Osteoporosis – Decreasing Osteoporosis Risk Factors

Making healthy lifestyle choices when it comes to diet and exercise can make all the difference when it comes to overall bone health and decreasing risks of osteoporosis.

As bone is lost, the skeleton becomes more and more osteoporotic and prone to bone fracture. While everyone loses some bone, there are those that are less likely to suffer from osteoporosis until they are very, very old, if at all, while still others may develop osteoporosis at a younger age.

Those that do not develop osteoporosis have strong bones to begin with or their rate of bone loss is slower so the bones remain strong well into old age. For the majority though the process of bone thinning is much faster.

Being aware of the risk factors and making changes to them or avoiding them altogether may make all the difference in the affect that osteoporosis may have on one’s life.

Decreasing Risk Factors

There are many risk factors for osteoporosis. Some of the risk factors can be minimized or decreased, and some cannot.

Osteoporosis is largely preventable for most people. Prevention of this disease is very important because, while there are treatments for osteoporosis, there is currently no cure.

The risks are additive, meaning that the more risk factors you possess, the greater your chances for developing the disease. While there are many factors that are unavoidable, there are several that can be changed.

Avoidable Risk Factors For Osteoporosis

Risk factors that can be controlled include the following;

Inadequate Amounts Of Calcium

Your bone mass is at its peak around age 30. Maintaining strong bones can be ensured through a few measure, one of the most important of which is getting proper levels of dietary calcium. According to the Institute of Medicine, Food and Nutrition Board, for adults aged 19-50, the recommended dietary intake is 1000 mg/day. For age 51 and over, it is 1200 mg/day.

The best sources of calcium are dairy products, as well as some green vegetables such as kale, broccoli and spinach. Women who get most of their daily calcium from food have healthier bones than women whose calcium comes mainly from supplemental tablets, according to a 2015 study by Washington University School of Medicine researchers. Surprisingly, this is true even though the supplement takers have higher average calcium intake.

One daily dairy serving will equal about 300 milligrams. One serving size of dairy is the equivalent of one 8 ounce cup of milk, a cup of yogurt or one to 1.5 ounces of cheese.  A 2006 study found that high-calcium mineral waters were just as absorbable as milk calcium or slightly better, and might provide useful quantities of bio-available calcium.

Since calcium is absorbed with the aid of vitamin D, it is also an important nutrient in the maintenance of bone health. 
Sunlight is the most common source of vitamin D, and it doesn’t take much. 5 to 15 minutes of sun exposure between 10 AM to 3 PM at least two times a week to the face, arms, hands, or back is usually enough for most people to guarantee sufficient vitamin D levels. Also, vitamin D-containing foods such as salmon, sardines, egg yolks, or fortified milk can be added to your diet to make up for the days when you are not able to get sun.

If you are still unsure if you are getting enough, it is recommended by the NIH Osteoporosis and Related Bone Diseases ~ National Resource Center that adults have vitamin D intakes of 600 IU (International Units) daily up to age 70. Men and women over age 70 should increase their uptake to 800 IU daily.

Not Enough Estrogen

woman and dog
Estrogen is essential for healthy bone, and when the production of estrogen is reduced, as occurs normally in postmenopausal women and pathogenically after exposure to radiation or chemotherapeutic drugs, bones become brittle and break easily.

Estrogen helps the activity of osteoblasts, cells that produce bone. So when estrogen levels drop, either due to menopause or other factors, osteoblasts are unable to produce bone effectively.

Therapy for replacement of estrogen can slow bone loss and promote the absorption and retention of calcium. Estrogen therapy does, however, carry risks, and it is recommended only for women at high risk for osteoporosis who have other reasons for using it, such as severe menopausal symptoms.

Treatment alternatives to hormone therapy include bisphosphonate drugs such as Actonel, Atelvia, Boniva and Fosamax, which have been shown to slow bone loss, increase bone density, and reduce the risk of fractures.

Evista is a selective estrogen receptor modulator (SERM) drug that functions similar to estrogen. It can prevent bone loss at the spine, hip, and other areas of the body and has been shown to decrease the rate of vertebral (back) fractures by up to 30 to 50 percent.

In men, low testosterone levels can increase risk. Although it is natural for testosterone levels to decrease with age, there should not be a sudden drop in this hormone that is comparable to the drop in estrogen experienced by women at menopause. However, medications such as glucocorticoids (steroid medications used to treat diseases such as asthma and rheumatoid arthritis – bone loss is a very common side effect of these medications), cancer treatments (especially for prostate cancer), and many other factors can affect testosterone levels.

Testosterone replacement therapy may be helpful in preventing or slowing bone loss. 

Research suggests that estrogen deficiency may also be a cause of osteoporosis in men. For example, estrogen levels are low in men with hypogonadism and may play a part in bone loss. Osteoporosis has been found in some men who have rare disorders involving estrogen. Therefore, the role of estrogen in men is under active investigation.

Lack Of Exercise

A sedentary lifestyle or long-term bed rest can cause weak bones. Research has shown a positive correlation between bone mineral density and exercise. Intervention studies suggest that high impact exercises are better at increasing bone mineral density (BMD). For example, weight training, running and squash can increase BMD, but swimming has no effect.

squash
Regular weight bearing exercise, at least half an hour three times a week will help to develop and maintain bone strength and may help reverse the effects of bone loss.

Smoking

Cigarette smoking was first identified as a risk factor for osteoporosis decades ago. Studies have shown a direct relationship between tobacco use and decreased bone density.

man
Analyzing the impact of cigarette smoking on bone health is complicated. It is hard to determine whether a decrease in bone density is due to smoking itself or to other risk factors common among smokers. For example, in many cases smokers are thinner than nonsmokers, tend to drink more alcohol, may be less physically active, and have poor diets.

Women who smoke also tend to have an earlier menopause than nonsmokers. These factors place many smokers at an increased risk for osteoporosis apart from their tobacco use.

Use of Alcohol

Alcohol negatively affects bone health for several reasons. To begin with, excessive alcohol interferes with the balance of calcium, an essential nutrient for healthy bones. Calcium balance may be further disrupted by alcohol’s ability to interfere with the production of vitamin D, a vitamin essential for calcium absorption.

In addition, chronic heavy drinking can cause hormone deficiencies in men and women. Men with alcoholism may produce less testosterone, a hormone linked to the production of osteoblasts (the cells that stimulate bone formation).

wine glasses
In women, chronic alcohol exposure can trigger irregular menstrual cycles, a factor that reduces estrogen levels, increasing the risk for osteoporosis. Also, cortisol levels may be elevated in people with alcoholism. Cortisol is known to decrease bone formation and increase bone breakdown.

Because of the effects of alcohol on balance and gait, people with alcoholism tend to fall more frequently than those without the disorder. Heavy alcohol consumption has been linked to an increase in the risk of fracture, including the most serious kind — hip fracture. Vertebral fractures are also more common in those who abuse alcohol.

To sum it up, minimizing your risk can be as simple as getting outside everyday and getting exposure to sunshine, taking dietary supplements, quitting smoking or limiting alcohol consumption.

Unavoidable Risk Factors For Osteoporosis

One unavoidable factor is being female. Women are twice as likely as men to suffer from fractures (a symptom of the disorder).

woman
One reason that women are at higher risk is that they tend to live longer than men. Women also start out with lower bone density then men do. When women reach menopause, they have a drop in estrogen production that accelerates bone mass loss. Once men reach 75, they are then just as likely as women to get osteoporosis.

Aging

Another risk factor for osteoporosis is age. As we age our bones naturally lose density and become weaker, so the older you are, the greater the risk for developing Osteoporosis.

Throughout childhood, adolescence and early adulthood bone mass and density strengthens until it reaches its peak somewhere around age 30 in normal, healthy adults.

Growing bone

Growing bone. Credit: Wellcome Images

Through a process called remodeling, bones are constantly being removed and replaced with new bone. Sometimes too much bone is removed, not enough is replaced, or both. Aging naturally slows this process as well as causing most everyone to experience some bone loss.

Race

Race is another risk factor. Those at highest risk are Caucasian women, then women of Southeast Asian heritage. Those men and women of Black or Hispanic heritage are also at risk.

The bone density of both men and women of Asian or Caucasian descent has been shown to be up to 10% less than that of those who are of African, Mediterranean or Aboriginal descent.

Medications

Medications can be a risk factor for this disorder. Steroid medications such as are used for chronic inflammatory diseases like asthma, rheumatoid arthritis and even psoriasis. Your healthcare provider can prescribe medications that can help prevent bond loss if you have to be on these steroids.

Certain hormone therapies like those used to treat under active thyroid can cause bone loss. Diuretics are used when there is a buildup of fluids in the body. When taken over time they can cause bone loss.

Other Factors

Those who have a family history, especially a female who has had fractures due to osteoporosis, will increase other family members risk.

Those of us who are thin or small framed are at higher risk for osteoporosis.

Those who suffer from eating disorders are at higher risk for osteoporosis. Eating disorders such as anorexia nervosa and bulimia are examples of eating disorders.

These risk factors cannot be changed. While possessing one or more of them does increase your risk of developing Osteoporosis it is not definitive, just as if you have none of them there is no guarantee that you will not develop the disease.

Unfortunately it may not be possible to avoid these risk factors but they may be amenable to management to minimize the risks, so discuss the options with your healthcare provider.

Lani Simpson
Dr. Lani’s No-Nonsense Bone Health Guide
Hunter House; 2014 ISBN-13: 978-0897936613

Waugh EJ, Lam MA, Hawker GA, McGowan J, Papaioannou A, Cheung AM, Hodsman AB, Leslie WD, Siminoski K, Jamal SA (January 2009)
Risk factors for low bone mass in healthy 40–60 year old women: a systematic review of the literature
Osteoporosis International  20 (1): 1–21