1. How can I prevent osteoporosis before it starts?
Experts consider osteoporosis a largely preventable disease. Prevention should start early. Getting enough calcium and vitamin D as a child and teenager can dramatically cut your risks of developing osteoporosis later in life. Even if you’re an adult, eating a healthy diet, getting enough calcium and vitamin D, exercising, and avoiding unhealthy lifestyle habits such as smoking and excessive drinking, may help prevent osteoporosis. After menopause, women who have osteopenia, or thinning of the bones, and who have a high probability for a future fracture from osteoporosis can consider drug therapies to prevent bone loss and reduce their risk of osteoporosis. To learn about osteoporosis prevention techniques, talk to your health care provider.
2. Am I getting enough calcium — and how much is too much?
The amount of calcium you need depends on your age. The Institute of Medicine recommends the following:
- Adolescents should get 1,300 milligrams of calcium a day.
- Adults from 19 to 50 years of age should get 1,000 milligrams of calcium a day.
- Adult women over the age of 50 should get 1,200 milligrams of calcium a day.
- Adult men should receive 1,000 milligrams up to age 70 and 1,200 milligrams after age 70.
Read food labels and select foods that contain 10% or more of the Daily Value for calcium. When food shopping, look for terms such as “high in calcium," “fortified with calcium," “calcium-rich," or “excellent source of calcium."
If you think you’re coming up short, talk to your health care provider about ways you can boost your calcium levels in your diet. Talk to your doctor about what is best for you.
3. Is calcium from dairy products better than from other sources?
Dairy products have high levels of calcium per serving, which is why they’re often recommended for bone health. But calcium from other sources — like spinach, bok choy, and mustard greens, beans, tofu, almonds, fish, and many fortified cereals and juices — can be just as beneficial. However, it may be difficult to get adequate calcium from food if you don’t eat dairy. And osteoporosis experts do say the best source of calcium is from foods, not supplements. Food contains other important nutrients that help the body use calcium.
4. Does osteoporosis affect children — and should I give them calcium supplements?
Osteoporosis in children is rare. It’s usually the result of a chronic health condition such as asthma or cystic fibrosis that is treated with long-term steroids. Anticonvulsant drugs used to manage epilepsy, or used to manage mania in bipolar disorder, and other conditions may also interfere with calcium and vitamin D metabolism, leading to weak bones. Treatment usually depends on controlling the underlying disease or changing the medication. Sometimes, children will develop osteoporosis with no clear cause. It’s called idiopathic juvenile osteoporosis, but the good news is that it usually goes away on its own within two to four years.
Of course, calcium and vitamin D are the most important nutrients for strong bones and are important for all children whether they have osteoporosis or not. Even if children are healthy now, low levels of calcium and vitamin D can greatly increase their risk of osteoporosis later in life. So keep track of how much calcium your children get from food and ensure they get adequate amounts of vitamin D. If you are worried they aren’t getting enough calcium and vitamin D, talk to their health care provider. Don’t give them supplements unless they are recommended by your child’s health care provider.
5. Am I likely to develop vitamin D deficiency in winter — and why is vitamin D essential for calcium absorption?
Our bodies create vitamin D from sunshine — 10 to 15 minutes of sun a day is all that is needed. During winter, we spend less time outdoors, and we’re bundled up against the cold. So some experts think the risk of vitamin D deficiency is higher in winter.
But year-round, many of us don’t get the vitamin D we need. The Institute of Medicine recommends:
- 600 IU (international units) a day for adults through age 70
- 800 IU a day for adults ages 70 and older
Vitamin D plays a vital role in getting calcium into the bloodstream from the intestines and the kidneys. Without enough vitamin D, a lot of the calcium you take in from food or supplements could pass out of the body as waste. If you don’t get outdoors much or get vitamin D from fortified foods, ask your health care provider about taking vitamin D supplements.
6. Can genetics predispose me to low bone density and osteoporosis?
Your genes can play a big role in your risk of developing osteoporosis. For instance, studies show that if your parents had a history of bone fractures, you’re more likely to have weaker bones and a higher risk of fractures yourself.
Your risk of getting osteoporosis is also higher if other family members, like aunts or siblings, had it too. A genetic risk for osteoporosis can be inherited from either your mother or father.
If osteoporosis does run in your family, talk to your health care provider. You may need to take extra steps to prevent it.
7. Why would I have low bone density if I haven’t gone through menopause?
Although the drop in estrogen levels during menopause can result in dramatically thinning of bone and increases your risk of osteoporosis, it isn’t the sole cause of the disease. Many other factors — like your genes, some diseases and treatments, eating disorders, excessive exercising and weight loss , smoking, excess alcohol, and deficiencies of calcium and vitamin D — can play an important role. Remember that men can get osteoporosis too, even though they don’t go through menopause.
8. What is a bone density test and what do the scores mean?
A bone mineral density test is the typical way of diagnosing osteoporosis and helps to predict your risk of fractures. It’s a kind of X-ray that reveals the hardness of your bones. The most common type is called a dual-energy X-ray absorptiometry (DXA or DEXA). Usually, the scans look at the density of the bones of your hip and spine; this information is then used to help estimate your risk of fractures. Your doctor will calculate your risk of future fractures with a tool known as a FRAX score and determine whether you would benefit from treatments .
A normal bone density is a T-score of plus one (+1) to a score of a minus one (-1). A low bone mass (osteopenia) is a bone density T-score of -1 to -2.5. Osteoporosis is defined as a bone density score of -2.5 or below.
9. Should men worry about osteoporosis — and what are the signs of it in men?
Although osteoporosis is often thought of as a disease that only affects women, about 20% of cases are in men. But osteoporosis in men is often unrecognized and untreated. And since osteoporosis is a silent disease, the first symptom is often a broken bone.
Men who are at higher risk for osteoporosis should focus on prevention. Risk factors for osteoporosis in men include taking certain drugs (like steroids, anticonvulsants, and some cancer treatments), some chronic diseases, smoking, lack of exercise, low testosterone, and a family history of weak bones. If you think you might be at risk, talk to your health care provider.
Referenced on 20/05/2021
- Shreyasee Amin, MD, rheumatologist, assistant professor of medicine, Mayo Clinic, Rochester, Minn.
- Black, D. NEJM, May 3, 2007.
- John Schousboe, MD, director, Park Nicollet Clinic Osteoporosis Center, St. Louis Park, Minn.; consultant rheumatologist, American College of Rheumatology.
- Mulder, J. Nat Clin Pract Endocrinol Metab, 2006.
- National Osteoporosis Foundation: “Physician’s Guide to Prevention and Treatment of Osteoporosis," “BMD Testing: What the Numbers Mean," “Osteoporosis in Men."
- New York State Osteoporosis Prevention and Education Program: “Heredity."
- U.S. Department of Health and Human Services and the National Institutes of Health: “Osteoporosis."
- WebMD Medical Reference: “Juvenile Osteoporosis."
- WebMD Feature: “Exercise for Osteoporosis."
- University of Arizona, College of Agriculture: “High Calcium Foods."