Osteoporosis is not inevitable: what actually puts your bones at risk and how to fight back
An NYU Langone endocrinologist dismantles the fatalistic belief that bone loss is just part of getting older — and lays out who is truly at risk and what can be done about it.
The most dangerous thing about osteoporosis may not be what it does to your bones — it may be what people believe about it. The assumption that bone loss is simply an unavoidable fact of aging is both widespread and false, according to Dr. Susan Zweig, who serves as an endocrinologist and associate director of clinical affairs in the Holman Division of Endocrinology, Diabetes and Metabolism at NYU Langone Health.
Osteoporosis is clinically classified as a 'silent disease': bone density decreases and bone tissue deteriorates without any pain, aching, or physical warning. In many cases, a fracture resulting from a minor fall — or even an ordinary daily activity — is the first indication that anything is wrong. By that point, significant damage has already been done.
The stakes are serious. Vertebral fractures can lead to chronic pain. Hip fractures in older adults carry a risk of complications and death that, according to Zweig, can approach 30% within one year in some studies. Even a non-fatal fracture can strip someone of their mobility and independence — and the fear of falling can itself become disabling, leading people to exercise less, withdraw from activities they enjoy, and become socially isolated.
While postmenopausal women are among those at highest risk — because declining estrogen levels accelerate bone loss — Zweig is direct that osteoporosis is not exclusively a women's disease. Men can develop it too, particularly when testosterone levels fall. The risk profile is broader than most people assume.
Low body weight, low BMI, significant weight loss, and smaller stature are all risk factors, as people in these categories may have less bone mass to begin with. A prior fragility fracture — the kind that results from something as minor as a low-impact fall — substantially elevates the odds of sustaining another one. Family history matters too: having a parent who fractured a hip can substantially increase a person's own risk of a hip fracture or other major osteoporotic fracture.
Several medical conditions can also undermine bone health. These include hyperthyroidism, Cushing's syndrome (which causes excess cortisol production), rheumatoid arthritis and other inflammatory conditions, and chronic diseases affecting the kidneys, liver, and gastrointestinal tract. Certain medications add to the risk as well — drugs that suppress estrogen or testosterone, and some seizure medications, can contribute to bone loss. That means breast cancer patients, prostate cancer patients, and people treated for epilepsy may need their bone health monitored.
Lifestyle factors are among the most controllable variables. Smoking and heavy alcohol consumption — defined as more than two drinks a day for men and more than one for women — increase the risk of bone loss. A sedentary lifestyle is another significant factor.
On the prevention side, Zweig points to nutrition and exercise as the two pillars. The typical daily calcium requirement for adults runs from 1,000 to 1,200 milligrams, an amount obtainable through dairy products and fortified foods. Vitamin D — available from sunlight and foods including salmon, mackerel, egg yolks, and dairy — is also essential, as are magnesium, potassium, and vitamins K and C. Adequate protein intake matters too.
For exercise, weight-bearing activities — brisk walking, hiking, running, dancing, aerobics — and resistance training are the most effective for building and maintaining bone strength. According to Zweig, yoga, Pilates, and tai chi deliver genuine benefits for flexibility, core strength, and balance — all of which can lower the risk of falls — but they are not substitutes for weight-bearing or resistance exercise when bone density is the goal.
The most effective long-term strategy, Zweig writes, is to accumulate as much bone mass as possible in early life — peak bone mass arrives in the late 20s — and then preserve it through consistent healthy habits. Some bone loss with age is normal; significant, fracture-causing bone loss is not.
Why it matters — Osteoporosis affects men and women across a wide range of ages and health profiles, its consequences can be fatal, and yet it is largely preventable through steps that can be taken at any stage of life.
⚠ Not yet confirmed
- Mortality after a hip fracture can approach 30% within one year.
Reported by nypost.com, news.grabien.com, archive.md
