10 Warning Signs Your Bones Are Thinning -- and What You Can Do Now

Find out the symptoms of osteopenia, the precursor to osteoporosis, and what you can do to help thinning bones.
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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.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

3 months, said...

I am 54 years old and was diagnosed with OSTEOPOROSIS in 2015. The results of the scan indicated that I had the bones of a 75 year old. I was on Fosamax for years, before switching to Boniva since it could be taken once monthly. After a year of taking Boniva, my latest bone density test showed that both my hips had gotten worse. My primary care provider suggested i try a more natural approach and referred me to RICH HERBS FOUNDATION, i immediately started on their OSTEOPOROSIS HERBAL FORMULA. The treatment effectively reversed my condition. I did another bone density test and it came out perfect. Visit rich herbs foundation web page ww w. richherbsfoundation. com. The severe knee pain and sharp pains through my back stopped.

over 1 year, said...

Im at a young age and my bones start hurting and feel weakened and BTW, 12!!

over 2 years, said...

Hi Doctor, iam 34 yrs lady i have 2 kids and i was getting hand pain frquently & the pain becomes more when i used my right hand more for work like washing clothes etc.. when i went to doctor they said that ur bones have become weak & u have bone thinning problem & u have to 6 months treatment iam worried pls suggest what to do on this

over 3 years, said...

I only had time for a very quick skim but I got the gist of your excellent article

over 3 years, said...

What if I fracture my right arm. Like broken like 2 times

over 3 years, said...

Osteopenia osteoporosis extreme scoliosis disc disease sciatica , bones look like Swiss cheese. Neurosurgeon , suggests narcotic implant in back, as pain management is not working so great. Mahal bar from neck down back other option yet feel I will not withstand recoup time. Currently I can functionat decent level, chronic pain. 61 years young.

over 3 years, said...

There is evidence that supplementing with vitamin D could contribute to bone loss. I can't find my link now, but it has to do with the balance of vitamin K (K2), which is being studied for th purpose of reduced arterial calcification (hardening of the arteries). We haven't been testing bones for calcium, we'vebeen using blood. What they seemto be finding is that vtamin D makes blood hold calcium, both taking it from bones and then dropping it whenever conditons (what conditions no one knows) are 'right.'. My bigger concern, though, is the folks are pumping thier bodies too full of both calcium and vitamin D, making thier blood no choice but to deposit it in thier veins and arteries, and having no real benefit to bones in the process. I'm no expert. Please check it out. These people seem to be doing some good work on the subject http://lpi.oregonstate.edu/infocenter/vitamins/vitaminK/

over 3 years, said...

Hello. I am very concerned because my Doctor has me on several antidepressants and I have osteopenia and have had several significant bone fractures in the last few years. I had a left hip replacement because it was bone again bone two years ago and it still bothers me. I tripped and severely fractured my right shoulder and arm three years ago. In August this last year I tripped a have a tipea and fibula fracture that is not healing correctly. I was in the hospital in a brace for 2 months because I couldn't walk or get up stairs. Tthey did NOT do surgery because of too many fragments. NOW they are discussing surgery with a total knee replacement and possible screws and not sure what to expect. Im on extra calcium vitamin D but of course exercise is limited. And a new brace to keep my leg from being boe legged. I am 66 years old but a fairly active person. I get terrible depressed but afraid depression medicine is doing more harm than. Any suggestions?

over 3 years, said...

I agree with Top Mom, regarding the necessity of a high fiber die. Also, moderate exercise, I like Thi Chi. lets add walking too. As for adding supplements, I take Vit D3 5000 IU, Vit K2, Calcium with Magnesium and hair nutrients.

almost 4 years, said...

Nice and useful article.No option except exercising keeps you fit mentally and physically in all ages.

almost 4 years, said...

Can your bones hurt if your bones are thinning?

almost 4 years, said...

Tai Chi Chuan is highly recomended for increasing bone density. One needs to start as early as possible. What one practises daily will naturally, and gradually become a permanent part of ones' daily doing. It is very difficult to learn at any age. Daily diciplined practise at any age will benefit all. Thank you!

about 4 years, said...

What was not mentioned as a valuable source of calcium is green, leafy vegetables--spinach, kale, romaine, etc. As a bonus, these vegetables have high amounts of fiber. As a 70-year old female who suffers from osteoporosis, I have had to do a lot of my own research, as the doctors had little advice that was usable for me. I take 2000 mgs. of calcium daily as a supplement, The calcium is from various sources to make it more bio-available (calcium carbonate, calcium gluconate, calcium citrate) along with 750 mgs magnesium and Vitamin D in divided doses throughout the day. In addition, I take 90 mgs Vitamin K2 (proven healthy for both the heart and bones) and at night 3 mgs boron. The magnesium is very important in that gets the calcium to the bones where it is needed and keeps it from building up in the arteries, where it could cause blockage. For many years I had been taking prescribed bisphosphonates (Fosamax) and even underwent a course of injection therapy at quarterly intervals for a year. Concerned about serious side effects, like osteonecrosis, I have gone off the bisphosphonates, and keep to my high fiber diet and the supplement regimen I mentioned. Seems to work for me. I am 70 years old, Caucasian, of small frame, and have birthed 5 children. I feel this is valuable information and am hopeful someone can benefit from it.

about 4 years, said...

I recently went to my Primary Doctor's for general not feeling well all the way around.. I did not have a flu shot but nor have I ever in my life before... I am also having a full mouth extraction and have had a very harsh pain in my lower back. I told them about it thinking I just moved the wrong way and boy was I ever wrong.. They did an exray and within 2 hours they diagnosed me with a compressed hairline fracture of the L-1 As it turns out it is caused by low bone density... They are running a test on June 30th and in the mean time I am in so much pain it is ridiculous.... They said for 3-8 weeks do no lifting nor exercising if the exercise seems to irritate my lower back.. Well as it turns out I can't do much at all.. I over extended myself and did lift a vacum cleaner just to vacum because it was in bad shape.. Did I ever pay... I have two dogs and they are long haired little guys with short legs.. I had to life to put onto bed and OMG.. I can't do anything without harming myself and I am a active person... I don't know what they will do but I do know that bare minimum is about the extent of my activities.... It is so frustrating but I have put myself on a supplement that should help a great deal... I neglected to take better care of myself and it is my own doing and age... Such is life....

about 4 years, said...

Hello Taffi, If you are in need of housing resources in your area you are welcome to contact our Family Advisors at 800 325 8591. They are available 7 days a week.

about 4 years, said...

Thanks 4 info if u know of any housing in Pensacola, Florida please let me know

about 4 years, said...

The info on alcohol and lactose intolerance.

about 4 years, said...

very helpful.

over 4 years, said...

Good things to be aware of and too bad I didn't see it 20 years ago as I'm "small" (5'1" & 100#) and always have been. Asked my doctor in the mid 90s for a bone density scan and she said (1) I didn't need it and (2) my insurance wouldn't pay for it. I told her it certainly wouldn't if she didn't order it in the first place! I moved, changed doctors and asked again; got the test and learned I had osteopenia in my lumbar spine and osteoporosis in my left hip. Having been a gymnast (back in the 'dark ages' in high school) I was a bit surprised and took action. An rx (Actonel) and extra calcium, D3, etc., has helped to improve my bones, thank God.

over 4 years, said...

We now know that diets high in dairy are very bad for us. See the article about inflammation.

over 4 years, said...

Umm, vocabulary lesson... Nearly all of these are not warning signs. They are risk factors... You'd think a "senior editor" would know that.

over 4 years, said...

During my time in bed I sometimes feel cold in my bones; it is apparent when I arise in the morning; it is very uncomfortable; it is a new type of pain in my life that I am feeling more of as I age; I am YOB 1960; it lasts for ever (seems to): I need to understand this pain; to listen and change or adapt to it. May you give me more understanding please?