Osteoporosis Archive

Ounce for ounce, bone bears as much weight as reinforced concrete. However, unlike reinforced concrete, bone is a living tissue. It serves as a repository of minerals for the rest of the body to use, continuously lending them out and replacing them. Bone also gets stronger when "stressed" by physical activity, and can repair itself when injured.

The building and tearing down of bone tissue is called remodeling. This process happens continuously throughout your entire life. At first, your body rebuilds more bone than it demolishes. Typically, a person reaches peak bone mass around the age of 30. Among women, bone mass usually remains steady for the next 20 years or so until the onset of menopause, when bone is lost much more quickly than it is replaced. When bone loss is significant, the result is osteoporosis (which means "porous bone"). Bone loss generally starts later for men — typically in the late 50s — and progresses more slowly than in women. But men can also get osteoporosis.

Ask the doctors

Q. Is there any way to tell if you are getting osteoporosis? Are there symptoms?

A. Osteoporosis is a disease that causes your bones to become weak and brittle and more likely to break. Unfortunately, you probably won't have any symptoms until the disease is advanced or you actually experience a fracture. However, there are two visible clues of osteoporosis: changes in your posture (such as a hunched-over appearance) and loss of height. Both of these changes may be caused when your spine becomes curved or compressed from weakness or tiny fractures (called compression fractures) in your vertebrae, the small bones that make up your spine.

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Although bone-weakening osteoporosis is quite common among older people, it isn't an inevitable part of aging. There's a lot you can do to shield your bones from this disease.

The best insurance against osteoporosis is building the highest bone density possible by your 30s and minimizing bone loss after that. But if you you're already in midlife or beyond, there is still much you can do to preserve the bone you have and perhaps even to replace lost bone. Daily weight-bearing exercise, like walking, is the best medicine. Getting enough calcium and vitamin D are two other critical strategies for keeping bones strong.

Those extra inches around the middle may signal increased fat around abdominal organs and rising health risks.

It's a rare woman over age 50 who has the same waist measurement she had as a teenager. But in the past decade or so, women's waistlines have been expanding regardless of age. A 2014 report from the National Health and Nutrition Examination Survey found that from 1999 to 2012, the average body mass index (BMI) for women age 20 or older held steady. But during the same period, the average female waistline grew slowly and steadily, from 36.2 inches to 37.8 inches. Researchers are still searching for an explanation for this phenomenon, but they do know one thing: increasing waistlines are linked to greater risks for heart disease, diabetes, and osteoporosis.

What's in a waistline?

Regardless of whether your weight has changed over the years, your height is likely to have decreased, the result of declining volume in the intervertebral discs of the spine. As your torso shortens, your abdominal organs have less vertical space to inhabit, so they move horizontally. If you haven't gained weight, an increase of an inch or two around the waist may simply reflect lost height.

Denosumab (Prolia) is recommended for people at high risk for fractures for whom other bone-loss treatments were ineffective or had intolerable side effects.

The disease strikes more women, but men are also at risk.

Osteoporosis is often considered a woman's disease, but men also need to be concerned about this bone-weakening condition. About 2 million men have osteoporosis and another 12 million are at high risk, according to the National Osteoporosis Foundation.

In fact, older men have a greater risk for an osteoporosis-related fracture than for getting prostate cancer, and about one in four men older than 50 will break a bone because of osteoporosis during his lifetime.

Forgoing drugs that slow bone loss to avoid rare side effects can be the wrong decision for your hips and spine.

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A front-page article in the June 1, 2016, edition of The New York Times carried this headline: "Fearing drugs' rare side effects, millions take their chances with osteoporosis." The article described a situation all too familiar to doctors. Women are declining prescriptions of bisphosphonates—drugs that slow the rate at which the body breaks down bone—or discontinuing the medications far earlier than recommended. In fact, according to a 2015 report in the Journal of Bone and Mineral Research, the rate of bisphosphonate use fell by half between 2008 and 2012. That article documented a wave of media coverage of scientific studies that reported two rare side effects—osteonecrosis (bone death) of the jaw and atypical fractures near the top of the femur (thigh-bone)—and suggested that the reports had kindled fears that had led women to abandon bisphosphonates.

"The perception of risk is so much greater than the actual risk," says Dr. Meryl LeBoff, director of the skeletal health and osteoporosis center at Harvard-affiliated Brigham and Women's Hospital. Compared with many other common diseases, we are fortunate that we have good therapies to reduce the risk of osteoporotic fractures by 70% at the spine and 40 to 50% at the hip. She points to statistics referenced in the New York Times article: for every 100,000 women taking a bisphosphonate, fewer than three will have osteonecrosis of the jaw and one will have an atypical femur fracture, but 2,000 will have avoided an osteoporotic fracture.

You may have seen the recent headlines proclaiming that tequila is good for bone health. While that sounds appealing to many, the truth is that there are many caveats to the study behind those headlines. This latest story is just one example of news articles that proclaim our favorite foods, like coffee and chocolate, are actually good for us. As with all these stories, it’s important to look deeper than the flashy headline.