Preventing or mitigating the effects of osteoporosis is important because it is considered a silent disease—sometimes, the first sign is a fracture from a minor slip or fall. A broken bone, especially if it’s the hip, can have serious consequences, including loss of mobility, independence, and even death, for an older person.

Although osteoporosis affects an estimated 10 million Americans, women account for 80% of those affected. Women tend to have bones that are less dense than men, and low bone density increases the risk of bone breakage. What’s more, estrogen helps to preserve bone density, which is why women are particularly susceptible to osteoporosis after the loss of ovarian estrogen production due to menopause.

There is no cure for osteoporosis, but bone loss can be slowed down.

Bones are living tissues that are continually “remodeling.” This involves the resorption, or breakdown, of old bone and the formation of new bone.

As kids and young adults, our bones typically grow faster than they break down. By ages 25 to 30, our bones will reach peak mass—or the greatest amount of bone tissue an individual can produce. Bone mass plateaus from around ages 30 to 50. After age 50, our bones begin to break down quicker than they regenerate, leading to an aging-related loss of bone mass. As bone mass decreases, bone structure changes, too—leading to less dense, thinner, and more fragile bones.

“Osteoporosis is defined as bone loss beyond a threshold that quadruples the fracture risk compared to a healthy 35-year-old woman,” says Dr. Bergwitz.

For people with severe osteoporosis, simple actions, such as bending over, coughing, or bumping into furniture, can lead to a broken bone. Wrist, hip, and spine fractures are among the most commonly affected areas, but fractures can occur anywhere in the body.

Doctors can measure bone density with tests called dual-energy X-ray absorptiometry (DEXA) scans. DEXA scans use low-energy X-rays to measure how tightly minerals are packed in a bone segment. Health care providers recommend routine DEXA scans starting at age 65 for women and age 70 for men. The test is repeated every few years or more often if necessary. If patients have additional risk factors, physicians may suggest beginning DEXA scans earlier.

Some of those risk factors include smoking, excessive alcohol consumption, having an inflammatory disease, such as rheumatoid arthritis (the drugs—steroids—often used to treat it can also weaken bones), using hormone blockers to treat breast or prostate cancer, having low testosterone (in men), and being thin (because fat protects bones from injury).

The DEXA scans can also detect osteopenia, a condition in which your bone density is lower than normal but not severe enough to be considered osteoporotic.

DEXA scan results are presented as “T-scores” and “Z-scores.” T-scores, which are used for postmenopausal women and men ages 50 and older, compare a patient’s bone mineral density to that of a healthy 35-year-old woman.

T-score results can fit into one of several categories:

• Normal bone density: +1 to -1
• Low bone mass (osteopenia): -1 to -2.5
• Osteoporosis: -2.5 or lower

Z-scores are used for children, young adults, premenopausal women, and men younger than 50. These scores compare patients’ bone density to the average bone density of healthy people of the same age, ethnicity, and sex. Z-scores of –2.0 or lower indicate a low bone density—essentially, you may have lost bone more rapidly than others your age.

While DEXA scans can show bone strength, they are only one factor that predicts the likelihood of a fracture. Health care providers may use the Fracture Risk Assessment Tool—or FRAX—to calculate the 10-year probability of bone fracture in a patient and include other risk factors (more on that below).

Whether you are trying to prevent osteoporosis or lessen its effects if you have it, Dr. Bergwitz advises focusing on what he calls the four pillars of bone health: nutrition, weight-bearing exercise, fall prevention, and medication, if needed.

Nutrition

In addition to overall healthy nutrition, getting proper amounts of calcium and vitamin D are important to bone health, Dr. Bergwitz says. Calcium hardens and strengthens bones, and almost all calcium in the body is stored in the bones and teeth. Vitamin D helps the body absorb the calcium people get from food.

“Through a blood test, we can measure vitamin D levels, and typically, we are looking to see them between 30 to 50 nanograms per milliliter,” he says.

Doctors can also order a parathyroid function, blood, and urine calcium test to measure the body’s calcium levels, which, if low, can cause reduced bone density and loss.

If the vitamin D and calcium levels are low, Dr. Bergwitz recommends that patients take a supplement for both if they can’t reach the ideal amounts in their diet. “Before menopause, we recommend women get 1,000 milligrams of calcium and 800 units of vitamin D a day from their diet and/or supplements,” he says. (This is also the recommended daily amount for adult men.) “After menopause, it’s 1,200 milligrams of calcium and 1,000 units of vitamin D.”

Vitamin D is not found naturally in many foods, but good sources are alfalfa sprouts, mushrooms, yeast, wild-caught mackerel, salmon, and tuna. It is also added to milk and other dairy products, as well as to orange juice, soymilk, and some cereals. Calcium is easier to find in foods; some that are rich in the mineral include collard greens, kale, broccoli, dried figs, oranges, and dairy products.

While many health experts generally advise people to get their calcium and vitamin D from food sources, Dr. Bergwitz acknowledges this can be difficult if someone is trying to watch their calorie intake, as it takes about four servings of dairy to reach the daily calcium recommendations.

If people choose to take supplements, Dr. Bergwitz suggests taking them with food to improve calcium absorption.

Weight-bearing exercise

Putting stress on your bones through impact and weight-bearing exercises can strengthen them. Activities such as brisk walking, running, dancing, climbing stairs, and sports, such as tennis, badminton, and pickleball, apply stress to the bones, which stimulates bone formation, increases bone density, and slows down bone loss.

“Join a gym, talk to a trainer, and find things that are right for you,” Dr. Bergwitz says. “You want to incorporate weight-bearing activities. Things like swimming and cycling are great for cardiovascular health, but they don’t put much or any stress on the bones.”

Resistance training (lifting weights or using weight machines or resistance bands) can also help strengthen bones. Such movements make the muscles work harder and become stronger. He adds that strong muscles also support balance, thereby lowering fall and fracture risk.

How much activity you should do each day or week is highly dependent on your fitness level, overall health, and goals. Everyone should consult with their family physician before starting a new routine, he notes.

Fall prevention

When exercising, it’s also important to concentrate on balance because poor balance increases the risk of falls and, therefore, bone fractures.

Yoga, tai-chi, balance classes, and even simple home exercises, such as standing on one foot, walking backward, and doing lunges, are just a few ways to improve your balance.

“People can also decrease their fall risk by inspecting their homes for safety. This might entail adding handrails in the bathroom or non-slip coating in the shower and tub, and removing clutter or obstacles from your general living space,” Dr. Bergwitz says.

Medication

The last pillar to treating osteopenia and osteoporosis is medication. In addition to a DEXA scan, doctors often use the Fracture Risk Assessment (FRAX) tool from the University of Sheffield in the United Kingdom. As mentioned above, the tool has an algorithm to predict someone’s 10-year probability of hip fracture or breaking other major bones.

These scores combine DEXA results with other factors, such as family and personal history, which can help decide whether the benefits of using medication outweigh the risks. All the medications, Dr. Bergwitz notes, have both immediate and long-term side effect risks, the latter of which typically occur after 10 years of using the same therapy.

There are many different types of drugs to treat osteoporosis, and they work in different ways, including inhibiting bone loss (thereby increasing or maintaining bone density) and increasing bone formation. They include a class of drugs called bisphosphonates (Actonel®, Fosamax®, Boniva®, and Reclast®), estrogen therapy (Evista®, for postmenopausal women), a synthetic version of parathyroid hormone (Forteo® and Tymlos®), and two monoclonal antibodies (Prolia® and Evenity®). They are also delivered in different ways, including by pill, injection, or infusion.

Because there are so many different options, each with its own set of side effects or contraindications, an individual with osteoporosis should discuss all options with their physician, who could be their primary care provider or a specialist, such as an endocrinologist.

“The big picture is that the benefits of these medications outweigh the risks, and their use merits a serious discussion between the patient and the provider,” Dr. Bergwitz says. “Many people are reluctant to take these medications because osteoporosis doesn’t hurt you until you have a fracture. But a hip fracture can be life-threatening, cause permanent mobility issues, and a loss of independence for older people.”