postmenopausal

Osteoporosis is a disease in which your bones become weak and are likely to fracture (break). The disease can develop when your bone mineral density and bone mass decrease. It can also happen if the structure and strength of your bones change.

Osteoporosis is called a "silent" disease because it doesn't usually cause symptoms. You may not even know you have the disease until you break a bone. This could happen with any bone, but it's most common in the bones of your hip, vertebrae in the spine, and wrist.

Your bones are made of living tissue. To keep them strong, your body breaks down old bone and replaces it with new bone. Osteoporosis develops when more bone is broken down than replaced. You lose bone mass and changes happen in the structure of your bone tissue. This can happen as you get older. Other risk factors can also lead to the development of osteoporosis or increase your chance of developing the disease.

Anyone can develop osteoporosis, but you are more likely to develop it if you have one or more risk factors:

• Your sex. Osteoporosis is more common in women, especially after menopause (postmenopausal).
• Your age. Your risk increases as you get older. It is most common in people over age 50.
• Your body size. It is more common in people who are slim and thin boned.
• Your race:
  • White and Asian women are at highest risk.
  • African American and Mexican American women have a lower risk.
  • White men are at higher risk than African American and Mexican American men.
• Family history. Your risk of osteoporosis may be higher if one of your parents has osteoporosis or broke their hip.
• Changes to hormones. Low levels of certain hormones can increase your chance of developing osteoporosis.
• Diet. A diet that is low in calcium and/or vitamin D or does not include enough protein can raise your risk.
• Long-term use of certain medicines, such as:
  • Corticosteroids
  • Proton pump inhibitors (which treat GERD)
  • Medicines to treat epilepsy
• Having other medical conditions, such as:
  • Endocrine diseases
  • Certain digestive diseases
  • Rheumatoid arthritis
  • Certain types of cancer
  • HIV
  • Anorexia nervosa, a type of eating disorder
• Your lifestyle. Certain lifestyle factors can contribute to bone loss, such as:
  • Smoking tobacco
  • Long-term heavy alcohol use
  • Physical inactivity or prolonged periods of bedrest

Osteoporosis usually doesn't cause symptoms. You may not know that you have it until you break a bone.

Health care providers often diagnose osteoporosis during routine screening for the disease. The U.S. Preventive Services Task Force recommends screening for:

• Women age 65 and older
• Postmenopausal women under age 65 who have factors that increase the chance of developing osteoporosis

For men, it isn't clear yet whether regular screening is helpful. More research is needed to know for sure.

To find out if you have osteoporosis, your provider:

• Will ask about your medical history and whether you have ever broken a bone
• May do a physical exam, which could include checking for:
  • A loss of height and/or weight
  • Changes in your posture
  • Balance and gait (the way you walk)
  • Your muscle strength
• Will likely order a bone density scan
• May do a fracture risk assessment, which is a short questionnaire that helps estimate your risk of breaking a bone in the next 10 years
• Will likely order a bone density scan
• May do a fracture risk assessment, which is a short questionnaire that helps estimate your risk of breaking a bone in the next 10 years

The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures. Your provider may recommend:

• A healthy, balanced diet that includes enough calcium, vitamin D, and protein
• Lifestyle changes such as quitting smoking and limiting alcohol
• Regular physical activity including weight-bearing exercise (like walking), strength training, and balance exercises
• Fall prevention to help prevent fractures
• Medicines, such as:
  • Medicines that slow down bone loss
  • Medicines that help rebuild bone

In addition to managing your osteoporosis, it's important to avoid activities that may cause a fracture. These can include movements that involve:

• Twisting your spine, like swinging a golf club
• Bending forward from the waist, like sit ups and toe touches

You can also help reduce the risk of breaking a bone by preventing falls.

To help keep bones strong and help prevent osteoporosis, the best thing to do is to eat a healthy diet rich in calcium and vitamin D. Getting regular physical activity, limiting alcohol, and not smoking can also help.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Calcium is a mineral, a nutrient that you need (in small amounts) to keep your body healthy. You have more calcium in your body than any other mineral.

Calcium has many important jobs:

• To build and maintain strong bones. Your body stores almost all of its calcium in your bones and teeth to keep them strong.
• To help your muscles move.
• To help your nerves to carry messages between your brain and the rest of your body.
• To help your blood vessels move blood throughout your body.
• To help release hormones that affect many functions in your body.

Not getting enough calcium can cause several conditions, including:

• Osteoporosis, a disease which can make your bones weaker and more likely to break.
• Rickets, a disease in children that causes soft, weak bones.
• Osteomalacia, a condition which causes soft bones in children and adults.

You can get calcium from foods and supplements. You may be able to get enough calcium by eating a variety of foods, including:

• Dairy products such as milk, cheese, and yogurt. These are the main food sources of calcium for most people in the United States.
• Leafy, green vegetables such as kale, broccoli, and Chinese cabbage (bok choi).
• Fish with soft bones that you can eat, such as canned sardines and salmon.
• Calcium-enriched foods such as breakfast cereals, fruit juices, soy and rice drinks, and tofu. The product labels for these foods will show how much calcium they have.

Calcium is available in supplements. It is also included in many multivitamins. The two main forms of calcium supplements are calcium carbonate and calcium citrate:

• Calcium carbonate is absorbed best when taken with food. Some over-the-counter antacids, such as Tums and Rolaids, also contain calcium carbonate.
• Calcium citrate is absorbed well on an empty stomach or a full stomach. People with low levels of stomach acid absorb calcium citrate more easily than calcium carbonate.

Calcium is absorbed best when you take 500 mg or less at one time. If you are taking more than that amount each day, take a smaller dose twice a day rather than taking it all at once.

Calcium supplements might cause gas, bloating, and constipation in some people. If you have any of these symptoms, you could try:

• Spreading out the calcium dose throughout the day
• Taking it with meals
• Switching the form of calcium you take

The amount of calcium you need each day depends on your age and other factors. The recommended amounts, in milligrams (mg), are:

• Birth to 6 months: 200 mg
• Infants 7-12 months: 260 mg
• Children 1-3 years: 700 mg
• Children 4-8 years: 1,000 mg
• Children 9-13 years: 1,300 mg
• Teens 14-18 years: 1,300 mg
• Adults 19-50 years: 1,000 mg
• Adult men 51-70 years: 1,000 mg
• Adult women 51-70 years: 1,200 mg
• Adults 71 years and older: 1,200 mg
• Pregnant and breastfeeding teens: 1,300 mg
• Pregnant and breastfeeding adults: 1,000 mg

Certain people may have trouble getting enough calcium, including:

• Children and teens age 4 to 18 years
• People who are Black or Asian
• Adults age 50 years and older living in poverty
• Postmenopausal women; your body absorbs and retains less calcium after menopause
• People who don't drink milk or eat other dairy products

Check with your health care provider to see if you need to take calcium supplements, and if so, how much you should take. Your provider may want to first do a calcium blood test to see if you are getting enough of it.

NIH: National Institutes of Health Office of Dietary Supplements