Osteoporosis: Protecting Your Bones Before a Fracture Happens

Osteoporosis is often called a "silent disease" — and for good reason. Bones lose density gradually over years, causing no pain and no obvious symptoms. Most people do not know they have it until a bone breaks.

In the United States, osteoporosis affects approximately 10 million adults, and another 44 million have low bone density that puts them at risk. A hip fracture in an older adult can be life-altering — and in some cases, life-threatening.

The encouraging news: osteoporosis is largely preventable, and when caught early, it is very treatable.

Bone is living tissue that is constantly being broken down and rebuilt. In youth, new bone is made faster than old bone is removed — so bone density increases. Around age 30, bone mass peaks. After that, the balance gradually shifts.

Osteoporosis occurs when bone loss outpaces bone formation, leaving bones porous and fragile. Even a minor fall — or in severe cases, a cough or sneeze — can cause a fracture.

The most common fracture sites are the hip, spine, and wrist.

Women are at significantly higher risk than men. Estrogen plays a protective role in bone maintenance, and the rapid drop in estrogen at menopause accelerates bone loss. Women can lose up to 20% of their bone density in the five to seven years following menopause.

Additional risk factors include:

• Age — Risk increases significantly after 50
• Family history — A parent or sibling with osteoporosis or hip fracture
• Small body frame — Less bone mass to draw from
• Low calcium and vitamin D intake — Essential nutrients for bone formation
• Physical inactivity — Weight-bearing exercise builds and maintains bone
• Smoking — Reduces bone density and impairs calcium absorption
• Excessive alcohol — Interferes with bone formation
• Certain medications — Long-term corticosteroids (prednisone), some antidepressants, and proton pump inhibitors can reduce bone density
• Medical conditions — Rheumatoid arthritis, celiac disease, inflammatory bowel disease, and hyperthyroidism increase risk

A DEXA scan (dual-energy X-ray absorptiometry) is the gold standard for measuring bone density. It is painless, takes about 15 minutes, and uses very low levels of radiation.

Results are reported as a T-score:

• -1.0 or above: Normal bone density
• -1.0 to -2.5: Osteopenia (low bone density — a warning sign)
• -2.5 or below: Osteoporosis

Who should be screened?

• Women age 65 and older
• Postmenopausal women under 65 with risk factors
• Men age 70 and older
• Anyone who has had a fracture from a minor injury after age 50

Calcium is the primary mineral in bone. Most adults need 1,000–1,200 mg per day from food and supplements combined.

Good dietary sources include:

• Dairy products (milk, yogurt, cheese)
• Fortified plant milks (almond, soy, oat)
• Canned sardines and salmon with bones
• Leafy greens (kale, bok choy, broccoli)
• Fortified orange juice

If you cannot get enough from food, calcium supplements (calcium carbonate or calcium citrate) can help — but more is not better. Excess supplemental calcium has been linked to kidney stones and possibly cardiovascular risk. Discuss the right dose with your doctor.

Vitamin D is essential for calcium absorption. Without adequate vitamin D, your body cannot use the calcium you consume.

Most adults need 600–800 IU per day — and many older adults or those with limited sun exposure need more. Your doctor can check your vitamin D level with a simple blood test.

Sources include sunlight, fatty fish (salmon, mackerel, tuna), egg yolks, and fortified foods. Supplements are often necessary, especially in Florida's indoor-heavy summer months.

Physical activity stimulates bone formation. The most effective types are:

• Weight-bearing aerobic exercise: Walking, hiking, dancing, tennis, stair climbing
• Resistance training: Lifting weights or using resistance bands
• Balance exercises: Yoga, tai chi — reduce fall risk

Aim for at least 30 minutes of weight-bearing activity most days of the week.

For people with osteoporosis, preventing falls is as important as treating bone loss. Practical steps include:

• Remove tripping hazards at home (loose rugs, clutter)
• Install grab bars in the bathroom
• Ensure adequate lighting
• Have your vision checked regularly
• Review medications that cause dizziness or balance problems

When lifestyle changes are not enough, several medications can slow bone loss or stimulate new bone formation:

• Bisphosphonates (alendronate, risedronate) — The most commonly prescribed class; reduce fracture risk significantly
• Denosumab — An injection given every six months; effective for postmenopausal women
• Raloxifene — A selective estrogen receptor modulator; also reduces breast cancer risk
• Teriparatide and abaloparatide — Anabolic agents that stimulate new bone growth; used for severe osteoporosis
• Romosozumab — A newer option that both builds bone and slows bone loss

Your doctor will recommend treatment based on your T-score, fracture history, and overall health.

Bone health is not just a concern for older adults. The habits you build in your 30s, 40s, and 50s directly determine your bone density in your 60s and 70s. It is never too early — or too late — to take action.

At Manatee Primary Care, we screen for osteoporosis, order DEXA scans when appropriate, and work with you on a personalized prevention and treatment plan.

Call us at (941) 867-9362 or request an appointment to discuss your bone health today.