Osteoporosis in Aging
Protect Your Bones with Exercise
\n ![\"Illustration](\"http://newsinhealth.nih.gov/files/jan2015/images/feature1.jpg\")
\n Bones feel solid, but the inside of a bone is actually filled with holes like a honeycomb. Bone tissues are broken down and rebuilt all the time. While some cells build new bone tissue, others dissolve bone and release the minerals inside.
\nAs we get older, we begin to lose more bone than we build. The tiny holes within bones get bigger, and the solid outer layer becomes thinner. In other words, our bones get less dense. Hard bones turn spongy, and spongy bones turn spongier. If this loss of bone density goes too far, it\u2019s called osteoporosis. Over 10 million people nationwide are estimated to have osteoporosis.
\nIt\u2019s normal for bones to break in bad accidents. But if your bones are dense enough, they should be able to stand up to most falls. Bones weakened by osteoporosis, though, are more likely to break.
\n\u201cIt\u2019s just like any other engineering material,\u201d says Dr. Joan McGowan, an NIH expert on osteoporosis. If you fall and slam your weight onto a fragile bone, \u201cit reaches a point where the structures aren\u2019t adequate to support the weight you\u2019re putting on them.\u201d If the bone breaks, it\u2019s a major hint that an older person has osteoporosis.
\nBroken bones can lead to serious problems for seniors. The hip is a common site for osteoporosis, and hip fractures can lead to a downward spiral of disability and loss of independence. Osteoporosis is also common in the wrist and the spine.
\nThe hormone estrogen helps to make and rebuild bones. A woman\u2019s estrogen levels drop after menopause, and bone loss speeds up. That\u2019s why osteoporosis is most common among older women. But men get osteoporosis, too.
\n\u201cA third of all hip fractures occur in men, yet the problem of osteoporosis in men is frequently downplayed or ignored,\u201d says Dr. Eric Orwoll, a physician-researcher who studies osteoporosis at Oregon Health and Science University. Men tend to do worse than women after a hip fracture, Orwoll says.
\nExperts suggest that women start getting screened for osteoporosis at age 65. Women younger than age 65 who are at high risk for fractures should also be screened. Men should discuss screening recommendations with their health care providers.
\nScreening is done with a bone mineral density test at the hip and spine. The most common test is known as DXA, for dual-energy X-ray absorptiometry. It\u2019s painless, like having an X-ray. Your results are often reported as a T-score, which compares your bone density to that of a healthy young woman. A T-score of ?2.5 or lower indicates osteoporosis.
\nThere\u2019s a lot you can do to lower your risk of osteoporosis. Getting plenty of calcium, vitamin D, and exercise is a good start, Orwoll says.
\nCalcium is a mineral that helps bones stay strong. It can come from the foods you eat\u2014including milk and milk products, dark green leafy vegetables like kale and collard greens\u2014or from dietary supplements. Women over age 50 need 1,200 mg of calcium a day. Men need 1,000 mg a day from ages 51 to 70 and 1,200 mg a day after that.
\nVitamin D helps your body absorb calcium. As you grow older, your body needs more vitamin D, which is made by your skin when you\u2019re in the sun. You can also get vitamin D from dietary supplements and from certain foods, such as milk, eggs, fatty fish, and fortified cereals. Talk with your health care provider to make sure you\u2019re getting a healthy amount of vitamin D. Problems can arise if you\u2019re getting too little or too much.
\nExercise, especially weight-bearing exercise, helps bones, too. Weight-bearing exercises include jogging, walking, tennis, and dancing. The pull of muscles is a reminder to the cells in your bones that they need to keep the tissue dense.
\nSmoking, in contrast, weakens bones. Heavy drinking does too\u2014and makes people more likely to fall. Certain drugs may also increase the risk of osteoporosis. Having family members with osteoporosis can raise your risk for the condition as well.
\nThe good news is, even if you already have osteoporosis, it\u2019s not too late to start taking care of your bones. Since your bones are rebuilding themselves all the time, you can help push the balance toward more bone growth by giving them exercise, calcium, and vitamin D.
\nSeveral medications can also help fight bone loss. The most widely used are bisphosphonates. These drugs are generally prescribed to people diagnosed with osteoporosis after a DXA test, or to those who\u2019ve had a fracture that suggests their bones are too weak. Bisphosphonates have been tested more thoroughly in women, but are approved for men too.
\nResearchers are trying to develop drugs that increase bone growth. For now, there\u2019s only one available: parathyroid hormone. It\u2019s effective at building bone and is approved for women and men with osteoporosis who are at high risk for having a fracture.
\nAnother important way to avoid broken bones is to prevent falling and occasions for fracture in the first place. Unfortunately, more than 2 million so-called fragility fractures (which wouldn\u2019t have happened if the bones had been stronger) occur nationwide each year. \u201cTo reduce the societal burden of fracture, it\u2019s going to take a combined approach of not only focusing on the skeleton but focusing on fall prevention,\u201d says Dr. Kristine Ensrud, a physician-researcher who studies aging-related disorders at the University of Minnesota and Minneapolis VA Health Care System.
\nMany things can affect the risk for a fall, such as how good a person\u2019s balance is and how many trip hazards are in the environment. The kind of fall matters, too. Wrist fractures often occur when a person falls forward or backward. \u201cIt\u2019s the active older person who trips and puts her hand out,\u201d McGowan says. Hip fractures often arise when a person falls to the side. Your hip may be strong enough to handle weight that goes up and down, but not an impact from another direction.
\n\u201cThat\u2019s why exercise that builds balance and confidence is very good at preventing fractures,\u201d McGowan says. For example, she says, tai chi won\u2019t provide the loads needed to build bone mass, but it can increase balance and coordination\u2014and make you more likely to catch yourself before you topple.
\nNIH-funded researchers are looking for better ways to tell how strong your bones are, and how high your chances are of breaking a bone. For now, though, the DXA test is the best measure, and many seniors, even older women, don\u2019t get it, Ensrud says. If you\u2019re concerned about your bone health, she adds, \u201cAsk your health care provider about the possibility of a bone density test.\u201d
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Reference: Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. J Bone Miner Res. 2007 Mar;22(3):465-75. PMID: 17144789.
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