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National Institute on Aging

AgePage

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Osteoporosis:

The Bone Thief

Helen grew up on a farm in the

Midwest. She drank lots of milk as

a child. She also walked a lot. After

graduating from high school, she got

married and found a job. Family

and work kept her too busy to exercise.

Helen went through menopause at

age 47. At age 76, she was enjoying

retirement—traveling and working

in her garden. But then she slipped

on a small rug in her kitchen and

broke her hip. After Helen recovered,

she needed a cane to walk, and

gardening was a lot harder to enjoy.

Helen had osteoporosis,

but she didn’t know it

before she fell. Osteoporosis is a disease that

weakens bones to the

point where they

break easily—most

often bones in the

hip, backbone (spine), and

wrist. Osteoporosis is called

the “silent disease”—you may not

notice any changes until a bone

breaks. But your bones have been

losing strength for many years.

Bone is living tissue. To keep

bones strong, your body is always

breaking down old bone and replacing it with new bone tissue. As people

enter their forties and fifties, more

bone is broken down than is replaced.

A close look at the inside of bone

shows something like a honeycomb.

When you have osteoporosis, the

spaces in this honeycomb grow larger.

And the bone that forms the honeycomb gets smaller. The outer shell of

your bones also gets thinner. All this

loss makes your bones weaker.

Who Has Osteoporosis?

Millions of Americans have osteoporosis. They are mostly women, but

more than 2 million men also have

this disease. White and Asian women

are most likely to have osteoporosis.

Other women at great risk include

those who:

✦ have a family history of the disease,

✦ have broken a bone while an adult,

✦ had surgery to remove their ovaries before their periods stopped,

✦ had early menopause,

✦ have not gotten enough calcium

throughout their lives,

✦ had extended bed rest,
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✦ used certain medicines for a

long time, or

✦ have a small body frame.

The risk of osteoporosis grows as

you get older. At the time of menopause women may lose bone quickly

for several years. After that, the loss

slows down, but continues. In men

the loss of bone mass is slower. But,

by age 65 or 70 men and women

are losing bone at the same rate.

What Is Osteopenia?

Millions more Americans have

osteopenia. Whether your doctor calls

it osteopenia or just says you have low

bone mass, consider it a warning. Bone

loss has started, but you can still take

action to keep your bones strong and

maybe prevent osteoporosis later in

life. That way you will be less likely to

break a wrist, hip, or vertebrae (bone

in your spine) when you are older.

Can My Bones Be Tested?

For some people the first sign of

osteoporosis is to realize they are

getting shorter or to break a bone

easily, like Helen. Don’t wait until that

happens to see if you have osteoporosis. You can have a bone density test to

find out how solid your bones are.

Your doctor may suggest a type of

bone density test called a DEXA-scan

(dual-energy x-ray absorptiometry) if

you are age 65 or older or if he or she

thinks you are at risk for osteoporosis.

The DEXA-scan tells what your

risk for a fracture or broken bone is. It

could show that you have normal bone

density. Or, it could show that you have

low bone mass or even osteoporosis.

How Can I Keep My

Bones Strong?

There are things you should do at any

age to prevent weakened bones. Eating foods that are rich in calcium and

vitamin D is important. So is including

regular weight-bearing exercise in your

lifestyle. These are the best ways to

keep your bones strong and healthy.

Calcium. Getting enough calcium

all through your life helps to build

and keep strong bones. People over

age 50 need 1200 mg of calcium every

day. Foods that are high in calcium are

the best source. For example, eat lowfat dairy foods, canned fish with soft

bones such as salmon, dark green leafy

vegetables, and calcium-fortified foods

like orange juice, breads, and cereals.

If you think you aren’t getting

enough calcium in your diet, check

with your doctor first. He or she may

tell you to try a calcium supplement.

Calcium carbonate and calcium citrate

are two common forms. You have to be

careful though. Too much calcium can
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cause problems for some people.

On most days you should not get

more than 2500 mg of total calcium.

That includes calcium from all

sources—foods, drinks, and

supplements.

Vitamin D. Your body uses

vitamin D to absorb calcium.

Most people’s bodies are able

to make enough vitamin D if they

are out in the sun for a total of 20

minutes every day. You can also get

vitamin D from eggs, fatty fish, and

cereal and milk fortified with vitamin

D. If you think you are not getting

enough vitamin D, check with your

doctor. Each day you should have:

✦ 400 IU (international unit)

if you are age 51 to 70

✦ 600 IU if you are over age 70.

As with calcium, be careful. More

than 2000 IU of vitamin D each day

may cause side effects.

Exercise. Your bones and muscles

will be stronger if you are physically

active. Weight-bearing exercises, done

three to four times a week, are best

for preventing osteoporosis. Walking,

jogging, playing tennis, and dancing

are examples of weight-bearing

exercises. Try some strengthening

and balance exercises, too. They may

help you avoid falls which could cause

a broken bone.

Medicines. Some common

medicines can make bones weaker.

These include a type of steroid drug

called glucocorticoids used for

arthritis and asthma, some

antiseizure drugs, certain

sleeping pills, treatments

for endometriosis, and some

cancer drugs. An overactive

thyroid gland or using too

much thyroid hormone for an

underactive thyroid can also be a

problem. If you are taking these

medicines, talk to your doctor about

what you can do to help protect

your bones.

Lifestyle. Smoking increases loss

of bone mass. For this and many

other health reasons, stop smoking.

Limit how much alcohol you drink.

Too much alcohol can put you at

risk for falling and breaking a bone.

What Can I Do for

My Osteoporosis?

Treating osteoporosis means stopping

the bone loss and rebuilding bone to

prevent breaks. Diet and exercise can

help make your bones stronger. But

they may not be enough if you have

lost a lot of bone density. There are

also several medicines to think about.

Some will slow your bone loss, and

others can help rebuild bone.
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Talk with your doctor to see if one of

these might work for you:

✦ Alendronate or risedronate. These

medicines are bisphosphonates,

drugs that slow the breakdown of

bone and increase bone density.

They can make it less likely that

you will break a bone, most of all

in your spine, hip, or wrist. Side

effects may include nausea, heartburn, and stomach pain. A few

people have muscle, bone, or joint

pain while using these medicines.

These drugs must be taken in a

certain way—when you first get up,

before you have eaten, and with a

full glass of water. You should not lie

down, eat, or drink for at least onehalf hour after taking the drug.

Even if you follow the directions

closely, these drugs can cause

serious digestive problems so be

aware of any side effects. These

pills are available in both oncedaily and once-a-week versions.

✦ Raloxifene. This drug is used to

prevent and treat osteoporosis.

It is a SERM (selective estrogen

receptor modulator). It prevents

bone loss and spine fractures,

but may cause hot flashes or

increase the risk of blood clots

in some women.

✦ Estrogen. Doctors sometimes

prescribe this female hormone

around the time of menopause

to treat symptoms like hot flashes

or vaginal dryness. Estrogen also

slows bone loss and increases

bone mass in your spine and hip,

so women can use it to prevent or

treat osteoporosis. But, estrogen

use is thought to be risky for some

women. Talk to your doctor. Ask

about the benefits, risks, and side

effects, as well as other possible

treatments for you.

✦ Calcitonin. This hormone increases bone mass in your spine

and can lessen the pain of fractures already there. It comes in

two forms—a shot or nasal spray.

The shot may cause an allergic

reaction and has some side effects

like nausea, diarrhea, or redness

in your face, ears, hands, or feet.

The only side effect of the nasal

spray is a runny nose in some

people. Calcitonin is most useful for women who are 5 years

past menopause.

✦ Parathyroid hormone (PTH).

Also called teriparatide, this shot

is given daily for up to two years

to postmenopausal women and

men who are at high risk for

broken bones. It improves bone

density in the spine and hip.

Common side effects include

nausea, dizziness, and leg cramps.
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Can I Avoid Falling?

When your bones are weak, a simple

fall can cause a broken bone. This

can mean a trip to the hospital and

maybe surgery. It might also mean

being laid up for a long time, especially in the case of a hip fracture.

So, it is important to prevent falls.

Some things you can do are:

✦ Make sure you can see and

hear well. Use your glasses

or a hearing aid if needed.

✦ Ask your doctor if any of the

drugs you are taking can

make you dizzy or unsteady

on your feet.

✦ Use a cane or walker if your

walking is unsteady.

✦ Wear rubber-soled and lowheeled shoes.

✦ Make sure all the rugs and

carpeting in your house are

firmly attached to the floor,

or don’t use them.

✦ Keep your rooms well lit and

the floor free of clutter.

✦ Use nightlights.

You can find more suggestions

in the National Institute on Aging’s

Preventing Falls and Fractures Age Page,

available from the National Institute

on Aging Information Center listed

in the resource section.

Do Men Have

Osteoporosis?

Osteoporosis is

not just a woman’s

disease. Not as

many men have

it as women do, but men need to

worry about it as well. This may be

because most men start with more

bone density than women and lose

it more slowly as they grow older.

Experts don’t know as much

about this disease in men as they

do in women. However, many of

the things that put men at risk are

the same as those for women:

✦ family history

✦ not enough calcium or

vitamin D

✦ too little exercise

✦ low levels of testosterone

✦ too much alcohol

✦ taking certain drugs

✦ smoking.

Older men who break a bone

easily or are at risk for osteoporosis

should talk with their doctors about

testing and treatment. Men can use

alendronate, risedronate, or parathyroid hormone to increase bone

density. Testosterone supplements

may help some men with low levels

of testosterone.
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Resources

National Osteoporosis Foundation

1232 22nd Street, NW

Washington, DC 20037-1292

202-223-2226

www.nof.org

National Institutes of Health

Osteoporosis and Related Bone

Diseases~National Resource Center

2 AMS Circle

Bethesda, MD 20892-3676

1-800-624-BONE (1-800-624-2663)

202-466-4315 (TTY)

www.osteo.org

National Library of Medicine

MedlinePlus

In Health Topics, go to:

“Osteoporosis”

“Falls”

www.medlineplus.gov

The National Institute on Aging has

information on health and aging,

including a booklet and video about

exercise for older people and several

helpful Age Pages. Contact:

National Institute on Aging

Information Center

P.O. Box 8057

Gaithersburg, MD 20898-8057

1-800-222-2225

1-800-222-4225 (TTY)

E-mail: niaic@jbs1.com

To order publications

(in English or Spanish) online,

visit www.niapublications.org.

The National Institute on Aging

website is www.nia.nih.gov.

Visit NIHSeniorHealth.gov

(www.nihseniorhealth.gov), a seniorfriendly website from the National

Institute on Aging and the National

Library of Medicine. This simple-touse website features popular health

topics, including exercise, for older

adults. It has large type and

a “talking” function that

reads text aloud.

U.S. Department of Health and

Human Services

Public Health Service

National Institutes of Health

December 2004