What is Osteoporosis and How Do I Prevent It?

WHAT IS OSTEOPOROSIS?

Osteoporosis is a medical condition that causes bones to become more brittle and are more likely to fracture. The word “osteoporosis” literally means “porous bone.” Under a microscope, healthy bone looks like a honeycomb, but in someone with osteoporosis, the holes and spaces in the honeycomb are much larger. This structural weakening makes bones fragile and more prone to breaks.

HOW DOES IT HAPPEN?

Throughout your life, your bones are constantly renewing themselves. Old bone tissue is broken down and replaced with new bone in a process called remodeling. When you're young, your body builds new bone faster than it breaks down old bone, increasing your bone mass. But as you age this balance shifts. Your bone-building cells slow down and bone is broken down faster than it’s rebuilt, leading to a gradual loss of bone density.

WHO IS AT RISK?

Osteoporosis can affect anyone, but certain groups are more at risk, including:

• Postmenopausal women – Due to a sharp drop in estrogen, a hormone that helps protect bones.

• Older adults – Bone mass naturally decreases with age.

• People with a family history of osteoporosis

• Individuals with low body weight or small frame size

• Those with poor nutrition or low calcium/vitamin D intake

• People with sedentary lifestyles

• Smokers or heavy alcohol users

• Those taking certain medications like corticosteroids for long periods

WHY IT MATTERS

Osteoporosis often develops silently and painlessly. Most people don’t know they have it until they experience a fracture—commonly in the hip, wrist, or spine. Spinal fractures, also known as compression fractures, in particular, can lead to height loss, back pain, and a hunched posture. Hip fractures can lead to loss of independence and even serious complications, especially in older adults.

Because the disease progresses quietly, prevention and early detection are crucial to protecting your bone health for the long term.

HOW DO I PREVENT OSTEOPOROSIS?

NUTRITION

A balanced diet for maintaining bone health should ensure adequate intake of protein and calories, alongside ample calcium and vitamin D, which are critical for supporting bone formation and density. Refer to the summary below.

Calcium consumption — Women who are postmenopausal should aim for a daily intake of 1200 mg of calcium. This encompasses calcium from foods, beverages, and supplements (such as pills), which may be necessary if your dietary calcium is insufficient.

It's important not to exceed 2000 mg of calcium daily to avoid the risk of side effects such as kidney stones.

Key sources of dietary calcium include milk and other dairy products, like cottage cheese, yogurt, and hard cheese, as well as green vegetables, such as kale and broccoli. A rough estimate of your calcium intake can be calculated by multiplying your daily dairy servings by 300 mg. Some examples are listed in a table below.

Supplements are frequently recommended for women due to their higher risk of developing osteoporosis, and often they do not get sufficient calcium through their diet. If you need to take over 500 mg/day of calcium in supplement form, it's advisable to divide it into smaller doses (e.g., once in the morning and once in the evening). You can also get by using TUMS if you don't want to purchase a calcium supplement.

Vitamin D consumption — Specialists suggest postmenopausal women should ingest 2000 international units of vitamin D each day. This quantity appears to lessen bone loss and fracture risk among older individuals with adequate calcium intake.

Vitamin D-fortified milk is a significant dietary source of vitamin D; it contains about 100 international units per 8 oz (236 mL). Salmon is another excellent source, offering roughly 800 international units per 3 oz (98 g) serving. Additionally, other products such as orange juice, yogurt, and breakfast cereals may be available with added vitamin D.

Alcohol — reduce heavy alcohol use as alcohol reduces absorption of certain minerals and gives you "empty calories" tricking your body into thinking you've eaten when you have not. This leads to malnutrition, reducing the amount of calcium intake. Having more than two drinks daily has been shown to elevate your risk of fractures.

The recommended daily intake of Vitamin D for women is 2000 IU.
The suggested daily calcium intake for women is 1200 mg.

Here are some ideas and how much calcium they contain:

• Milk (8 oz) 300 mg

• Yogurt (6 oz) 250 mg

• Orange juice (with calcium, 8 oz) 300 mg

• Calcium-fortified tofu (1/2 cup) 435 mg

• Cheese (1 oz) 195 to 335 mg (hard cheese has more calcium)

• Cottage cheese (1/2 cup) 130 mg

• Ice cream or frozen yogurt (1/2 cup) 100 mg

• Soy milk (8 oz) 300 mg

• Beans (1/2 cup cooked) 60 to 80 mg

• Dark leafy greens (1/2 cup cooked) 50 to 135 mg

• Almonds (24 whole) 70 mg

• Orange (1 medium) 60 mg

PHYSICAL ACTIVITY

Engaging in regular exercise can lower fracture risks by enhancing bone mass in premenopausal women and helping sustain bone density in those post-menopause. It also fortifies muscles, boosts balance, and reduces the likelihood of falls that could lead to fractures or injuries. Most specialists recommend at least 30 minutes of exercise three times per week. Diverse forms of exercise, including resistance training (e.g., using free weights or resistance bands), jogging, jumping, and walking, yield effective results. Weight-bearing exercises are those that require you to counteract gravity, like walking, running, or light weight lifting, but should not include activities such as rowing, cycling, or swimming. The advantages of exercise can be rapidly lost if you cease physical activity. Finding an enjoyable routine can help ensure you continue exercising long-term.

TOBACCO USE

It is highly advised to avoid or quit smoking due to its negative impact on bone health, as smoking has been linked to accelerated bone loss. Research indicates that women who smoke a pack daily throughout their adult lives may experience a 5 to 10 percent decrease in bone density by the time they reach menopause, which increases their fracture risk.

FALL AVOIDANCE

Falls considerably heighten the risk of osteoporotic fractures in older adults. Implementing strategies to prevent falls can significantly lower fracture risk. Such strategies may include:

• Eliminating loose rugs, electrical cords, or any other tripping hazards in your home.

• Ensuring adequate lighting in all indoor and outdoor areas, including staircases and entryways.

• Steering clear of slippery surfaces like ice or wet, polished floors.

• Avoiding strolls in unfamiliar outdoor locations.

• Regularly reviewing medications to replace those that may heighten fall risks with safer alternatives.

• Consistently visiting an eye care specialist to monitor your vision.

What If I Already Have Osteoporosis?

If you've already been diagnosed, it's not too late to take action. Treatments and lifestyle changes can help manage the condition and reduce the risk of fractures:

• Medication: Your doctor may prescribe medications to slow bone loss or increase bone formation, usually starting with a bisphosphonate like alendronate (AKA Fosamax).

• Nutrition and Exercise: A healthy diet and safe, guided physical activity can help maintain your bone strength.

• Fall Prevention: Make your home safer by removing tripping hazards, installing grab bars, and wearing proper footwear.

Most importantly, work with your healthcare provider to create a plan that fits your needs.

Osteoporosis might be silent, but it doesn’t have to be invisible. With the right habits, you can protect your bones for life.

Stay well,

Sandra Koehn DO