabolism. Our physicians participate in research to test new treatments for osteoporosis and help to prevent fractures in women. Click here for more information.