Osteoporosis Risk: Keeping Bones Dense

Note: This post was updated with new information on November, 21 2008. After reading this, click here, for more information about medicaions and how long you should take them.

Osteopenia and osteoporosis are conditions where thinning of the bones increase the risk for fracture – most commonly in the hip and spine. Fractures can lead to chronic pain, disability and even death. Treatment is aimed at early identification and prevention in order to avoid these three potential life-altering events. Compare the picture on the left of healthy dense bone to the one on the right of osteoporetic bone. The healthy bone is dense and sturdy while the osteoporetic bone would fracture easily if enough force were exerted on it, from a fall, for example.

Osteopenia and osteoporosis occur most often in post-menopausal women due to the lack of estrogen after menopause. (Estrogen helps keep bones strong.) But they can also occur in men, too (see the list of risk factors below). Osteopenia is “pre-osteoporosis.” In other words, the bones have thinned some, but not to the extent that they have in full blown osteoporosis.

An easy way to understand this is to picture a slice of swiss cheese. If there are only a few holes, the bones remain strong. If there are a few more holes but the slice is still more cheese than holes, that’s what osteopenia is like. If there are more holes than there is cheese (as in our picture) then the scaffold that supports the bone is weak and will easily fracture.

Osteopenia and osteoporosis have no symptoms and do not cause pain. So if you aren’t screened for them with a bone density test, they might go undetected until a fracture occurs. Bone density can be measured with a test called a DEXA scan. It is painless and takes only a few moments to perform. To learn more about bone density testing, click here.

Risk Factors for Osteopenia and Osteoporosis

  • Post-menopausal females (lack of estrogen leads to bone thinning).
  • Being Caucasian or from Southeast Asia.
  • Thin body frame (and that’s true for both both men & women).
  • Being an alcoholic (again, that’s for both men & women).
  • Long term treatment with steroids now or in the past (men and women).
  • Taking Depo-Provera for birth control.
  • Being malnourished or having an eating disorder like anorexia or bulimia (men and women).
  • Avoiding or not getting enough weight bearing exercise.
  • Being treated with a high a dose of thyroid medicine or have an overactive thyroid gland.
  • Having a family with history of osteopenia or osteoporosis.
  • Not getting enough calcium and vitamin D intake daily (1200 to 1500 mgs/day of calcium and 400IU of Vitamin D).

Treatment for Osteopenia and Osteoporosis

Treatment to maintain your current bone density and prevent further thinning of your bones employs lifestyle modifications and sometimes medication. Maintaining bone density with lifestyle and adequate calcium and vitamin D early in life (meaning starting in your teens) is the best way to build and maintain bone density. Medication can preserve thinning bones and reduce fractures in those who are older and at high risk according to their FRAX score. If you have any problems with this link just Google “FRAX score”.

Lifestyle Behaviors

Lifestyle behaviors that help prevent and slow the progress of osteopenia and osteoporosis include a diet with adequate amounts of vitamin D and calcium plus weight bearing exercise. If you are at risk, daily dosages of 400-800 IU of vitamin D plus 1200-1500 mg of calcium are recommended. If you are not getting that much vitamin D and calcium in your diet, you should take quality vitamin supplements. Exercise should be targeted to achieve three results:

  1. Increased weight bearing to maintain bone density (i.e. walking or running versus biking or swimming).
  2. Improving balance to reduce your fall risk (yoga, physical therapy, and Tai Chi are all great ways to improve your balance).
  3. Training with weights to build muscle strength (elderly body builders achieve more improvement in their strength than younger people do)!


Most of the common medications used for osteopenia and osteporosis do not build bone, they just prevent further thinning. All the various medications used to treat osteoporosis and osteopenia are reviewed here.

Do you need medication?

At the present time, treatment with medication is recommended for those who have full-blown osteoporosis as measured by their bone density test. Younger post-menopausal women with osteopenia and low risk on their FRAX score may postpone treatment with medication and engage in those lifestyle behaviors that maintain their bone density. All women after menopause should have their bone density tested every two years. Check with your provider about the costs and coverage of DEXA scanning.

Links to More Info on Osteopenia and Osteoporosis

  1. This is a 3 minute story from NPR about a new online tool created by the World Health Organization that measures your risk.
  2. Here’s the risk tool talked about in the NPR story in English: FRAX – Fracture Risk Assessment Tool. It is available in other languages at this link.
  3. Here is a link to the National Osteoporosis Foundation..
  4. Finally, here is a mother lode of great information at the National Institutes of Health website: Medline on Osteoporosis

So what are you doing to stay strong!

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

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#1 | On January 20, 2009, Dr. Diane Brzezinski, DO said:

Hi Carla,
Don’t forget about those women using Depo-Provera as a contraceptive.  They are also at high risk and need appropriate screening.  Great job!  Keep up the good work.

#2 | On January 20, 2009, Carla Mills said:

Thanks for the comment, Dr. B., and for stopping by the blog

Readers, let me introduce Dr. Diane Brzezinski, the physician with whom I share an internal medicine practice in Naples, FL. Ostoporosis is one of her areas of interest and expertise, so I appreciate her reading this post and pointing out that those of you on Depo-Provera also need to watch your bone densities. I’ve added it to the other risk factors listed above.

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