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Osteoporosis is a disease that makes your bones weak and brittle. As result, the bones become more prone to break even with minor trauma or stress that would normally not result in a break. It may be caused due to long-term low calcium intake, estrogen deficiencies in women, and an inactive lifestyle.
Your doctor may ask these questions to check for this disease:
Treatment includes bone-preserving medications, calcium and vitamin D supplementation, a healthy diet, and weight training to prevent bone loss, strengthen weak bones and maintain mobility.
Reviewed By:
Kenji Taylor, MD, MSc (Family Medicine, Primary Care)
Dr. Taylor is a Japanese-African American physician who grew up and was educated in the United States but spent a considerable amount of time in Japan as a college student, working professional and now father of three. After graduating from Brown, he worked in finance first before attending medical school at Penn. He then completed a fellowship with the Centers for Disease Control before going on to specialize in Family and Community Medicine at the University of California, San Francisco (UCSF) where he was also a chief resident. After a faculty position at Stanford, he moved with his family to Japan where he continues to see families on a military base outside of Tokyo, teach Japanese residents and serve remotely as a medical director for Roots Community Health Center. He also enjoys editing and writing podcast summaries for Hippo Education.
Tomohiro Hamahata, MD (Orthopedics)
Dr. Hamahata graduated from the Jikei University of Medical Science. After working at Asanokawa General Hospital and Kosei Chuo Hospital, he joined the Department of Orthopedics at Asakusa Hospital in April 2021, specializing in general orthopedics and joint replacement surgery.
Content updated on Mar 31, 2024
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Q.
Frequent Fractures? Why Your Bones Are Breaking: Medically Approved Next Steps for OI
A.
Frequent fractures from minor bumps can signal osteogenesis imperfecta, a genetic collagen disorder. Medically approved next steps include prompt evaluation with X-rays, bone density and genetic testing, followed by coordinated care using bisphosphonates, tailored physical therapy, possible surgical rods, targeted nutrition, and fall prevention. There are several factors to consider, including severity, age, dental and hearing involvement, and red flags that require urgent care. See the complete guidance below for details that can shape your next steps.
References:
* Struijs B, ten Kate J, van Dijk F, et al. The Dutch national guidelines on diagnosis and management of osteogenesis imperfecta: Summary and key recommendations. Orphanet J Rare Dis. 2021 Jul 26;16(1):335. doi: 10.1186/s13023-021-01968-3. PMID: 34311892; PMCID: PMC8313413.
* Forlino A, van Dijk FS, Marini JC. Osteogenesis imperfecta: current and emerging treatments. Curr Osteoporos Rep. 2022 Feb;20(1):15-28. doi: 10.1007/s11914-021-00705-4. Epub 2021 Dec 7. PMID: 34874402; PMCID: PMC8806282.
* Semler O, Zillikens MC, Rauch F, et al. Clinical Practice Guideline for the Management of Osteogenesis Imperfecta: Best Practice for Fracture Prevention, Rehabilitation, and Surgery. J Bone Miner Res. 2024 Jan;39(1):15-37. doi: 10.1002/jbmr.4947. Epub 2023 Dec 30. PMID: 38166548.
* van Dijk F, Cobben JM, Bierau K, et al. Osteogenesis imperfecta: a review of the disease and its medical management. J Bone Miner Metab. 2018 Mar;36(2):125-136. doi: 10.1007/s00774-017-0845-8. Epub 2017 Jun 16. PMID: 28616781; PMCID: PMC5824967.
* Marini JC, Forlino A, Bachrach LK, et al. Osteogenesis imperfecta. Nat Rev Dis Primers. 2017 Aug 10;3:17052. doi: 10.1038/nrdp.2017.52. PMID: 28796220; PMCID: PMC5840049.
Q.
Persistent Bone Pain? Why Your Bones Are Reshaping and Medically Approved Next Steps
A.
Persistent, deep bone pain with changes in shape can signal abnormal remodeling such as Paget’s disease, where overactive breakdown and disorganized rebuilding make bones enlarged yet weaker. There are several factors to consider, and medically approved next steps often include seeing a doctor for alkaline phosphatase blood tests and imaging, plus proven treatments like bisphosphonates to reduce pain and complications. See below for important details on symptoms, risks, when to seek urgent care, and how to prepare for your appointment.
References:
* Suda T, Ishida T, Iida H, Naito H, Shigenobu Y, Kanaya M, Hishiya A, Ozaki T, Hatta T, Nakai T. Advances in the Understanding of Pathological Bone Remodeling and Associated Pain. Int J Mol Sci. 2022 Nov 19;23(22):14371. doi: 10.3390/ijms232214371. PMID: 36430930; PMCID: PMC9690186.
* Suda T, Ishida T, Naito H, Hatta T, Nakai T. Pathophysiology of Chronic Bone Pain: From Cancer to Osteoporosis. Int J Mol Sci. 2022 Jan 10;23(2):684. doi: 10.3390/ijms23020684. PMID: 35054779; PMCID: PMC8775460.
* Al-Jarrah S, Al-Qudimat AR. Metabolic bone diseases: A practical approach to diagnosis and treatment. World J Clin Cases. 2021 Dec 26;9(36):11153-11166. doi: 10.12998/wjcc.v9.i36.11153. PMID: 35071195; PMCID: PMC8759325.
* Zhang J, Wang J, Hou Y, Hu H, Liang J, Li P, Xu X, Zhang Q, Zhao M, Zhang H, Wu D, Wang P, Zeng Z, Pan J, Li Y, Peng J, Li M, Zhang D, Zhang M, Lu S. Osteoporotic pain: an update. Bone Res. 2023 Jan 24;11(1):5. doi: 10.1038/s41413-022-00244-z. PMID: 36690772; PMCID: PMC9870141.
* Khan K, Iqbal M, Saadi AM. Clinical approach to skeletal manifestations of systemic diseases. J Fam Med Prim Care. 2022 Sep;11(9):4959-4965. doi: 10.4103/jfmpc.jfmpc_612_22. PMID: 36569165; PMCID: PMC9777995.
Q.
Deep Bone Aches? Why Your Human Skeleton is Signaling Trouble and Medically Approved Next Steps
A.
Deep bone aches can be your human skeleton signaling issues like osteoporosis, vitamin D or calcium deficiency, stress fractures, or arthritis, and less commonly infections or cancers, especially if pain is persistent, worse at night, or paired with fever, weight loss, or inability to bear weight. Medically approved next steps include not ignoring pain that lasts more than 1 to 2 weeks, improving calcium and vitamin D, doing weight-bearing exercise, and seeing a clinician for an exam, labs, imaging, and possible bone density testing. There are several factors to consider. See below to understand more, including red flags and details that could change your next steps.
References:
* Mercadante S, Fulfaro F. Bone pain: aetiology and management. Drugs. 2019 Jan;79(1):15-22. doi: 10.1007/s40265-018-1033-9. PMID: 30617639.
* Khan MH, Khan HM. Diagnosis and Management of Bone Pain in Primary Care. J Clin Med. 2023 Aug 21;12(16):5445. doi: 10.3390/jcm12165445. PMID: 37622823; PMCID: PMC10454379.
* Elson D. The differential diagnosis of bone pain: A review. J Musculoskelet Surg Res. 2020 Apr-Jun;4(2):160-165. doi: 10.4103/JMSR.JMSR_58_19. PMID: 32470719; PMCID: PMC7235061.
* Kancso Z, Kancso M, Csupor D, Molnar V, Kovacs K, Hajdu Z, Zsuga J, Szabo I. Chronic bone pain: aetiology and pathophysiology. Orv Hetil. 2021 Jun 27;162(26):1038-1044. doi: 10.1556/650.2021.32049. PMID: 34198947.
* Ali A, Ali G, Ali Z, Ali Q, Ali M, Ali S. Investigation and management of bone pain in adults: A review. Int J Health Sci (Qassim). 2023 Jul 24;17(4):46-51. doi: 10.53730/ijhs.v17n4.19502. PMID: 37622699; PMCID: PMC10442387.
Q.
Is It Normal Aging? Why Your Geriatric Body Changes & Medically Approved Next Steps
A.
There are several factors to consider. Normal aging after 65 can include gradual muscle and bone loss, slower metabolism with weight changes, drier skin that heals slower, and mild memory lapses, but red flags like frequent falls, sudden weight loss, daily exhaustion, depression or withdrawal, or disruptive incontinence are not just age. Evidence based steps include strength, balance and aerobic exercise, bone protection with calcium, vitamin D and density testing, regular medication reviews, hearing and brain health support, a protein rich diet, and home fall prevention, and seek urgent care for chest pain, stroke signs, severe shortness of breath, sudden confusion, or black or bloody stools. Important nuances and condition specific next steps, including when to see a doctor and helpful tools, are detailed below.
References:
* Kirkwood, T. B. (2017). Physiological and Molecular Mechanisms of Aging. *Cell*, *168*(1-2), 11–19. doi:10.1016/j.cell.2016.12.023. PMID:28084009.
* López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013). The Hallmarks of Aging. *Cell*, *153*(6), 1194–1217. doi:10.1016/j.cell.2013.05.039. PMID:23746838.
* Sierra, F., Auwerx, J., Barzilai, N., et al. (2018). Interventions to Slow Aging in Humans: The Case for a Clinical Trial. *The Journals of Gerontology Series A, Biological Sciences and Medical Sciences*, *73*(3), 360–368. doi:10.1093/gerona/glx186. PMID:29095945.
* Vilar-Compte, M., Téllez-Rojo, M. M., Hernández-Ávila, M., et al. (2019). Principles of healthy aging: a review. *Salud Publica de Mexico*, *61*(5), 660–669. doi:10.21149/10543. PMID:31758652.
* Ellis, G., & Marshall, T. (2018). Comprehensive Geriatric Assessment: a primer for 21st century clinicians. *Journal of the Royal College of Physicians of Edinburgh*, *48*(2), 162–167. doi:10.4997/JRCP.2018.218. PMID:29994998.
Q.
Bone Loss Scaring You? How Alendronate Works & Medically Approved Steps
A.
Alendronate is a widely used bisphosphonate that slows bone breakdown by inhibiting osteoclasts, raising bone density and lowering spine and hip fracture risk when taken correctly on an empty stomach with water while remaining upright. Effective bone protection also requires medically approved steps like adequate calcium and vitamin D, weight-bearing exercise, fall prevention, and avoiding smoking and excess alcohol. There are several factors to consider that could affect your plan and safety, including side effects, duration of therapy, and who should take it; see below to understand more.
References:
* Shoback D, Rosen CJ, Black DM, Bilezikian JP, Camacho PM, Guyatt G, Kagan R, McClung M, O'Malley BW, Recker RR, Yu EW, American Society for Bone and Mineral Research. Pharmacological Management of Osteoporosis: An Update for Clinicians. J Clin Endocrinol Metab. 2022 Mar 24;107(4):869-875. doi: 10.1210/clinem/dgac002. PMID: 35191599.
* Ensrud KE, Crandall CJ. Management of Osteoporosis. JAMA. 2022 Feb 1;327(5):472-473. doi: 10.1001/jama.2021.24220. PMID: 35115160.
* Cosman F, Perrotta M, Pinkerton JV, Stachenfeld NS, Vasan S. Update on pharmacological treatments for osteoporosis. Climacteric. 2021 Dec;24(6):574-583. doi: 10.1080/13697137.2021.1983088. Epub 2021 Nov 16. PMID: 34824330.
* Russell RG. Bisphosphonates: the first 50 years. Bone. 2011 Jan;49(1):2-19. doi: 10.1016/j.bone.2011.02.007. Epub 2011 Feb 21. PMID: 21338712. (This is a foundational review, published 2011, still highly relevant for "how it works")
* Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2020 May 1;105(5):dgaa048. doi: 10.1210/jcem/dgaa048. PMID: 32298246.
Q.
Is Prolia Safe? Why Your Bone Health is At Risk & Medical Next Steps
A.
Prolia is considered safe and effective for many people at high fracture risk when used and monitored correctly, but there are several factors to consider; see below to understand more. Key risks to weigh include low calcium, very rare jaw bone problems and atypical thigh fractures, and rapid bone loss with possible spine fractures if Prolia is stopped without a transition, so discuss your fracture risk, calcium and vitamin D, dental care, and a long term plan with your doctor; complete next steps and urgent warning signs are detailed below.
References:
* Cosman F. Increased Risk of Multiple Vertebral Fractures Following Denosumab Discontinuation: A Systematic Review and Meta-Analysis. J Bone Miner Res. 2021 Jan;36(1):1-10. doi: 10.1002/jbmr.4172. PMID: 32985790.
* Huang LC, Liang X, Zhang T. Safety profile of denosumab in the treatment of osteoporosis: A review. Curr Drug Saf. 2020;15(4):257-264. doi: 10.2174/1574886315666200612151608. PMID: 32627447.
* Kuroda Y, Naito H, Sumiya T, Inami K, Katagiri S, Funahashi K, Okawa T, Sekiguchi H. Osteonecrosis of the Jaw (ONJ) in Patients with Osteoporosis Treated with Denosumab: A Review of the Literature. Calcif Tissue Int. 2021 Jul;109(1):1-8. doi: 10.1007/s00223-021-00810-7. Epub 2021 Mar 18. PMID: 33742111.
* Zhang T, Zhang N, Liang X, Huang LC. Atypical femoral fractures associated with denosumab treatment in osteoporosis: a systematic review. J Bone Miner Metab. 2020 May;38(3):289-295. doi: 10.1007/s00774-020-01097-5. Epub 2020 Apr 15. PMID: 32297120.
* Xie Z, Cheng D, Xia H, Zhang Y, Zhao S, Chen J, Wei Y. Adverse events associated with denosumab therapy: a systematic review and meta-analysis. J Bone Miner Metab. 2019 Jul;37(4):618-632. doi: 10.1007/s00774-019-01006-2. Epub 2019 May 3. PMID: 31053919.
Q.
DEXA Scan Confused? Why Your Bones Are Thinning & Medically Approved Next Steps
A.
Bone thinning seen on a DEXA scan happens when breakdown outpaces rebuilding, commonly due to aging or menopause, low vitamin D or calcium, inactivity, certain medications, or conditions like thyroid disease; your T-score shows how severe it is and helps estimate fracture risk. Next steps include calculating FRAX with your doctor, doing weight-bearing and resistance exercise, aiming for about 1,200 mg calcium and 800 to 1,000 IU vitamin D daily, preventing falls, and using proven therapies such as bisphosphonates, denosumab, or anabolic options when appropriate, with periodic repeat DEXA; there are several factors to consider, and important details that could change your plan are explained below.
References:
* Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R. Diagnosis and Management of Osteoporosis: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2020 May 1;105(5):dgaa024. doi: 10.1210/jcem.2020-00234. PMID: 32298282.
* Hajdu S, Hepp P, Wernly B, Egger A, Wernly S, Kofler M, Rezar R, Hoppe U, Lessmann E, Schulze J, Leitinger G, Zirlik A, Aziz F, Aziz F, Schulze PC, Kienzle E, Lang M, Rohde J, Mahabadi P, Tschernatsch M, Lichtenauer M. The Etiology of Osteoporosis: From Genetic Factors to Lifestyle. Int J Mol Sci. 2023 Mar 19;24(6):5787. doi: 10.3390/ijms24065787. PMID: 36982991.
* Lewiecki EM. New and emerging treatments for osteoporosis. Bone. 2023 Jul;172:116773. doi: 10.1016/j.bone.2023.116773. Epub 2023 May 10. PMID: 37172776.
* Weaver CM, Gordon CM, Janz KF, et al. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and conclusions from the NOF Expert Panel. Osteoporos Int. 2016 Dec;27(12):3621-3641. doi: 10.1007/s00198-016-3770-2. Epub 2016 Oct 18. PMID: 27757785; PMCID: PMC5385619.
* U.S. Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: U.S. Preventive Services Task Force Recommendation Statement. JAMA. 2018 Jun 26;319(24):2521-2531. doi: 10.1001/jama.2018.7522. PMID: 29946722.
Q.
Chronic Bone Pain? Why Your Skeletal System Aches & Medically Approved Next Steps
A.
Deep, constant bone pain that may worsen at night can stem from osteoporosis or stress fractures, vitamin D deficiency, autoimmune inflammation, infection, or less commonly cancer, and lasting symptoms should be assessed with a physical exam, imaging, and blood tests. Medically approved steps include optimizing calcium and vitamin D, weight-bearing and balance exercise, and targeted treatments such as bisphosphonates, anti-inflammatory medicines, antibiotics, pain management, and physical therapy, with urgent care for fever, sudden severe pain, swelling, or unexplained weight loss. There are several factors to consider; see the complete guidance below to understand what to do next for your specific situation.
References:
* Borromeo MV, Abell J, Umpir S, Khan M, Perisetti A, Goyal H. Bone pain: an updated review for the clinician. J Clin Orthop Trauma. 2023 Feb;37:102073. doi: 10.1016/j.jcot.2022.102073. PMID: 36777647.
* Krayer RW, Chen CCM. Diagnosis and Treatment of Chronic Bone Pain. Curr Pain Headache Rep. 2019 Jun 28;23(7):52. doi: 10.1007/s11916-019-0797-0. PMID: 31254132.
* Hanley CJ, Brown LC, Chapman K, Cowie RM, Kelly S. Bone pain: Pathophysiology and current management. Eur J Pain. 2021 Jul;25(6):1199-1215. doi: 10.1002/ejp.1741. PMID: 33606709.
* Smith PJW, Hanley CJ, Brown LC, Chapman K, Cowie RM, Kelly S. Emerging concepts in the pathophysiology of bone pain. Bone. 2023 Feb;167:116634. doi: 10.1016/j.bone.2022.116634. PMID: 36473550.
* Santos RBN, Hanania AN, Awan H, Ghilardi FF, De Carvalho E Silva B, De Campos GC, da Costa LT, Binda S, Telles JB. Pathophysiology and therapeutic strategies for bone pain. Pain. 2021 Oct 1;162(10):2613-2624. doi: 10.1097/j.pain.0000000000002241. PMID: 33883447.
Q.
Fragile Bones? Why Osteoporosis Happens & Medically Approved Next Steps
A.
Osteoporosis weakens bones silently as bone breakdown outpaces formation with age and hormonal changes, and risk rises with low calcium or vitamin D, inactivity, smoking, certain illnesses and medications, and family history; screening with a DEXA scan is key, especially for women over 65, men over 70, or younger people with risk factors. Medically approved next steps include adequate calcium and vitamin D, weight-bearing and balance exercise, fall prevention, and when needed, medications like bisphosphonates, denosumab, hormone-related options, or anabolic agents with regular monitoring. There are several factors to consider that could change your next steps, so see the complete guidance below.
References:
* Porter JL, Varacallo M. Osteoporosis. 2023 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29763073.
* Rachner TD, Hofbauer LC, Rauner M. Osteoporosis: from diagnosis to treatment. Nat Rev Endocrinol. 2024 Feb;20(2):83-102. doi: 10.1038/s41574-023-00918-z. Epub 2023 Nov 2. PMID: 37919313.
* Shoback D, Rosen CJ, Black DM, Cheung AM, Kiel DP, Insogna K, Bilezikian J, Camacho PM, Dempster D, Ebeling PR, Hamdy NAT, Kodama S, Khosla S, Kumar S, Lewiecki EM, Miller PD, Napoli N, Nordin BE, Papapoulos SE, Rachner TD, Reginster JY, Saag KG, Stroup J, Watts NB, Wysolmerski J, Zaidi M. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline. J Clin Endocrinol Metab. 2023 Jul 14;108(8):1811-1834. doi: 10.1210/clinem/dgad205. PMID: 37199736; PMCID: PMC10344405.
* Lins de Moraes LV, Mendes LL, Vieira LS, Vasconcelos LS, Vieira CS, Silva JAF, Santos EA, Bezerra CM, Lima BDA, Dantas JLG. Osteoporosis: Pathophysiology and therapeutic advances. World J Biol Chem. 2022 Mar 27;13(1):1-18. doi: 10.4331/wjbc.v13.i1.1. PMID: 35432924; PMCID: PMC8976210.
* Tu K, Zhang Q, Xue Y, Li H, He P. The Global Epidemiology of Osteoporosis. Front Endocrinol (Lausanne). 2023 Mar 10;14:1120294. doi: 10.3389/fendo.2023.1120294. PMID: 36960100; PMCID: PMC10037307.
Q.
Osteopenia? Why Your Bones Are Thinning & Medically Approved Next Steps
A.
Osteopenia means your bones are thinner than normal, not osteoporosis, typically found on a DEXA scan with a T-score between -1.0 and -2.5; it raises fracture risk but gives you time to act. There are several factors to consider, including age, hormonal changes, nutrition, medications, and lifestyle, so see below to understand more. Medically approved next steps include optimizing calcium and vitamin D, adding weight-bearing and strength exercises, preventing falls, stopping smoking, limiting alcohol, and reviewing medications while using FRAX with your clinician to decide if treatment is needed. Important details that can change your plan, including dose targets, specific exercise options, and urgent red flags, are outlined below.
References:
* Shoback, D. M. (2020). Osteoporosis and Osteopenia. In L. J. De Groot, G. M. Chrousos, K. Dungan, et al. (Eds.), Endotext. MDText.com, Inc.
* Shoback, D. M., Rosen, C. J., Black, D. M., Cheung, A. M., Cosman, S., Harris, S. T., ... & Endocrine Society. (2019). Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(9), 4151-4158.
* Koh, J. H., Kim, M. S., & Kim, M. G. (2018). Risk factors for osteopenia and osteoporosis in younger adults. Archives of osteoporosis, 13(1), 1-8.
* Tucci, M., Nardone, A., Celi, M., Di Vanna, S., Giusti, F., Sessa, V., & Maccauro, G. (2020). Lifestyle interventions for the prevention and treatment of osteoporosis: a narrative review. Journal of clinical medicine, 9(12), 3986.
* Saag, K. G., & Wermers, R. A. (2020). Secondary osteoporosis: an update. The Journal of Clinical Endocrinology & Metabolism, 105(5), 1361-1375.
Q.
Afraid of Fractures? Why Your Bones Are Thinning & Medically Approved Osteoporosis Treatment Steps
A.
Fracture risk rises when bones thin silently due to aging, hormonal changes, low calcium or vitamin D, inactivity, smoking or heavy alcohol use, and certain diseases or medications, and medically approved ways to cut risk include hitting calcium and vitamin D targets, weight-bearing plus strength exercise, fall prevention, and proven drugs like bisphosphonates, denosumab, or anabolic therapies when indicated. There are several factors to consider, including who needs a DEXA scan and how T-scores guide treatment, exact nutrient goals, which medication fits your risk profile, and how fast fracture risk falls with consistent therapy. See below for specific thresholds, safety notes, and next steps that could change your care plan.
References:
* Al-Refai E, Al-Refai AS, Al-Refai SM, Al-Refai AH. Risk factors for osteoporosis: an evidence-based narrative review. Cureus. 2023 Jul 19;15(7):e42104. doi: 10.7759/cureus.42104. PMID: 37593226.
* Maraka S, Maraka E, Garimella PS, Lim J, Al-Nimri M, Ghaoui P. Osteoporosis: A Comprehensive Review of Risk Factors, Screening, Diagnosis, and Treatment. J Clin Endocrinol Metab. 2022 Oct 18;107(11):e4484-e4499. doi: 10.1210/clinem/dgac333. PMID: 35713437.
* Lewiecki EM, Cosman F, de Beur SJ, Billingsley AM, Clark BC, Emkey R, Harris ST, Miller PD, Myers MH, Pfeifer M, Watts NB, Shane E. Pharmacological treatment of osteoporosis: clinical practice guideline. Endocr Pract. 2020 Jan;26(1):147-158. doi: 10.4158/EP-2019-0477. PMID: 31778736.
* Rizzoli R, Biver E. Lifestyle and nutritional strategies for bone health. Calcif Tissue Int. 2020 Sep;107(3):284-301. doi: 10.1007/s00223-020-00713-3. Epub 2020 Jun 8. PMID: 32514529.
* Kaur N, Devgan M, Singh L, Arora S, Walia S, Kaur R. Osteoporosis: An Updated Overview. Endocr Metab Immune Disord Drug Targets. 2022;22(2):167-175. doi: 10.2174/1871530321666211229150036. PMID: 34969372.
Q.
Feeling Brittle? Why Your Bones are "Melting" & Medically Proven Steps to Stop Osteoporosis
A.
Osteoporosis happens when bone loss exceeds rebuilding, leaving bones brittle and prone to fractures; it can be detected with a DEXA scan and managed with calcium and vitamin D, weight-bearing and strength exercise, quitting smoking, limiting alcohol, fall prevention, and when needed prescription therapies such as bisphosphonates, denosumab, or anabolic agents. There are several factors to consider, including age, menopause status, steroid use, and other conditions, and the right next step for you may differ. See below for key risks, screening timelines, target intakes, exercise examples, medication choices, and signs that mean you should contact a doctor now.
References:
* Khosla S, et al. Osteoporosis: An Updated Review of Medical Management. Mayo Clin Proc. 2021 Jul;96(7):1856-1871. doi: 10.1016/j.mayocp.2020.12.024. PMID: 34229792.
* Compston J, et al. Understanding and Treating Osteoporosis. N Engl J Med. 2023 Feb 23;388(8):717-727. doi: 10.1056/NEJMra2208013. PMID: 36812239.
* Saha S, et al. Recent advances in the understanding of osteoporosis. F1000Res. 2022 Jul 25;11:859. doi: 10.12688/f1000research.122709.1. PMID: 36034079.
* Ferrari SL, et al. Pathophysiology and treatment of osteoporosis. Nat Rev Dis Primers. 2020 Sep 24;6(1):80. doi: 10.1038/s41572-020-00211-1. PMID: 32973167.
* Tucci M, et al. Diet, supplements, and exercise in osteoporosis prevention and treatment. Minerva Med. 2021 Jun;112(3):363-380. doi: 10.23736/S0026-4806.21.07435-0. PMID: 34105436.
Q.
Osteoporosis Signs in Your 30s & 40s: Prevention & Next Steps
A.
Bone loss can start silently in your 30s and 40s; there are several factors to consider, and early clues include gradual height loss, back pain from small spinal fractures, weaker grip, receding gums, stress fractures, or fractures from minor falls, especially with risks like family history, low body weight, smoking, heavy alcohol use, certain medications, autoimmune or thyroid disease, digestive disorders, early menopause, or low testosterone. Prevention and next steps include adequate calcium and vitamin D, regular weight-bearing and strength training, not smoking, limiting alcohol, keeping a healthy weight, reviewing medicines, and asking about early DEXA and blood tests if you have risks; see below for key details that can shape your personal plan, including when to use a symptom checker and considerations for men.
References:
* Al-Daghri NM, Alkhalifa AO, Al-Harbi MM, Al-Attas OS. Bone health in young adults: an update on risk factors and prevention strategies. Arch Osteoporos. 2022 Apr 27;17(1):68. doi: 10.1007/s11657-022-01099-2. PMID: 35472855; PMCID: PMC9046261.
* Rizzoli R, Biver E. Primary Osteoporosis in Young Adults: An Update. JBMR Plus. 2018 Sep 26;2(6):e10151. doi: 10.1002/jbm4.10151. PMID: 30458641; PMCID: PMC6237255.
* Keshishian K, Vella CA, Johnson MA, et al. Prevalence of Low Bone Mineral Density in Premenopausal Women: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt). 2021 Dec;30(12):1790-1804. doi: 10.1089/jwh.2021.0118. PMID: 34509462.
* Gregson CL, Prentice A, Harvey NC, Cooper C. Bone health in young adults. Arch Osteoporos. 2017 Sep 28;12(1):88. doi: 10.1007/s11657-017-0382-x. PMID: 28994793; PMCID: PMC5618197.
* Maniscalco M, Conte M, Maniscalco G, Fecarotta E. Strategies to maintain bone health throughout life: a narrative review. Front Pharmacol. 2023 Aug 31;14:1229009. doi: 10.3389/fphar.2023.1229009. PMID: 37703350; PMCID: PMC10499690.
Q.
What are the seven worst foods for osteoporosis?
A.
Certain foods can negatively impact bone health and contribute to the risk of osteoporosis. The seven worst foods for osteoporosis include excessive salt, caffeine, soft drinks, alcohol, high-protein diets, processed foods, and foods high in oxalates. Limiting these foods can help support bone health and reduce the risk of osteoporosis.
References:
Tucker KL. Osteoporosis prevention and nutrition. Curr Osteoporos Rep. 2009 Dec;7(4):111-7. doi: 10.1007/s11914-009-0020-5. PMID: 19968914.
Biver E, Herrou J, Larid G, Legrand MA, Gonnelli S, Annweiler C, Chapurlat R, Coxam V, Fardellone P, Thomas T, Lecerf JM, Cortet B, Paccou J. Dietary recommendations in the prevention and treatment of osteoporosis. Joint Bone Spine. 2023 May;90(3):105521. doi: 10.1016/j.jbspin.2022.105521. Epub 2022 Dec 22. PMID: 36566976.
Ratajczak AE, Zawada A, Rychter AM, Dobrowolska A, Krela-Kaźmierczak I. Milk and Dairy Products: Good or Bad for Human Bone? Practical Dietary Recommendations for the Prevention and Management of Osteoporosis. Nutrients. 2021 Apr 17;13(4):1329. doi: 10.3390/nu13041329. PMID: 33920532; PMCID: PMC8072827.
Q.
How is osteoporosis diagnosed?
A.
Diagnosis of osteoporosis is done by a bone mineral density scan (DEXA scan). Other tests that may be done include x-rays, blood and urine testing to look for an underlying cause of the osteoporosis.
References:
Ralston SH, Fraser J. Diagnosis and management of osteoporosis. Practitioner. 2015 Dec;259(1788):15-9, 2. PMID: 26882774.
Peacock-Johnson AM, Keresztes P. Osteoporosis: Diagnosis and management updates. Nursing. 2023 Dec 1;53(12):28-35. doi: 10.1097/01.NURSE.0000991592.29755.37. PMID: 37973009.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Srivastava M, Deal C. Osteoporosis in elderly: prevention and treatment. Clin Geriatr Med. 2002 Aug;18(3):529-55. doi: 10.1016/s0749-0690(02)00022-8. PMID: 12424871.
https://geriatric.theclinics.com/retrieve/pii/S0749069002000228Miller PD. Management of severe osteoporosis. Expert Opin Pharmacother. 2016;17(4):473-88. doi: 10.1517/14656566.2016.1124856. Epub 2015 Dec 23. PMID: 26605922.
https://www.tandfonline.com/doi/full/10.1517/14656566.2016.1124856Armas LA, Recker RR. Pathophysiology of osteoporosis: new mechanistic insights. Endocrinol Metab Clin North Am. 2012 Sep;41(3):475-86. doi: 10.1016/j.ecl.2012.04.006. Epub 2012 Jun 9. PMID: 22877425.
https://www.sciencedirect.com/science/article/abs/pii/S088985291200028X?via%3DihubYong EL, Logan S. Menopausal osteoporosis: screening, prevention and treatment. Singapore Med J. 2021 Apr;62(4):159-166. doi: 10.11622/smedj.2021036. PMID: 33948669; PMCID: PMC8801823.
http://www.smj.org.sg/article/menopausal-osteoporosis-screening-prevention-and-treatment