 Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis and broken bones are called “risk factors.” While you have no control over some of these risk factors, there are others you can change. Many of the choices you make each day can affect your bones. By making healthier choices you can help to reduce your risk of osteoporosis as well as the painful fractures it can cause. You can learn about many of the risk factors for osteoporosis below.
Age. Osteoporosis can affect people of all ages, but it is far more common in older people than younger people. All of us lose some bone density as we age, but some of us lose more bone or lose it faster than others. It is not true that every older person gets osteoporosis, but it does become more common with age.
Sex. Osteoporosis is more common in women than men. Eighty percent, or four out of five, of the 10 million Americans who have it are women. There are several reasons for this. Women have lighter, thinner bones to begin with. They also lose loose bone rapidly after menopause. In fact, a woman’s risk of osteoporosis is equal to her combined risk of breast, ovarian and uterine cancer.
But this doesn’t mean osteoporosis is just a women’s disease. Twenty percent, or two million people with osteoporosis, are men. A man older than 50 is more likely to break a bone due to osteoporosis than he is to get prostate cancer.
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Family History. Research suggests that heredity and genetics play a major role in osteoporosis. If either of your parents had osteoporosis or a history of broken bones, you are more likely to get it too. Also, if one of your parents had a noticeable amount of height loss or a spine that curved forward, they may have had osteoporosis.
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Low Body Weight/Being Small and Thin. Women and men with small bones are more likely than larger people to have osteoporosis. But that doesn’t mean heavier or larger people can’t get it.
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Race and Ethnicity. While osteoporosis affects all races and ethnicities, people in the U.S. who are Caucasian or of Asian or Latino descent are more likely to develop osteoporosis than those of African heritage.
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History of Broken Bones. People who have broken one or more bones during their adult years are at greater risk for osteoporosis. In fact, they may already have low bone density or osteoporosis. A person who has broken a bone as an adult should talk to their healthcare provider about osteoporosis.
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Menopause. For most women, bone loss increases after menopause, when estrogen levels drop sharply.
Low Sex Hormones
a) Estrogen Levels. In women, the sex hormone estrogen protects bones. If you are a woman and go through menopause early, your risk of osteoporosis increases. The same is true if you have your ovaries removed. That’s because your ovaries produce most of your body’s estrogen. In either of these cases, it’s important to speak with your healthcare provider about steps to improve bone health.
b) Missing Periods. If you are a young woman and don’t have regular periods, this could mean low estrogen levels. There could be many reasons for this, such as exercising too much or eating so little that you become too thin. Other causes could include disorders of the ovaries or the pituitary, which is the gland in the brain that directs hormone production by the ovaries. Regardless of the cause, loss of estrogen and extreme thinness can harm bone health. It can also affect other vital body systems. For these reasons, young women who don’t have regular periods should speak to their healthcare provider.
c) Testosterone Levels. In men, testosterone protects bone. Estrogen levels in men are also important. Low levels of these hormones can lead to bone loss. A number of factors can cause levels to be low, including eating too little or drinking too much alcohol. A simple blood test can tell you if your hormone levels are normal.
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Diet
a) Calcium. Calcium is a mineral that is important for healthy bones. It is a building block of bone.
b) Vitamin D. Vitamin D is important because it helps your body use calcium. If you don’t get enough vitamin D or if your body does not absorb it well, you are at much greater risk for bone loss and osteoporosis.
c) Phosphorous. Like calcium, phosphorous is a part of the bones. Because this mineral is naturally present in many foods, most people get enough phosphorus. It is sometimes added to processed foods and soft drinks in the form of phosphate or phosphoric acid. While some experts say that Americans may be getting too much phosphorous, many experts believe that phosphorous intake is not a problem as long as people get enough calcium.
d) Other Minerals and Vitamins. Magnesium, vitamin K, vitamin B6 and vitamin B12 are some of the many minerals and vitamins that are important for bone health. If you eat a well-balanced diet, you should be getting enough of these nutrients. Most experts recommend multivitamins or supplements for people who do not get what they need from foods.
e) Protein. Eating foods that supply protein is important for your health. But a very high protein diet, particularly animal protein, causes a loss of calcium through the kidneys. You can make up for this calcium loss by getting enough calcium to meet your body’s needs.
f) Caffeine. Found naturally in coffee and tea, caffeine is often added to soft drinks. Caffeine may decrease calcium absorption. One study suggests that drinking 330 mg of caffeine, or about four cups of coffee, daily increases the risk of fractures. To protect your bones, try not to have too many drinks with caffeine each day. You can also offset the calcium lost from drinking caffeine but increasing your calcium intake.
g) Soft Drinks. Some people are concerned that the phosphorous and/or caffeine in certain soft drinks may harm bone health. Other experts suggest the harm to bone is caused by people substituting soft drinks for milk and calcium fortified juices. In other words, when soft drinks take the place of milk and other sources of calcium, bone health may be affected.
h) Sodium (salt). Eating foods that have a lot of sodium may decrease your body’s ability to retain calcium. Eating too much sodium is bad for your bones and can cause bone loss. Try cooking without adding extra salt, and limit the salty snacks and processed foods that you eat.
i) Spinach. Spinach contains high levels of oxalate. Oxalate prevents the body from absorbing calcium from spinach. The body can absorb calcium found in most other green vegetables such as broccoli and kale. Although spinach can be part of a healthy diet, it just can’t be counted as a source of calcium. It does not affect calcium absorption from other foods.
j) Wheat Bran. 100% wheat bran is the only food that appears to reduce the absorption of calcium in other foods that are eaten at the same time. If you are taking calcium supplements, you may want to take your supplement two or more hours before or after eating any foods with 100% wheat bran. Although wheat bran may interfere with calcium absorption, foods with wheat bran are still considered a part of a healthy diet.
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Other Factors That Affect Bone Health
a) Inactive Lifestyle. People who are bedridden, are inactive or do not exercise are at high risk of osteoporosis. Certain kinds of regular exercise can help keep your bones strong.
b) Smoking. Smoking is bad for your bones in many ways. The chemicals in cigarettes are bad for your bone cells. Smoking also might make it harder to absorb calcium. For women, smoking can prevent estrogen from protecting the bones.
c) Alcohol Abuse. Drinking heavily can reduce bone formation. In many cases, people who drink too much do not get enough calcium. Drinking may also affect your body’s calcium supply. In addition, drinking too much is bad for your overall health and can make you more likely to fall. This is how many people break bones. Alcohol in smaller amounts, however, does not harm bone health. This usually means no more than two drinks a day.
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Medications That May Cause Bone Loss.
Some medications can be harmful to your bones, especially if you take them at high doses or for a long time. One of the riskiest types of medications for bones is steroid medications. Many people take these medications to ease inflammation in conditions like rheumatoid arthritis or asthma.
It’s important to talk with your healthcare provider about the risks and benefits of any medications you take and about how they may affect your bones. Do not stop any treatment or change the dose of your medications unless your healthcare provider says it’s safe to do so. Many of the medications that can cause bone loss include the following:
- Aluminum-containing antacids
- Antiseizure medications (only some) such as Dilantin® or Phenobarbital
- Aromatase inhibitors such as Arimidex®, Aromasin® and Femara®
- Cancer chemotherapeutic drugs
- Cyclosporine A and FK506 (Tacrolimus)
- Glucocorticoids such as cortisone and prednisone
- 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®, Prilosec® and Prevacid®
- Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro®, Prozac® and Zoloft®
- Tamoxifen® (premenopausal use)
- Thiazolidenediones (Actos® and Avandia®)
- Thyroid hormones in excess
This list may not include all medications that cause bone loss.
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Diseases and Conditions That Cause Bone Loss.
There are many health problems that can harm your bones and increase your risk of osteoporosis. Some of these include:
Anorexia Nervosa and Other Eating Disorders.
Anorexia nervosa is a major risk factor for osteoporosis for many reasons. In women with anorexia nervosa, estrogen levels decrease to such an extent that menstrual periods either become irregular or stop. This drop in estrogen causes bone loss. Poor nutrition in women with anorexia and other eating disorders is also harmful to bones. Although more common in teenage girls and young women, men can also have eating disorders. They can also be at great risk for bone loss and osteoporosis.
Celiac Disease. People with celiac disease have trouble digesting foods with gluten. Gluten is found in grains such as wheat, rye and barley. People with this condition also have problems absorbing nutrients, including calcium and vitamin D.
Depression. Research suggests a link between depression and low bone density or osteoporosis. More studies will help us to better understand the relationship between these two conditions.
Hyperparathyroidism. This is a condition in which the parathyroid glands (two pairs of small glands located near the thyroid in the neck) produce too much parathyroid hormone (PTH). Having too much PTH causes bone loss. This condition is more common in women after menopause. A simple blood test can tell your healthcare provider if this is a problem.
Hyperthyroidism. In people with this condition, the thyroid gland produces too much thyroid hormone. This can lead to weak muscles and fragile bones. The same thing can happen if a person has an underactive thyroid and take too much thyroid hormone medication.
Inflammatory Bowel Disease (IBD). There are different types of IBD including Crohn’s disease and ulcerative colitis. Steroid medications are commonly used to treat these conditions. People with IBD may also have trouble absorbing calcium and vitamin D.
Loss of Height. Vertebral (spine) fractures cause height loss and kyphosis. In many cases, a person with spine fractures already has low bone density or osteoporosis. For many people these fractures do not cause any pain. Kyphosis is an abnormal forward curvature of the spine. When there is no pain, these fractures often go unnoticed until a person becomes aware that a significant loss of height of an inch or more has occurred.
Multiple Myeloma. This is a cancer of the bone marrow. Its first symptoms may be back pain and fractures of the vertebrae. Blood and urine tests can detect the problem. Other forms of cancer that affect bones or bone marrow can also cause fractures.
Organ Transplants. People who have organ transplants must take medications to prevent their bodies from rejecting their new organs. Some of these drugs can weaken bones.
Rheumatoid Arthritis (RA). People with rheumatoid arthritis are at increased risk for osteoporosis. In addition, RA is often treated with steroid medications, which further increases the risk.
Weight Loss. Losing weight can cause bone loss. Many serious conditions such as heart disease and diabetes are associated with obesity and excess weight. Fortunately, you can protect your bones while losing weight by exercising regularly and eating a healthy diet that provides enough calcium and vitamin D.
Other Diseases and Conditions. Many other health problems can also affect the bones. Some of these include genetic disorders and diseases of the kidneys, lungs or digestive system. With proper treatment, most people can live well with these diseases. Living well also involves taking good care of your bones.
Medical Conditions That Can Lead to Osteoporosis
- AIDS/HIV
- Ankylosing spondylitis
- Blood and bone marrow disorders
- Breast cancer
- Cushing’s syndrome
- Eating disorders
- Emphysema
- Female athlete triad
- Gastrectomy
- Gastrointestinal bypass procedures
- Hyperparathyroidism
- Hyperthyroidism
- Idiopathic scoliosis
- Inflammatory bowel disease
- Diabetes mellitus
- Kidney disease
- Lupus
- Lymphoma and leukemia
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- Malabsorption syndromes (examples are celiac disease and Crohn’s disease)
- Multiple myeloma
- Multiple sclerosis
- Organ transplants
- Parkinson’s disease
- Poor diet
- Post-polio syndrome
- Premature menopause
- Prostate cancer
- Rheumatoid arthritis
- Severe liver disease (including biliary cirrhosis)
- Spinal cord injuries
- Stroke (CVA)
- Thalassemia
- Thyrotoxicosis
- Weight loss
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This list may not include all conditions that cause bone loss.
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It is important to take action now to find out your risk for developing osteoporosis. Your healthcare provider can help you determine whether you should have a bone mineral density (BMD) test.
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