We all know an older person with osteoporosis -- it's one of the most common problems of aging, striking more than half of all adults over age 50. And we all hope osteoporosis doesn't happen to us, since weak bones can lead to fractures, and fractures, in turn, lead to all sorts of scary consequences.
But how do you know if your bones are sturdy enough to keep you safe? It's tricky, because osteopenia -- the process of bone thinning that precedes full-blown osteoporosis -- can happen without obvious symptoms. Here are the top 10 warning signs of thinning bones, along with tips about how you can respond:
1. You've had more than one fracture in the past two years, or you've had a fracture that seemed unusually severe for the circumstances.
Kim Noles of Pennsylvania found out she had osteopenia, or mild osteoporosis, when she fractured her ankle simply by stepping the wrong way off a curb. Your bones need to be strong enough to sustain some impact, and if they aren't, you'll want to know more about what's behind that.
What you can do: Get a bone density test, also called a DXA scan or densitometry, which is a specialized type of X-ray that measures the amount of calcium and other key bone-hardening minerals within each bone segment. Doctors consider bone density tests a fairly accurate predictor of fracture risk, because they show whether your bones are dense and solid or porous (which makes them fragile).
2. You're naturally thin or small-framed.
Unfortunately, if your bones are small and thin to begin with, you have less bone to lose. People with small, delicate frames are likely to develop osteoporosis at a younger age. This doesn't mean that heavy or big-boned people don't get osteoporosis; just that people who are thin or small-boned don't have as far to go before they're at risk for fracture.
We reach peak bone mass and stop building bone when we're between 20 and 25 years old, and somewhere between 30 and 40 we start losing bone. The rate of bone loss depends on our genetics and on how vigilant we are about diet, exercise, and other factors that keep our bones strong.
What you can do: If you're under age 40, do everything you can in your 30s to build bone: Eat a diet high in dairy and other calcium-rich foods and get plenty of high-impact exercise, which is anything that involves running or jumping. If you're 40 or older, continue to eat nutritiously, add a calcium-magnesium-vitamin D supplement, and do strength-training exercise in addition to impact exercise. Strength training has been shown to prevent bone loss.
3. You take prednisone or other corticosteroids to treat an autoimmune condition.
Taking cortisone drugs over a long period of time interferes with hormone levels in a way that leaches calcium, vitamin D, and other nutrients from your bones. People who have autoimmune diseases such as Crohn's disease, lupus, or rheumatoid arthritis have osteoporosis at a much higher rate than the average person because of the corticosteroids used to treat these conditions.
This warning sign is most especially likely to matter to women, because they're more likely to get autoimmune diseases to begin with. They're also more prone because normal estrogen levels are necessary for maintaining healthy bone. Taking a thyroid hormone for low thyroid or taking antidepressants in the SSRI class is also linked to higher levels of bone loss, though experts aren't sure why yet.
What you can do: If you need to take corticosteroids to treat a health condition, the resulting risk to your bones requires a doctor's careful supervision. Most doctors now have patients get a bone density scan soon after going on corticosteroids, to make sure they have the bone mass necessary to withstand the effect of the drugs. Your doctor can also order a 24-hour urine calcium analysis and a vitamin D test to check your level of that bone-strengthening nutrient.
If you're on corticosteroids long-term, you should probably have your spine X-rayed, as sometimes tiny fractures result that you may not feel at first. Many doctors will also prescribe biphosphonates, which are bone-building drugs.
Lifestyle Choices That Can Lead to Osteoporosis
4. You smoke.
Experts don't know exactly how smoking sabotages bones, but it's clear from numerous studies that it does. Smoking has a high statistical correlation with osteoporosis, so if you've been a smoker throughout your adult life, chances are high that you've compromised your bones.
What you can do: No one wants to be told once again to stop smoking, but that's exactly what your bones are asking you to do. The good news is that no matter your age when you quit, you can still reap the health benefits of being a nonsmoker and give your body the chance to recuperate.
5. You drink more than two alcoholic drinks a day.
Alcohol is a bone-weakener; it leaches calcium, magnesium, and other minerals from your bones. The more you drink, the more likely it is that it's happening. Women are more vulnerable to this type of bone loss than men, perhaps because they're more vulnerable to the effects of alcohol in general.
What you can do: Unfortunately for those who like to imbibe, the primary solution here is to cut back. Try savoring one or two glasses of wine a night, then switching to herb tea or warm milk with honey.
6. You're lactose intolerant or have other reasons for not drinking milk.
Milk is one of the best bone-builders, and not just because of the calcium. Vitamin D, an important ingredient in fortified milk, is even more important. Most American adults are severely D-deficient, says Robert Recker, director of the Osteoporosis Research Center in Nebraska, putting us at risk for not only weak bones but for several types of cancer. And store-bought milk, which is fortified with vitamin D, is one of the only dietary sources of this important nutrient.
What you can do: It's the calcium, vitamin D, and other minerals in milk that are important, not the milk itself. Look for soy or rice milk that's been fortified with these nutrients, and drink it regularly. Also take a supplement that contains calcium, magnesium, and vitamin D; these three minerals work synergistically to build and protect bone.
7. You've struggled with an eating disorder.
A history of anorexia is a major red flag for osteoporosis. That's because artificially low body weight lowers hormone levels, causing skipped periods, says Columbia University endocrinologist Elizabeth Shane. "Anything that lowers estrogen levels interferes with bone building," she says.
What you can do: If you have a history of anorexia or bulimia, bring it to the attention of your doctor or a therapist. There are treatment programs that have proven successful in getting eating disorders under control, and this is important so you can protect your bones for the future. Also, be sure to drink calcium and vitamin D-fortified milk, and take a cal-mag-D supplement to keep your bones and teeth strong.
Health Issues That Put You at Risk for Bone Thinning
8. Women only: Your periods are irregular or infrequent.
Low levels of estrogen are typically responsible for missed periods or a cycle that starts and stops. Unfortunately, low estrogen contributes directly to bone loss, so women who aren't regular may find their bones are irregular too. Low estrogen can be caused by an eating disorder, overexercising, or polycystic ovary disease (PCOS).
What you can do: If your periods are irregular and you're not underweight, talk to your doctor. You may have a hormone-related condition such as polycystic ovary disease (PCOS), which is easily treatable. Your doctor may put you on low-dose birth control pills, for example, which is an easy fix for irregular periods and the hormonal disruptions that may be behind them.
9. You have a first- or second-degree relative who had osteoporosis before the age of 50 or before menopause.
Family history is a major indicator that your bones are weakening. If you come from a family where the older adults have a history of fractures, poor posture, or loss of height, chances are your family members had osteoporosis, whether or not it was ever diagnosed. And if they had it, it's likely you do too.
What you can do: Compile a family health history by talking to your parents, grandparents, and anyone else privy to family information. If you had relatives who suffered from osteoporosis, tell your doctor. If you're younger and your doctor has been resisting requests for a bone scan, this information will aid you in your quest, as doctors take family history seriously.
10. You're Caucasian or Asian, female, and over 50.
Just one of these risk factors makes it more likely your bones are thinning. If all three are true for you, there's a good chance your bones are at risk for fracture.
But African-American women also have reason to be concerned. A recent study showed that low bone mass is much more common than once believed in all ethnic groups, including African-Americans.
If you're 60, 70, or beyond, pay even more attention. Bone-thinning risk increases with age; osteoporosis experts estimate that after the age of 75, 90 percent of women will suffer a fracture.
What you can do: You can't change any of the racial, gender, or age factors that make you who you are. But knowing which risk category you fall into can help you be more aware of the state of your bones and advocate for yourself with your doctor. If you're over age 50 and tests show that your bones are weakening, your doctor may prescribe a biphosphonate drug or estrogen replacement therapy to build your bone strength.