Worldwide the incidence of osteoporosis is growing at alarming proportions. However, like risks associated with heart disease and high cholesterol many of the risk factors associated with osteoporosis can be reduced by individual actions. Those which cannot be reduced through lifestyle changes can still be lessened by taking other measures to increase bone health (osteoporosis prevention). Risk factors associated with osteoporosis can be divided into two categories: Modifiable (arising from an unhealthy lifestyle) and fixed (the ones you can do nothing about).
Modifiable Risk Factors
These are risk factors which arise as a result of lifestyle choices, such as unhealthy diet and lack of exercise. Most of these factors directly affect bone quality and lead to a decrease in bone mineral density (BMD).
The most common modifiable risks are:
Large scale studies show that smoking increases the risk of a person developing osteoporosis by 150 percent. Studies carried out in the UK show that postmenopause women who smoke have a much more rapid decline of BMD than non-smokers. In fact one in 8 hip fractures which occur in women can be attributed to the effects of smoking. Smoking also decreases levels of estrogen in women, and estrogen is known to keep bones healthy. Smokers also go through menopause earlier, which again means estrogen levels drop sooner. They may also have difficulties in absorbing calcium, another essential ingredient for bone health. If that is not enough, fractures heal more slowly in smokers (both men and women).
This may appear confusing, as studies show that moderate amounts of alcohol is 'good' for your bones, but too much is 'bad'. So what is a moderate amount? The US Department of Health and Human Services defines moderate as one unit a day for women and no more than 2 units for men. As a rough guide, one unit is: One glass of beer (4 percent) 250ml/8.75oz; One glass of wine (12.5 percent) 80ml/2.80oz; One Spirit (40 percent) 25ml/0.88oz. Excess alcohol has negative effects on bones as it can lead to difficulties in the body absorbing calcium, as well as increasing levels of the stress hormone cortisol. The good news is, when people reduce drinking, bones can partially restore themselves.
Diet & Nutrition
Calcium is essential for bone mineral, as well as for many other body functions. Women older than 50 years of age need about 1500 mg of calcium a day which can be gained from drinking 4 glasses of fortified milk. As well as ingesting calcium it is important to note that certain foods rob the body of it. High protein foods increase the amount of calcium excreted in the urine (which is one of the negative side effects of a high protein diet). Too much salt is another culprit as well as sodas. Recent studies show that drinking dark colas (both diet and regular) my reduce bone density. Finally, vitamin D is essential as it helps calcium absorption. See also alternative treatment for osteoporosis.
Low Body Mass Index
If you have a small frame and narrow hips you may never have reached a high bone density during your formative year. This exposes you to increased risk of osteoporosis and other bone and joint problems in later years. Some studies are more exact and indicate that if you weigh 127 pounds or less (regardless of height) you are more prone to the disease. Doctors consider a body mass index (BMI) of 20 to 25 as ideal. Above this is considered overweight and over 30 is obese. BMI below 19 is considered underweight. Although fatter women have more estrogen, which protects bones, the net benefits is considered minimal.
Lack of Exercise
Men and women who have a sedentary lifestyle are more likely to have a hip fracture. For example, women who sit more than 9 hours a day are 50 percent more likely to have a hip fracture than those who sit for 6 hours a day. Like muscles, bones respond to being 'stressed' - in other words, weight bearing exercise. The best forms of weight bearing exercise are fast walking, jogging, lifting weights, dancing and jumping.
Those who suffer from eating disorders such as anorexia or bulimia are more likely to develop osteoporosis and experience bone fractures. This is connected to a lack of adequate nutrition, extreme weight loss and faults in hormone production (namely estrogen). The likelihood of developing the condition can be dramatically reduced by taking a calcium supplement.
Fixed Risk Factors
These are factors which are not 'fixable', in other words, there is very little we can do about. The most common fixed risks are:
Research shows that around 40 percent of women in America today are likely to develop osteoporosis, compared to about 10 percent of men. Postmenopausal women are more susceptible because they produce less estrogen. See Osteoporosis Statistics.
This is one of the primary risk factors. The vast majority of hip fractures (90 percent) occur in people aged 50 or older. This is because the bone regeneration process (called bone remodeling) slows down when a person is in their 20s, evens out in their 30s and tips into negative from the 40s onwards.
Genes play an important role in developing osteoporosis. If a parent develops a fracture the offspring is also more likely to develop one in later life, regardless of bone mineral density. This would suggest that additional factors are at play in bone health.
Caucasian women older than 65 are twice as likely to develop symptoms of osteoporosis (fractures) as African-American women. Latino's are somewhere between the two. This may be because white women have 5-10 percent less bone density starting off, but further research is necessary. Women with fair skin and light hair are also more prone, as well as those who start to go gray in their 20s and who are at least 50 percent gray by their 40s.
Both men and women are twice as likely to have a second fracture, if they experience a first one. The reason for this is not clear. BMD only accounts for about 10 percent of the risk. It may be that those who experience a fracture have less ease of movement, making them more prone to a second fall. This is why an osteoporosis diagnosis is important once a fracture has occurred.
An early menopause (which is becoming more common due to our stressful, toxic environment), increases the risk of osteoporosis as the body stops producing estrogen sooner. This means the bones have fewer years of estrogen benefit than in women who have a later menopause (read more about how menopause affects the body). The same principle applies to women who have a complete hysterectomy which involves removal of the ovaries. Even those who keep their ovaries, although they produce some estrogen for a time, often find it is not enough to prevent bones weakening (osteopenia, sometimes a precursor to osteoporosis).
When Periods Start
As estrogen rises during the menstrual cycle, the earlier you start your periods, the more likely you are to be protected from developing osteoporosis. The same principle applies to an early menopause and a halt to periods. The longer you menstruate, the better.
Certain medications can cause bone loss. If you do take these medications it is important to talk to your doctor about reducing your risk of developing osteoporosis. Medications include:
• Corticosteroids such as prednisone (used as an anti-inflammatory as well as for asthma, severe allergies or arthritis (see: cause of arthritis).
• Thyroid medication (such as L-Thyroxine).
• Heparin, a blood thinner for coronary heart disease treatment.
• Any drug that lowers estrogen or testosterone levels such as Lupron.
• Glucocorticosteroids, those taken orally or inhaled.
• Some antipsychotics used to manage psychosis.
• Certain anticonvulsants used for the management of epileptic seizures.
• Lithium, most commonly prescribed for treating depression.
• Antacids used to neutralize stomach acid.
• Vitamin A, in excess of 3,000 mg a day.
• Methotrexate used in cancer treatments.
• Proton pump inhibitors (PPIs) prescribed to those suffering from GERD and peptic ulcers.