Can I change any of my risk factors?

You cannot change your age, gender, sex, race, fracture history, family history, menstrual history, time of menopause, genetic factors, and most medical conditions. You can, however, change some risk factors because most of them are related to lifestyle. Here's what you can do to lower your risk of developing osteoporosis or low bone mass:

• If you smoke, stop. If you don't already smoke, don't start. Appendix B lists resources for quitting smoking.

• If you drink alcohol, use moderation. More than two drinks per day increases your risk of osteoporosis as well as your risk of falling and breaking a bone.

• Replace caffeinated beverages with beverages rich in calcium. If you drink coffee or tea, consider adding milk. When drinking hot chocolate or cocoa, consider making it with milk to increase your calcium intake.

• Change your sedentary lifestyle to an active one by exercising daily (see Questions 42-44).

• Improve your diet. Take in adequate amounts of calcium, vitamin D, citric acid (found in citrus fruits), and phosphorus, and cut down on the amount of salt you eat. Be sure you get adequate amounts of protein and fiber, but remember that excessive amounts of fiber and protein can interfere with absorption of needed nutrients for bone development, unless you also supplement with calcium in your diet (see Questions 47-53).

• Ask your clinician if you could substitute medications that you are taking with ones that are less likely to cause bone loss or that will protect bones (see Question 15).

• If you have any medical conditions that put you at greater risk for bone loss, discuss with your clinician how your condition could be managed to reduce the risk of jeopardizing your bone health. For example, if you have an eating disorder, discuss getting the help you need to resume eating a healthy diet. Or if your BMI is less than 18 (meaning you are underweight), get the help you need to gain enough weight to have a healthier BMI. Although having a BMI of < 22 increases your risk for osteoporosis, exercising and maintaining a healthy BMI (18-25) is important for overall health. Exercise will also reduce your risk for osteoporosis.

• If you are exercising to the point of not having menstrual periods (amenorrhea), consider reducing the amount of time that you exercise or try taking in more calories to make up for the extra expenditure of calories from extreme exercise.

• If you are experiencing moderate to severe symptoms of postmenopause such as hot flashes and night sweats, talk with your clinician about taking estrogen to help relieve your symptoms as well as lower your risk of osteoporosis.

Grace's comment:

Well, being Black, I didn't really think it was a big problem for me. But my girlfriend just found out she has osteoporosis, and she has to take medication for it! She told me to get tested, so I talked to my doctor about it. He said we don't need to test for it until after my periods stop, that the estrogen I have in my body helps protect my bones, but that after the estrogen goes down due to menopause, then I will need to be tested. I asked what else I can do to protect my bones now and he said regular exercise, vitamins C and D, and calcium. And he said it is good that I don't smoke. So I learned that I can be at risk, too!

I have always worked hard to stay thin. Now that I have osteoporosis, I'm wondering if that was such a good idea. What's the connection between body weight and bones?

It really depends on how thin you are. Question 12 explains how to calculate your BMI. If your BMI is less than 22, then your weight is a risk factor for osteoporosis. You say that you have worked hard to stay thin.

Did you have to work hard in the sense that you were on a stringent diet and may not have had adequate intake of calcium, vitamin D, and protein? Or did you exercise excessively to stay thin? Both lifestyles could interfere with the normal process of bone breakdown and bone formation. If you had very low body weight as a child or adolescent, it's possible that you never reached peak bone mass.

Obesity[1] (BMI > 30) can also contribute to the development of osteoporosis, usually because people who are obese tend to be less active and, most importantly, they tend to exercise less. Lack of exercise is correlated directly with bone loss (see Question 42). But being overweight or obese is not all bad when it comes to bone health. The mere act of carrying around extra weight can increase the stress on bones, which contributes to the making of new bone. More muscle mass and higher bone turnover[2] are also generally present in individuals who are overweight or obese. Both men and women who are overweight or obese have more circulating sex hormones, which assist in maintaining normal bone mass. Still, it's not clear if being overweight actually lowers the risk of fracture. Some older studies indicate that the risk of fracture is reduced in overweight women. But in later studies this risk is the same as those for normal-weight women. Unfortunately, being obese carries with it enormous health problems, so it's still considered advisable for overweight individuals to lose weight.

The bad news for you, as a very thin person, is that lower body weight (< 127 pounds or BMI < 22) is definitely linked to a higher risk of fracture. So, if you are thin and older, you are more likely to fracture your hip if you fall than your overweight counterparts, who may have denser bones and more fat to pad their falls.

And if you lose weight, intending to or not, your risk of hip fracture still goes up.

So, for you, being very thin, gaining enough weight to reach a BMI between 22 and 25 would be advisable after a discussion with your clinician. Reducing the potential for fracture should be your goal (see Questions 42-53 and 86).

  • [1] Condition of being severely overweight based on body mass index greater than 30, and associated with many health problems.
  • [2] The process of breaking down bone and forming new bone in its place, a process that occurs throughout life. When bone is growing (during childhood through early adulthood) new formation exceeds breakdown; later in life breakdown exceeds formation.
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