What is osteoporosis?
Osteoporosis is a condition in which bones lose mass and become fragile, so they break easily, often from a fall that would not hurt a healthy bone. It usually has no symptoms until a fracture. It is far more common in women because bone loss speeds up after menopause: about 27 percent of US women 65 and older have it. Screening, treatment from a doctor, strength training, protein, calcium and vitamin D all lower the risk.
Key takeaways
- Osteoporosis means low bone mass and fragile bones, so bones break from minor falls.
- It is usually silent: the first sign is often a fracture of the hip, wrist or spine.
- About 27 percent of US women 65 and older have osteoporosis, against about 6 percent of men.
- Women lose bone faster in the first 4 to 8 years after menopause, as estrogen falls.
- The USPSTF recommends a bone density screen for all women 65 and older, and earlier for postmenopausal women at higher risk.
- Strength and impact training, enough protein, calcium and vitamin D protect bone. Medication prescribed by a doctor treats it.
- If you have broken a bone from a minor fall after 50, ask your doctor about osteoporosis.
Osteoporosis is one of the most common conditions in older women and one of the least noticed, because it does not hurt until something breaks. Knowing how it works makes the prevention advice make sense, and most of that advice is within your control.
What osteoporosis is
Bone is living tissue. It is constantly broken down and rebuilt. Osteoporosis happens when the breaking down gets ahead, so bones lose mass, the inner structure thins out, and the bone becomes fragile.
The US Preventive Services Task Force describes it as decreased bone mass that leads to bone fragility and a higher risk of fracture. The typical result is a fragility fracture: a bone broken by a fall from standing height or less, which would not break a healthy bone.1
On a bone density scan (DXA), osteoporosis is defined as a T-score of -2.5 or lower, which means bone density is 2.5 standard deviations below the average for a healthy young adult.1 A score between normal and that threshold is called osteopenia.
Who gets it
27%1
of US women 65 and older have osteoporosis, compared with about 6 percent of men the same age
Among all US adults 50 and older the figure is 12.6 percent, and it is much higher in women.1 The main reason is menopause. A small amount of bone loss after 35 is normal for everyone, but in the first 4 to 8 years after menopause women lose bone much faster, because estrogen falls.3
Other things that raise the risk include a family history of hip fracture, low body weight, smoking, heavy alcohol use, some medications and some medical conditions. Your doctor can put these together into an estimate of fracture risk.2
Why it matters
Hip, spine and wrist are the fractures that matter most. The USPSTF notes that osteoporotic fractures are linked with further fractures, loss of independence, difficulty with daily activities and a higher risk of death, and that hip fractures carry the heaviest toll.1 The clinician's guide from the Bone Health and Osteoporosis Foundation adds that any new fracture after 50 signals a higher risk of another one, especially in the following year.2
Screening: when to get a bone density scan
| Recommendation | Grade | |
|---|---|---|
| Women 65 and older | Screen for osteoporosis | B |
| Postmenopausal women under 65 at higher risk | Screen, after a clinical risk assessment | B |
| Men | Not enough evidence either way | I |
If you are under 65 and past menopause, ask your doctor whether your risk factors put you in the second group.1
What protects bone
Treatment of diagnosed osteoporosis is medical and usually includes medication, which your doctor will choose with you. The everyday habits below support bone at every stage, before and alongside treatment.
- Strength and impact training. Bone responds to load. In the LIFTMOR trial, women around 65 with low bone density who did supervised heavy lifting twice a week improved spine and hip bone density in eight months, while a light home exercise group lost bone.4 Strength training for women over 50 shows how to start.
- Enough protein. A review commissioned by the National Osteoporosis Foundation found no harm to bone from higher protein intake and moderate evidence of a small benefit for spine bone density.5 Protein also keeps muscle, and stronger muscles mean better balance and fewer falls.
- Calcium and vitamin D. Women 51 to 70 need 1,200 mg of calcium and 600 IU of vitamin D a day, mostly from food.6 The osteoporosis diet lists the foods that carry both calcium and protein.
- Not smoking, and moderate alcohol.
Where protein fits
Muscle and bone decline together after menopause, and the same habits protect both: loading them with training and feeding them with enough protein. Many women over 50 eat less protein than they think, especially at breakfast.
Protein Buddy works out a daily protein target from a short quiz on your weight, age, activity and goal, and Home shows how many grams are left today as you log. Typing meals in by hand is free with no limit. Choosing protein foods that also carry calcium, like yogurt, calcium-set tofu and canned fish with bones, covers two bone nutrients at once. Protein and bone health goes deeper into the research.
The worst foods for osteoporosis covers what is worth limiting.
Talk to your doctor
See your doctor about osteoporosis if you have broken a bone from a minor fall after 50, have lost height, are past menopause with risk factors, or are 65 or older and have never had a bone density scan. Treatment, supplements and the right exercise for your bones are decisions to make with your clinician.
More questions about Women over 40
What are the symptoms of osteoporosis?
Usually none until a bone breaks. Later signs can include losing height, a stooped upper back, or back pain from a small fracture in the spine. Because it is silent, screening with a bone density scan is how it is usually found before a fracture.
At what age should women be screened for osteoporosis?
The US Preventive Services Task Force recommends screening for all women 65 and older, and for postmenopausal women under 65 who are at higher risk of fracture. Your doctor can estimate your risk from things like family history, weight, smoking and past fractures.
Why is osteoporosis more common in women?
Women start with smaller, lighter bones, and they lose bone quickly in the first 4 to 8 years after menopause, when estrogen falls. That is why osteoporosis affects about 27 percent of women 65 and older, compared with about 6 percent of men.
Can you prevent osteoporosis?
You can lower the risk a lot. Regular strength and impact training, enough protein, calcium and vitamin D, not smoking and keeping alcohol moderate all help. If your risk is high, your doctor may also recommend medication.
Is osteoporosis the same as osteopenia?
No. Osteopenia means bone density is lower than normal but not low enough to count as osteoporosis. It is a warning sign and a good moment to start training, check your diet and talk to your doctor about your fracture risk.
References
- Osteoporosis to Prevent Fractures: Screening
- The clinician's guide to prevention and treatment of osteoporosis
- The Menopause Years
- High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial
- Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation
- Dietary Reference Intakes for Calcium and Vitamin D
