In itself, bone loss is a natural phenomenon. Your bones are made of collagen, a fibrous protein that supplies a soft framework, and the mineral calcium phosphate, which makes the framework harder and adds strength. But bones are not permanent fixtures. Like all living tissue, they change. When your body needs minerals like calcium, a special type of cells called osteoclasts break down bones to release the minerals – this is known as bone resorption. So throughout your life, old bone is reabsorbed by the body and new bone is formed. In fact, every 10 years, your skeleton is completely replaced with a brand new set of bones!1
Did you know women with osteoporosis are thrice as likely to have tooth loss than those without this condition? Thankfully, preliminary research indicates osteoporosis treatment may help improve dental health.2
So we can all expect some amount of bone loss as we age. But some people experience bone loss at a faster rate than is normal. Over time, this can lead to weak brittle bones with an increased risk of fracture, a condition known as osteoporosis. In some patients, bones can become so fragile that even a sneeze or a cough is enough to cause a rib fracture! And some fractures, particularly those that occur in the hip, can even permanently disable you.
What’s worrisome is that osteoporosis is not an uncommon problem. In fact, 53 million Americans either have osteoporosis or are at increased risk for it because they have low bone mass.3 There is, however, reason to take heart. While in the past, this condition was thought to be an unavoidable part of aging, experts now believe that controlling factors which increase your risk can go a long way in preventing osteoporosis. So let’s take a look at factors which may cause this disease.
Every day, bone tissue is added and withdrawn from your bones. During your childhood, adolescence, and early adult years, the rate at which new tissue is deposited is greater than the rate at which it is withdrawn. So, your bones become denser and stronger till the late 20s when you reach peak bone mass. But as you grow older, the rate at which bone tissue is withdrawn starts to outpace the rate at which it is formed. So you start to slowly lose bone density from around 35 years of age. Now, this happens to all of us, but some factors can increase your chances of accelerated bone loss and leave you vulnerable to osteoporosis. Age, of course, is a significant factor – women over 50 and men over 70 are at a higher risk for osteoporosis.4 5 6
2. Poor Diet
A well-balanced diet rich in fruits and vegetables and containing sufficient calcium, vitamin D, vitamin K, and calories is important to minimize bone loss. Calcium and vitamin D, which is required for calcium absorption, are particularly important.
You need 1300 mg of calcium in a day between the ages of 9 and 18 when your body’s building up its stock of this important mineral. Adults need 1000 mg per day. About 1200 mg per day is recommended from the age of 51 for women and after 70 for men. Where vitamin D is concerned, adult men and women need 600 IU of this vitamin per day and 800 IU after the age of 70.
What to do: Include calcium-rich foods like green leafy vegetables, milk, and soy beans in your diet. As far as vitamin D is concerned, your body can form this vitamin when you’re exposed to sunlight. But since overexposure to the sun can cause problems like premature skin aging and skin cancer, you may want to rely on dietary sources of vitamin D as well.7 Fish oils and fatty fish can give you vitamin D. Many foods like cereals and milk are also fortified with this vitamin.
3. Too Much Vitamin A
While vitamin A is important for bone growth, research indicates that excessive consumption of vitamin A, particularly retinol, can increase your risk of osteoporosis. Why does this happen? Too much vitamin A causes an increase of osteoclasts in the body. These cells are known to break down bone. Excessive use of vitamin A can also interfere with vitamin D, which is needed to preserve bone.8
What to do: It is advisable not to consume rich sources of vitamin A like liver more than once a week. And people who have a high risk for osteoporosis – for example, older people or post-menopausal women – are advised to limit their consumption of retinol to 1.5 mg per day. In fact, do check in with your doctor before taking any dietary supplements.9
4. Low Levels Of Sex Hormones
Low levels of the female hormone estrogen in women and the male hormone testosterone in men are associated with a higher risk of osteoporosis. We know that estrogen induces cell death in osteoclasts, the cells which break down bone so that the amino acids and minerals released can be used elsewhere in the body.10
The mechanism by which testosterone works is still a little hazy. We do, however, know that it is metabolized into an estrogen known as estradiol and that this is at least partly responsible for its bone-protecting properties.11
In women, menopause causes a sharp decline in estrogen levels. The most common symptom indicating an estrogen deficiency in women before menopause is the lack of menstrual periods. Irregular or missed periods can also be caused by a combination of intense exercise and low calorie intake which can mess with your hormone levels. Women who over-exercise and diet, say, professionals like ballet dancers or marathon runners, can be susceptible to this.
In men, low levels of testosterone may play a role in the development of osteoporosis. The excessive consumption of alcohol or the use of certain steroid medications may cause hormone imbalances in men.12
What to do: Hormone replacement therapy (HRT) may be recommended in some cases. However, this therapy is not without risks. For instance, estrogen replacement therapy is considered to increase the risk for breast cancer, stroke, and heart disease while testosterone replacement therapy may be associated with cardiovascular disease. Your doctor can help you evaluate the benefits and risks associated with HRT.13 14
5. Bed Rest Or Inactivity
Physical activity doesn’t just build your muscles, it makes your bones stronger too. And if you don’t get sufficient exercise or go through a long period of inactivity – for instance, if you’re confined to bed – the rate at which you experience bone loss may increase.
What to do: Get active. Weight-bearing exercises, which make you work against gravity, are considered best for your bones. Examples include walking, jogging, hiking, climbing stairs, lifting weights, tennis, and dancing.
A healthy person who undergoes bedrest can regain bone density by resuming weight-bearing exercises. When people are not able to resume such activities, taking medication meant to treat osteoporosis as well addressing other factors that increase their risk for osteoporosis may be helpful.15
Smoking doesn’t just wreak havoc on your heart and lungs, it can weaken your bones too. Various studies show that smoking increases your chances of getting osteoporosis. This could also be because smoking can reduce the production of estrogen in the body.16
What to do: Online programs, self-help guides, and counseling can help you quit smoking. Studies also show that the use of medications which reduce withdrawal symptoms and your urge to smoke can double your chances of getting rid of this habit. One common example of this is nicotine replacement therapy, where you take small doses of nicotine to deal with withdrawal.17 Here’s a very effective step by step guide to quit smoking.
7. Excessive Consumption Of Alcohol
Habitually consuming excessive amounts of alcohol can significantly increase your risk for osteoporosis. Heavy drinking not only disturbs the balance of calcium in the body but can also have an adverse impact on bone-protective hormones and vitamins.18
What to do: If you drink alcohol, then limit consumption to moderate levels. Moderate levels of alcohol are defined as a 1 drink in a day for women and 2 drinks for men.19 And one drink translates to about 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.20
8. Excessive Consumption Of Caffeine
While your morning cup of joe may provide a much-needed shot in the arm to get you through the day, excessive amounts of caffeine can contribute to bone loss.21 This may be because caffeine can potentially affect the viability of osteoblasts – cells that make bone as a response to mechanical stress and growth factors.22
What to do: While having more than 3 cups of coffee a day has been found to be a risk factor for osteoporosis, experts recommend limiting caffeine consumption to 400 mg per day. Pregnant women are advised to avoid caffeine altogether or limit intake to 300 mg in a day. An 8-ounce cup of coffee contains anything between 95 to 200 mg of caffeine.23
9. Eating Disorders
Eating disorders like anorexia nervosa and bulimia can leave you with nutritional deficiencies that adversely impact your bones. They may also cause hormonal imbalances – a deficiency in estrogen or testosterone or an increase in cortisol – which adversely impact your bones. An eating disorder may also cause hormonal imbalances – a deficiency in estrogen or testosterone or an increase in cortisol – which increase your chances of bone loss.24
What to do: Dietary counseling which helps you stick to a healthy diet, cognitive behavioral therapy which helps to identify and change unhelpful patterns of thought and behavior, and medications can be used to treat eating disorders.25
10. A Low Body Mass Index (BMI)
If your body mass index is 19 or lower, you have a higher risk of osteoporosis.26 Your BMI is a measure of your weight. You can calculate it by dividing your weight in kilograms by the square of your height in meters.27
What to do: If your BMI is low try to gradually gain weight. But don’t rely on foods like sugary drinks or cakes which can be high in sugar and saturated fat and ultimately harm your health. Instead, go for a healthy balanced diet with more calories. Make sure you include whole grains, fruits and vegetables, unsaturated oils, and pulses, eggs, meat, and other sources of protein in your diet.28
11. Certain Medications
Several medications including those used to treat breast cancer, prostate cancer, epilepsy, and seizures can cause bone loss. or breast cancer. So can long-term use of certain steroid medicines.
What to do: Check with your doctor to see if any medication you’re on can be harmful for the health of your bones. Your doctor may also be able to suggest safer alternatives in some cases.
12. Rheumatoid Arthritis
Various medical conditions can increase your risk for osteoporosis. Rheumatoid arthritis is one such autoimmune disease characterized by inflammation in your joints and tissues nearby. These inflamed tissues can release enzymes which wear away surrounding bone and cartilage. People with this conditions experience stiffness and pain in their joints as well as fatigue. And over time, joints may even become deformed. Pain and loss of function in joints may also result in inactivity which can further increase the risk of osteoporosis.29
Hormonal imbalances, infection, genes, and smoking are thought to be linked to rheumatoid arthritis. Treatment options can include physical therapy, medication, exercise, as well as surgery.30
13. Chronic Kidney Disease
Chronic kidney disease is the loss of kidney function over time. Your kidneys play an important part in keeping your bones healthy. They help maintain a balance of calcium and phosphorus levels. And they convert vitamin D from food into calcitriol, the active form of vitamin D which is used by the body.31 High blood pressure and diabetes are the most common causes of chronic kidney disease.
The loss of kidney function happens slowly and early symptoms may include loss of appetite, fatigue, headaches, itchy and dry skin, weight loss, and nausea. As kidney function worsens, you may notice abnormally light or dark skin, pain in your bones, blood in your stool, easy bruising, swelling or numbness in your hands and feet, drowsiness, excessive thirst, etc. Controlling blood pressure, blood sugar, and cholesterol can help slow down kidney damage. As the condition progresses, you may need dialysis or a kidney transplant.32
14. Overactive Parathyroid Gland
The parathyroid glands produce a hormone known as parathyroid hormone that helps control the levels of calcium, vitamin D, and phosphorus in your blood and bone. The symptoms seen in this condition are mostly due to the damage that results from high calcium levels in your blood or the loss of calcium from your bones. These can include pain in your bones, fatigue, increased urination, kidney stones, depression, loss of appetite, and nausea. Treatment may involve increasing the consumption of fluids to prevent kidney stones, estrogen therapy, vitamin D supplements, or surgical removal of overactive glands.33 34
Hyperthyroidism is a condition where your thyroid gland produces too much thyroid. High levels of the thyroid hormone thyroxine can speed up bone loss.35
You could experience symptoms like anxiety, trouble sleeping, fatigue, weight loss, and swelling in your neck if you have this condition. Treatment may involve medication, surgery, or radioiodine treatment which uses radiation.36
16. Malabsorbtion Problems
Various conditions that impede the proper absorption of nutrients by your body can also lead to bone loss. Examples include coeliac disease, cystic fibrosis, and Crohn’s disease, as well as gastric bypass surgery for weight loss.37
Osteoporosis Can Also Cause Tooth Loss
Osteoporosis can also have an impact on another area of concern as you age – your dental health. Research indicates that there’s an association between osteoporosis and bone loss in your jaws. The bone in your jaws anchor your teeth and when they become more fragile tooth loss can occur. In fact, it has been found that women with osteoporosis are thrice as likely to have tooth loss than those without this condition. While further research will determine if treatments for osteoporosis can benefit the bone in your jaws, scientists seem to be optimistic about this.
|↑1, ↑34, ↑37||What causes bone loss?. National Institutes of Health.|
|↑2||Oral Health and Bone Disease. National Institutes of Health.|
|↑3||Handout on Health: Osteoporosis. National Institutes of Health.|
|↑4||What causes bone loss? National Institutes of Health.|
|↑5||Osteoporosis – Causes. National Health Service.|
|↑6||Healthy Bones Matter. National Institutes of Health.|
|↑7||The Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You. National Institutes of Health.|
|↑8||Vitamin A and Bone Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases./|
|↑9||Food for strong bones. National Health Service.|
|↑10||Novack, Deborah V. “Estrogen and bone: osteoclasts take center stage.” Cell metabolism 6, no. 4 (2007): 254-256.|
|↑11||Mohamad, Nur-Vaizura, Ima-Nirwana Soelaiman, and Kok-Yong Chin. “A concise review of testosterone and bone health.” Clinical interventions in aging 11 (2016): 1317.|
|↑12, ↑26||Osteoporosis – Causes. National Health Service.|
|↑13||Androgen deficiency in men. Department of Health & Human Services.|
|↑14||Hormone Replacement Therapy. National Institutes of Health.|
|↑15||Bed Rest and Immobilization: Risk Factors for Bone Loss. National Institutes of Health.|
|↑16||Smoking and Bone Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases.|
|↑17||Using Nicotine Replacement Therapy. National Cancer Institute.|
|↑18||Smoking and Bone Health. National Institutes of Health.|
|↑19||Drinking Levels Defined. National Institutes of Health.|
|↑20||What Is A Standard Drink?. National Institutes of Health.|
|↑21||Osteoporosis. Department of Health & Human Services.|
|↑22||Tsuang, Yang-Hwei, Jui-Sheng Sun, Li-Ting Chen, Samuel Chung-Kai Sun, and San-Chi Chen. “Direct effects of caffeine on osteoblastic cells metabolism: the possible causal effect of caffeine on the formation of osteoporosis.” Journal of orthopaedic surgery and research 1, no. 1 (2006): 7.|
|↑23||Caffeine. National Institutes of Health.|
|↑24||What People With Anorexia Nervosa Need to Know About Osteoporosis. National Institutes of Health.|
|↑25||Eating disorders. National Health Service.|
|↑27||Assessing Your Weight. Centers for Disease Control and Prevention.|
|↑28||Underweight adults. National Health Service.|
|↑29||What People With Rheumatoid Arthritis Need to Know About Osteoporosis. National Institutes of Health.|
|↑30||Rheumatoid arthritis. National Institutes of Health.|
|↑31||Mineral & Bone Disorder in Chronic Kidney Disease. National Institutes of Health.|
|↑32||Chronic kidney disease. National Institutes of Health.|
|↑33||Hyperparathyroidism. National Institutes of Health.|
|↑35||Thyroid Disorders and Osteoporosis. British Thyroid Foundation.|
|↑36||Overactive thyroid (hyperthyroidism). National Health Service.|