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In the Spotlight

Bone Health and Osteoporosis: An Overview

Contributed by Jeanine Brown MS, RN, CCRC
Eun-Shim Nahm Ph.D., RN, FAAN

Osteoporosis progression

Bone health is important for overall health and quality of life. Healthy bones provide the body with a frame that allows for mobility and for protection against injury. They also serve as a storehouse for important minerals. As people enter their forties and fifties, they tend to lose more bone tissue, resulting in low bone mass. Fractures are a major concern for older adults with low bone mass.

Osteoporosis is a disease that makes bones become fragile and more likely to break. If it is not prevented or treated, it can progress painlessly. Because of this, it is often called "the silent disease." A condition where bone density is lower than normal and is believed to occur before osteoporosis is osteopenia. However, not every person diagnosed with osteopenia will develop osteoporosis.

Millions of Americans are at risk for this disease. Women are four times more likely than men to get Osteoporosis. As a result, it is often viewed as a "women's disease." However, men also get osteoporosis. There are 2 million American men with this disease. Another 12 million men are at risk. Even with the large number of men affected, it still remains under-diagnosed and under-reported.

Risk Factors

Illustration of osteoporosis prevention provisions

There are factors that may increase one's chance of developing osteoporosis. While some risk factors cannot be changed (non-modifiable), other factors can be changed (modifiable).

Risk factors that cannot be changed:

  • Age - it is more common in older adults

  • Gender - women are at greater risk

  • Menopause/Menstrual History - normal or early menopause increases the risk.

  • Family History - research suggests a connection between family history and risk for osteoporosis (such as, a parent with a history of spinal fractures)

  • Race - Caucasian and Asian women are more likely to develop the disease

  • Having a personal history of fractures as an adult

Risk factors that can be changed:

  • Low body weight - thin persons with small bones

  • Lifestyle - cigarette smoking, drinking too much alcohol or doing little or no weight-bearing exercise

  • Nutrition - a diet that lacks calcium and vitamin D

Other factors can also play a role in developing osteoporosis, such as certain chronic illnesses (such as, anorexia, celiac disease) or medicines (for example, glucocorticoids).

Diagnosis

Patient in Bone Mineral Density Machine

A Bone Mineral Density (BMD) test is the most effective way to find osteoporosis. Several types of BMD tests are available. The most widely available method is called dual DXA (PDF). This test measures BMD in the spine, hip, or forearm.

If a BMD test has to be repeated, it is important to use the same testing machine at the same facility. Plus, how you are positioned on follow-up scans should also be the same. This helps your health care provider accurately compare your latest test results with those of a previous test.

What does the BMD result mean? The results of your BMD test are usually reported as a "T score." The T score compares your bone density with that of healthy young adults. The World Health Organization (WHO) has defined T-scores and what they mean.

  • Normal bone density: -1.0 and above

  • Low bone density or osteopenia: between -1.0 and -2.5

  • Osteoporosis: -2.5 or lower

Screening recommendations for osteoporosis.

Several major organizations have made recommendations for screening based on careful review of the research available. To learn more, talk with your health care provider about what is right for you.

Prevention

The best way to good bone health is through prevention. There are many things you can do in your daily life to maintain bone health and prevent osteoporosis.

  • Get enough calcium and vitamin D

  • Do regular weight-bearing exercise

  • Avoid behaviors that harm bone health such as smoking and drinking alcohol

  • Reduce the risk of falls

  • Speak with a health care provider about osteoporosis. This is important if one is taking medicines or has a chronic disease that increases the risk for developing osteoporosis

Read More

Osteoporosis: The Bone Thief (National Institute on Aging)

Smoking and Bone Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases)

ChooseMyPlate.gov (United States Department of Agriculture)

About Osteoporosis: What Men Need to Know (National Osteoporosis Foundation)

Secondary Osteoporosis (International Osteoporosis Foundation) (PDF)

DXA Scanning to Diagnose Osteoporosis: Do You Know What the Results Mean? (The Cleveland Clinic)

Source Documents

Bone Health and Osteoporosis: A Report of the Surgeon General (2004)

Osteoporosis (MedlinePlus)

Calcium - Office of Dietary Supplements (National Institutes of Health)

Facts and Statistics about Osteoporosis and Its Impact (International Osteoporosis Foundation)

National Osteoporosis Foundation on Bone Mineral Density Testing

Osteoporosis in Men (International Osteoporosis Foundation)


Updated September 1, 2011