Being female and over forty puts you at risk of developing osteoporosis and broken bones, especially after menopause. Osteoporosis can be treated but more importantly it can be prevented.
What is Osteoporosis?
Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.
Osteoporosis means “porous bone.” Viewed under a microscope, a healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. If you’re 50 or older and have broken a bone, ask your doctor or healthcare provider about a bone density test.
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.
Your risk for osteoporosis is higher if you:
- Are past menopause. After menopause, your ovaries make very little of the hormone estrogen. Estrogen helps protect bone density. Some women lose up to 25% of bone mass in the first 10 years after menopause.
- Have a small, thin body (weigh less than 127 pounds)
- Have a family history of osteoporosis
- Are Mexican-American or white. One in four Mexican-American women and about one in six white women over 50 years old have osteoporosis. Asian-American women also have a higher risk for osteoporosis because they are usually smaller and thinner than other women and therefore may have less bone density.
- Do not get enough calcium and vitamin D. Calcium and vitamin D work together to build and maintain strong bones.
- Do not get enough physical activity. Women of all ages need to get regular weight-bearing physical activity, such as walking, dancing, or playing tennis, to help build and maintain bone density.
- Have not gotten your menstrual period for three months in a row (called amenorrhea). If you have amenorrhea and you are not pregnant, breastfeeding, or taking a medicine that stops your periods, talk to your doctor or nurse. Not getting your period means your ovaries may have stopped making estrogen.
- Have an eating disorder. Eating disorders, especially anorexia nervosa and bulimia nervosa, can weaken your bones. Anorexia can also lead to amenorrhea.
- Smoke. Women who smoke have lower bone density and often go through menopause earlier than nonsmokers. Studies also suggest that smoking raises your risk for broken bones, and this risk goes up the longer you smoke and the more cigarettes you smoke.
- Have a health problem that raises your risk of getting osteoporosis. These include diabetes, premature ovarian failure, celiac disease and inflammatory bowel disease, and depression.
- Take certain medicines to treat long-term health problems, such as arthritis, asthma, lupus, or thyroid disease.
- Drink too much alcohol. For women, experts recommend no more than one alcoholic drink a day if you choose to drink alcohol. Long-term, heavy drinking can cause many health problems, including bone loss, heart disease, and stroke.
Bone loss can happen for several reasons. Some of the most common reasons include:
- You do not get enough calcium from food. Your body uses calcium to build healthy bones and teeth and stores calcium in your bones. Your body also uses calcium to send messages through your nervous system, help your muscles contract, and regulate your heart’s rhythm. But your body does not make calcium. You have to get all the calcium your body needs from the foods you eat and drink (or from supplements). If you don’t get enough calcium each day, your body will take the calcium it needs from your bones.
- You are past menopause. The calcium taken from your bones causes you to lose bone density. Bone loss also speeds up after menopause and can lead to weak, brittle bones.
Diseases, Conditions and Medical Procedures That May Cause Bone Loss
There are many health problems and a few medical procedures that increase the likelihood of osteoporosis. If you have any of the following diseases or conditions, talk to your doctor or health care provider about what you can do to keep your bones healthy.
Autoimmune Disorders
- Rheumatoid arthritis (RA)
- Lupus
- Multiple sclerosis
- Ankylosing spondylitis
Digestive and Gastrointestinal Disorders
- Celiac disease
- Inflammatory bowel disease (IBD)
- Weight loss surgery
Medical Procedures
- Gastrectomy
- Gastrointestinal bypass procedures
Cancer
- Breast cancer
- Prostate cancer
Hematologic/Blood Disorders
- Leukemia and lymphoma
- Multiple myeloma
- Sickle cell disease
Neurological/Nervous System Disorders
- Stroke
- Parkinson’s disease
- multiple sclerosis (MS)
- Spinal cord injuries
Blood and bone marrow disorders
- Thalassemia
Mental Illness
- Depression
- Eating disorders
Endocrine/Hormonal Disorders
- Diabetes
- Hyperparathyroidism
- Hyperthyroidism
- Cushing’s syndrome
- Thyrotoxicosis
- Irregular periods
- Premature menopause
- Low levels of testosterone and estrogen in men
Other Diseases and Conditions
- AIDS/HIV
- Chronic obstructive pulmonary disease (COPD), including emphysema
- Female athlete triad (includes loss of menstrual periods, an eating disorder and excessive exercise)
- Chronic kidney disease
- Liver disease, including biliary cirrhosis
- Organ transplants
- Polio and post-polio syndrome
- Poor diet, including malnutrition
- Scoliosis
- Weight loss
Pregnancy and Lactation Associated Osteoporosis (PLO)
- Temporary decreases in bone density are a normal part of pregnancy and lactation—but fractures during this time are extremely rare.
- Fractures of the spine associated with severe back pain are most commonly described, but PLO can also be associated with hip fractures or other types of fracture.
- In the most common scenario, PLO is discovered after a pregnant or breastfeeding woman develops severe back pain, and imaging reveals multiple vertebral fractures.
- Some women with PLO have a pre-pregnancy diagnosis of osteoporosis, but most women with PLO have not been previously diagnosed with osteoporosis, and never had a bone assessment prior to the onset of symptoms.
Medicines that May Cause Bone Loss
Some medicines can be harmful to your bones, even if you need to take them for another condition. Bone loss is usually greater if you take the medication in high doses or for a long time.
It’s important to talk with your healthcare provider about the risks and benefits of any medicines you take and about how they may affect your bones, but do not stop any treatment or change the dose of your medicines unless your healthcare provider says it’s safe to do so. If you need to take a medicine that causes bone loss, work with your healthcare provider to determine the lowest possible dose you can take to control your symptoms.
The following medicines may cause bone loss:
- Aluminum-containing antacids
- Anti Seizure medicines (only some) such as Dilantin® or Phenobarbital
- Aromatase inhibitors such as Arimidex®, Aromasin® and Femara®
- Cancer chemotherapeutic drugs
- Cyclosporine A and FK506 (Tacrolimus)
- Gonadotropin releasing hormone (GnRH) such as Lupron® and Zoladex®
- Heparin
- Lithium
- Medroxyprogesterone acetate for contraception (Depo-Provera®)
- Methotrexate
- Proton pump inhibitors (PPIs) such as Nexium®, Prevacid® and Prilosec®
- Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro®, Prozac® and Zoloft®
- Steroids (glucocorticoids) such as cortisone and prednisone
- Tamoxifen® (premenopausal use)
- Thiazolidinediones such as Actos® and Avandia®
- Thyroid hormones in excess
Osteoporosis and Steroid Medicines
While steroid medicines can be lifesaving treatments for some conditions, they can also cause bone loss and osteoporosis. These medicines are often referred to as steroids, glucocorticoids or corticosteroids. They should not be confused with anabolic steroids, which are male hormones that some athletes use to build muscle.
Steroids are much like certain hormones made by your own body. Healthcare providers prescribe them for many conditions, including rheumatoid arthritis (but not osteoarthritis), asthma, Crohn’s disease, lupus and allergies. They are often prescribed to relieve inflammation. They are also used along with other medicines to treat cancer and autoimmune conditions and to support organ transplants. Common steroid medicines are cortisone, dexamethasone (Decadron®), methylprednisolone (Medrol®) and prednisone. Intravenous forms include methylprednisolone sodium succinate (Solu-Medrol®).
Taking steroid medicines as pills in a dose of 5 mg or more for three or more months can increase the chance of bone loss and developing osteoporosis. Talk with your healthcare provider about taking the lowest dose for the shortest period of time for your condition. If you need to take steroid medicines for longer than this, you should take steps to prevent bone loss. While taking steroids, it is especially important to get enough calcium and vitamin D. It’s also important to exercise and not smoke. You may also want to ask your healthcare provider if you need a bone density test.
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. - Click here to download the infographic: Osteoporosis in the Black Community: Practical Tips and Action
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.
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.
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.
Build strong bones
Yes, it’s important to build strong bones in your youth, but in one study, healthy middle-aged men with low bone mass successfully improved their bone density after just six months of jumping and muscle-strengthening exercises. “Since muscles are attached to bones, any time you build muscle, you’re building bone as well,” says Jo. Moreover, the National Osteoporosis Foundation (NOF) says daily weight-bearing and muscle-strengthening exercise is essential for bones, right up there with getting adequate calcium and vitamin D.
As for what to eat, if you’re a woman over 50 or a man over 70, you need 1,200 mg of calcium daily. “If you don’t hit that mark, your body takes the calcium from your bones, which makes you more susceptible to osteoporosis and bone fracture,” says Andrea J. Singer, M.D., chief medical officer of the NOF. To get enough, reach for calcium-rich almonds, tofu, sardines, broccoli, kale, dairy, and fortified milk alternatives. Sources of vitamin D include mushrooms, fatty fish, and fortified dairy, OJ, and breakfast cereals
