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AgePage

National Institute on Aging

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, she said, kept her too busy 

to exercise. Helen went through menopause 

at age 47. At 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 has 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 

Normal Bone Bone With 

Osteoporosis

bones in the hip, backbone (spine), and 

wrist. Osteoporosis is called the “silent 

disease”—because you may not notice 

any changes until a bone breaks. All 

the while, though, your bones had been 

losing strength for many years.

Bone is living tissue. To keep bones

strong, your body breaks down old bone

and replaces it with new bone tissue. As 

people enter their 40s and 50s, more bone 

may be 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 of this makes your bones weaker.
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Who Has Osteoporosis?

Ten million Americans have 

osteoporosis. They are mostly women, 

but men also have 

this disease. White 

and Asian women are 

most likely to have 

osteoporosis. Other 

women at great risk 

include those who:

F Have a family history of broken 

bones or osteoporosis

F Have broken a bone while an adult

F Had surgery to remove their ovaries 

before their periods stopped

F Had early menopause

F Have not gotten enough calcium 

throughout their lives

F Had extended bed rest

F Used certain medicines for a 

long time

F 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?

Around 34 million 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 did. Don’t wait until that happens

to see if you have osteoporosis. You can 

have a bone density test to find out how 

strong your bones are. Your doctor 

may suggest a type of bone density test 

called a DXA test (dual-energy x-ray 

absorptiometry) if you are a woman 

age 65 or older or if he or she thinks 

you are at risk for osteoporosis.

The DXA test gives you important 

information to help you understand 

your risk for a fracture or broken bone. 

It could show that you have normal bone 

density. Or, it could show that you have 

low bone mass or even osteoporosis.
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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. Those 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. Women over age 50 

need 1,200 mg (milligrams) of calcium 

every day. Men need 1,000 mg between 

ages 51 and 70 and 1,200 mg after 

age 70. Foods that are high in calcium 

are the best source. For example, eat 

low-fat dairy foods, canned fish with 

soft bones such as salmon, and some 

dark-green leafy vegetables. Check the 

labels on foods like orange juice, breads, 

and cereals to find those with calcium 

added.

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 cause problems 

for some people. On most days, you 

should not get more than 2,000 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 without sunscreen

for 10 to 15 minutes at least twice a 

week. 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:

F 600 IU (International Units) if you 

are age 51 to 70

F 800 IU if you are over age 70

As with calcium, be careful. More 

than 4,000 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, 
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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. People who smoke have 

an increased chance of breaking a 

bone. 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. Talk with 

your doctor to see if one of these might 

work for you:

Bisphosphonates. These medicines 

stop 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 pills 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 one-half 

hour after taking the drug. Even if you 

follow the directions closely, these drugs 
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can cause serious digestive problems, 

so be aware of any side effects. These 

pills are available in once-daily, once-aweek, and once-a-month versions. Some 

bisphosphonates are given by injection 

once every 3 months or once a year.

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. 

Because estrogen also slows bone loss 

and increases bone mass in your spine 

and hip, it can be used to prevent 

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 at least 

5 years past menopause.

Parathyroid hormone (PTH). Also 

called teriparatide, this shot is given 

daily for up to 2 years to postmenopausal 

women and to 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.

Denosumab. A shot given twice a 

year, this treatment for postmenopausal 

women with osteoporosis lessens the risk 

of fractures in the spine, wrist, and hip.

Common side effects include pain in 

the back, arms, legs, and muscles; high 

cholesterol; and bladder infections.

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 
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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:

F Make sure you can see and hear 

well. Use your glasses or a hearing 

aid if needed.

F Ask your doctor if any of the drugs 

you are taking can make you dizzy 

or unsteady on your feet.

F Use a cane or walker if your walking 

is unsteady.

F Wear rubber-soled and low-heeled 

shoes.

F Make sure all the rugs and carpeting 

in your house are firmly attached to 

the floor, or don’t use them.

F Keep your rooms well lit and the 

floor free of clutter.

F Use nightlights.

You can find more 

suggestions in the 

National Institute on 

Aging’s Falls and 

Fractures AgePage, 

available from the 

National Institute on 

Aging Information Center 

listed in For More Information.

Do Men Have Osteoporosis?

Osteoporosis is not just a woman’s 

disease. Not as many men have it as 

women do—maybe because most men 

start with more bone density. As they 

age, men lose bone density more slowly 

than women. But, men need to be aware 

of osteoporosis.

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:

F Family history

F Not enough calcium or vitamin D

F Too little exercise

F Low levels of testosterone

F Too much alcohol

F Taking certain drugs

F Smoking

Older men who break a bone easily 

or are at risk for osteoporosis should 

talk with their doctors about testing 

and treatment.
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For More Information

Here are some helpful resources:

Food and Drug Administration

Room 5377, Building 32

10903 New Hampshire Avenue

Silver Spring, MD 20993

1-888-463-6332 (toll-free)

www.fda.gov

National Institutes of Health

Osteoporosis and Related Bone 

Diseases—National Resource Center

2 AMS Circle

Bethesda, MD 20892-0001

1-800-624-2663 (toll-free)

1-202-466-4315 (TTY)

www.bones.nih.gov

National Library 

of Medicine

MedlinePlus

www.medlineplus.gov

National Osteoporosis 

Foundation

1150 17th Street, NW

Suite 850

Washington, DC 20036

1-800-231-4222 (toll-free)

www.nof.org

For more information on health and 

aging, contact:

National Institute on Aging

Information Center

P.O. Box 8057

Gaithersburg, MD 20898-8057

1-800-222-2225 (toll-free)

1-800-222-4225 (TTY/toll-free)

www.nia.nih.gov

www.nia.nih.gov/espanol

To sign up for regular email alerts 

about new publications and other 

information from the NIA, go to

www.nia.nih.gov/health.

Visit www.nihseniorhealth.gov, a seniorfriendly website from the National 

Institute on Aging and the National 

Library of Medicine. This website has 

health and wellness information for 

older adults. Special features make it 

simple to use. For example, you can

click on a button to make the type larger.

For tips on exercise and physical activity, 

visit Go4Life® at www.nia.nih.gov/Go4Life.

NIH...Turning Discovery Into Health®

November 2013