The 2023 Ultimate Guide to Osteoporosis

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What is Osteoporosis?

Osteoporosis is a disease that causes the body to lose a lot of bone, to stop making enough bone, or both. The word “osteoporosis” itself means “porous bone.” This is because as the disease progresses, the bones become more porous and lose their density.

As the bones lose their density, they become weaker and more likely to be broken or fractured. With osteoporosis, the bones can be injured by minor falls and bumps, and in severe cases, even regular activities like walking. These injuries are most likely to occur in the hip, spine, or wrist.

Osteoporosis most often affects older women, but it is a common disease that anyone can develop. According to the National Osteoporosis Foundation, approximately 50% of women and up to 25% of men over the age of 50 will break a bone because of osteoporosis. 

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• According to the National Osteoporosis Foundation, approximately 50% of women and up to 25% of men over the age of 50 will break a bone because of osteoporosis.

Osteoporosis vs. Normal Bone

Did you know that the inside of our bones looks like honeycombs? It’s completely normal for healthy bones to have holes and spaces when looked at under a microscope. But when someone develops osteoporosis, those holes and spaces become a lot larger and the bone becomes less dense. The outside of the bone also becomes thinner and weaker.

Osteoporosis vs. Osteopenia and the Stages of Osteoporosis

Normal Bone

As we’ve mentioned, before osteoporosis develops, normal bones are somewhat porous. That said, the holes within normal bones are small, allowing the bone to be dense and strong.

Osteopenia

Osteopenia is a very early stage of bone loss. In this stage, the bones begin to lose density but are not yet weak or frail enough for it to be considered osteoporosis. Those in this stage are not certain to develop osteoporosis, but they may be more at risk of the disease.

Osteoporosis

This is the stage at which the bone becomes porous enough to have a noticeably higher risk of being broken or fractured.

Severe Osteoporosis

As osteoporosis becomes more severe, the holes within the bones become much larger and the bones become incredibly frail and weak. It only is at this stage that symptoms typically start to appear.

Osteoporosis Risk Factors

There are quite a few factors that play a role in your risk of developing osteoporosis. These include:

• Age: Osteoporosis is most common in older adults and elderly people. This is because, as we age, our bones naturally start to lose density. 
• Gender: Women, especially European and Asian women, are statistically more likely to develop osteoporosis. 
• Family history: If those in your family have had osteoporosis, this could suggest that low bone density runs in the family and you may be more at risk. 
• Body frame size: Those with smaller body frames have less bone mass to lose as they age, putting them more at risk for osteoporosis. 
• Sex hormone levels: A decrease in the sex hormones estrogen and testosterone can put you more at risk for osteoporosis. The decrease of estrogen occurs as women go through menopause, and men experience a natural decrease in testosterone as they age. Additionally, prostate cancer treatment can reduce testosterone levels and breast cancer treatment can reduce estrogen levels. 
• Thyroid issues: An increase in the thyroid hormone is also associated with bone loss, whether that be from an overactive thyroid or from thyroid medication for an underactive thyroid. 
• Eating disorders: Restricting food can cause you to be underweight and have nutritional deficiencies, which can weaken the bones and put you more at risk of osteoporosis.  
• Other medical conditions: Other conditions such as an overactive parathyroid, overactive adrenal glands, celiac disease, inflammatory bowel disease, kidney disease, liver disease, cancer, lupus, multiple myeloma, and rheumatoid arthritis are associated with a higher risk of osteoporosis.
• Low calcium: Low calcium intake, especially consistently over a lifetime, can contribute to low bone density and early bone loss. 
• Gastrointestinal surgery: Surgery that reduces the size of your stomach or intestines also reduces the area that absorbs necessary nutrients like calcium, which can put you at a higher risk of osteoporosis. 
• Steroid use: Taking corticosteroid medications, such as prednisone and cortisone, over a long period can interfere with bone rebuilding. 
• Other medications: Medications used for seizures, cancer, gastric reflux, and transplant rejection have also been found to increase the risk of osteoporosis. 
• Smoking: Smoking can cause you to absorb less calcium from food, putting you more at risk of low bone density.
• Excessive alcohol consumption: Consuming more than two alcoholic beverages a day on a consistent basis can put you more at risk of osteoporosis. 
• Sedentary lifestyle: Activities such as walking, running, jumping, dancing, and weightlifting are beneficial for bone health. A sedentary lifestyle that doesn’t include regularly partaking in these activities may put you more at risk of osteoporosis.  

Treatment for Osteoporosis

oSTEOPOROSIS mEDICATIONS

Medication plans for osteoporosis most commonly include:

• Bisphosphonates: These are the most common medications prescribed to those with osteoporosis, as they prevent bone density loss. Some types of bisphosphonates include alendronate (Binosto, Fosamax), risedronate (Actonel, Atelvia), ibandronate (Boniva), and zoledrolic acid (Reclast, Zometa). They can be taken orally on a weekly or monthly basis or injected on a quarterly or yearly basis. 
• Denosumab: Denosumab (Prolia, Xgeva) prevents bone density loss and reduces the chance of fractures. It is taken as an injection under the skin every six months. According to Mayo Clinic, recent studies suggest that once starting denosumab, you would have to be on it permanently as stopping the drug could put you at a higher risk of spinal column fractures. 

Before starting these medications, be sure to have a dental examination and inform your dentist that you will be taking them. Once on the medication, be sure to take care of your teeth and visit the dentist regularly. One, albeit uncommon, side effect is the delayed healing of the jawbone.

Additionally, a decline in hormones like estrogen and testosterone can negatively impact bone density. So, hormone therapy may also be prescribed. This can include:

• Estrogen: Taking estrogen can help keep bone density from declining, but it can increase the risk of blood clots, endometrial cancer, breast cancer, and heart disease. Because of this, it is most often prescribed to younger, healthier women. 
• Raloxifene (Evista): This is a common estrogen alternative, as it mimics the effects of estrogen without as many risks. It can even reduce the risk of some types of breast cancer. That said, though, taking raloxifene can still increase the risk of blood clots. 
• Testosterone: A natural decrease in testosterone is linked to osteoporosis in men, and taking supplements can help. However, it is not often prescribed, and if it is, it is typically in addition to bisphosphonates or denosumab.

If you don’t respond well to any of the aforementioned medications, your doctor might suggest you try medication that stimulates bone growth, such as:

• Teriparatide (Forteo): This is taken as a daily injection under the skin for two years. Following that, other osteoporosis medications are taken to maintain the bone that has been grown from the help of teriparatide. 
• Abaloparatide (Tymlos): Similar to teriparatide, abaloparatide is taken for two years, and then an osteoporosis medication is taken to maintain the bone growth.
• Romosozumab (Evenity): This is a newer bone-building medication that would be given as an injection once a month by your doctor for a year. Then, like teriparatide and abaloparatide, an osteoporosis medication would be taken afterwards.  

nATURAL rEMEDIES FOR oSTEOPOROSIS

Some people with osteoporosis have found that natural supplements like vitamin K-2, soy, red clover, and black cohosh have had positive effects on their bone health. However, there are limited studies to support the benefits of these supplements. If you decide to use any natural supplements to treat or manage your osteoporosis, be sure to discuss it with your doctor first. Some supplements could have side effects or interact with other medications you’re taking.

Some more proven ‘natural remedies’ your doctor may suggest are lifestyle changes like diet and exercise, which we’ll discuss in the following section.

Living with Osteoporosis

In addition to medication, some lifestyle changes can help you cope with osteoporosis. Generally, this includes changing your diet, doing exercises that support bone health, and fall-proofing your home.

Foods Good for Osteoporosis

Including the proper foods in your diet can help maintain your bone strength or even make your bones stronger. Some of the best foods to eat with osteoporosis include those high in:

• Calcium: Foods like milk, yogurt, cheese, canned sardines, salmon, kale, broccoli, collard greens, okra, and Chinese cabbage are all great sources of calcium. Some packaged foods may be fortified with calcium as well. 
• Vitamin D: This includes fatty fish, like salmon, mackerel, tuna, and sardines. Some dairy products and other packaged foods may also be fortified with vitamin D.  
• Protein: Many adults don’t get enough protein in their diet, which can be bad for bone health. Some high-protein foods to try include chicken breast, turkey breast, lean beef, fish, eggs, almonds, oats, greek yogurt, lentils, brussels sprouts, and broccoli. 
• Magnesium: This can include vegetables like spinach, okra, tomatoes, potatoes, sweet potatoes, and artichokes. Pumpkin seeds, halibut, dark chocolate, black beans, almonds, raisins, and avocado are also rich in magnesium.
• Vitamin K: Vitamin K is most notably found in dark green leafy vegetables like spinach, kale, brussel sprouts, mustard greens, collard greens, and turnip greens. 
• Zinc: Foods like meat, shellfish, beans, lentils, chickpeas, pumpkin seeds and nuts are all great sources of zinc.

If you are unable to get enough of the necessary nutrients from your diet, you may consider taking supplements. Always talk to your doctor before taking supplements of any kind to ensure that you take the correct dosage and are aware of any possible side effects or interactions.

Additionally, there are foods you should avoid or consume in moderation if you have osteoporosis, as they may contribute to bone loss. These include:

• Salty or processed foods
• Wheat bran
• Alcohol
• Caffeine
• Coffee/tea
• Soft drinks

Exercises for Osteoporosis

Exercising, especially doing weight-bearing exercises, is important for maintaining your bone health. When you do weight-bearing exercises, your muscles move against your bones, which can signal the body to form new bone tissue. This increases bone density and strengthens the bones.

Some low intensity weight-bearing exercises that are good for those with osteoporosis include:

• Climbing stairs
• Walking
• Dancing
• Leg presses
• Squats
• Push-ups
• Using resistance bands or resistance machines
• Using dumbbells

Exercises that improve your balance and stability, such as tai chi, can also be helpful in preventing falls.

With osteoporosis, you’ll want to avoid high-intensity exercise with rapid movements, like running or jumping. These types of exercises can often cause weakened bones to become fractured. You’ll also want to avoid exercises that cause you to bend or twist your waist, such as sit ups, touching your toes, some yoga poses, golf, tennis, and bowling.

Always discuss your exercise plan with your doctor before partaking in it, especially if you’re not sure how healthy your bones are.

Preventing Falls

Making adjustments to prevent falls can also make living with osteoporosis easier. The less likely it is for a fall to occur, the less of a risk there is of fracturing or breaking a bone.

To prevent falls:

• Wear non-skid, low-heeled shoes
• Exercise regularly to improve balance
• Be aware of your surroundings and walk carefully on slippery or icy surfaces
• Get enough sleep to avoid the tired daze that can lead to falls
• Stand up slowly
• Use a mobile device like a cane or walker if needed

To fall-proof your home:

• Remove any clutter or items you could trip on from the floors, like electrical cords, clothes, or area rugs. If you’d like a rug or mat on your floor, be sure it’s non-skid.
• Ensure that there’s adequate lighting so you can see where you’re going
• Prevent slippery floors by cleaning up spills immediately and avoiding cleaners that leave surfaces slick
• Install grab bars and railings in more dangerous areas of the house, like the bathroom (inside and outside of the shower, beside the toilet, etc.) and stairways
• Ensure that you can get into and out of your bed easily

How to Prevent Osteoporosis

Some factors that put you at risk of osteoporosis are out of your control, like your gender or family history. However, there are steps you can take to prevent the disease to the best of your ability. These include:

• Eating a diet rich in protein and calcium to build strong bones
• Getting enough vitamin D, whether that be through sunlight, food, or supplements, to help your body absorb calcium
• Maintaining a healthy body weight to keep bones strong and reduce risk of fractures
• Quitting smoking and reducing alcohol intake

While it’s important to build strong bones when you are young, these preventative measures can be beneficial at any point in your life. Strengthening the bones and reducing bone loss are the keys to reducing the risk of osteoporosis, and that can be done no matter how old you are.

FAQs

Is osteoporosis a disability?

Although osteoporosis itself is not considered a disability by the Social Security Administration, you may still qualify for disability benefits if you meet certain medical criteria. For example, you may qualify by having a fractured or broken bone. You may also qualify if you have a condition related to osteoporosis, like kidney disease, a parathyroid disorder, or an autoimmune disorder.

About the Author

Stephanie Schwarten is a freelance writer and editor with a Bachelors degree in Professional Writing. She specializes in content marketing as well as both developmental and copy editing. 

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