Osteoporosis is a serious health problem in the United States. More than 10 million people have osteoporosis, and another 34 million are at risk due to low bone density (osteopenia). Each year, this disease contributes to more than 1.5 million fractures of the back, wrists and hips.

Eighty percent of people with osteoporosis are women, and it is the main cause of bone fractures in post-menopausal women and the elderly. However, men get osteoporosis as well. You could be at risk for osteoporosis for one or more reasons, such as a medical condition like rheumatoid arthritis or lupus, or from medications like corticosteroids (such as prednisone).

Bone is a changing, living tissue made up of calcium and other mineral deposits. During a lifetime, bone is broken down and built up again with strong, new bone over repeated cycles, each lasting about six months. From birth to the mid-20s, the calcium you get from food helps bone rebuild faster than it breaks down.

Your bones are the strongest they will ever be during your lifetime between ages 20 and 25, the age of highest bone-mass density or peak bone mass. At the peak, women have about 30 percent lower bone mass than men. Around age 40, bone mass begins to decline slowly. This is because bone breaks down faster than it is replaced.

During and after menopause, when estrogen levels drop, women lose bone mass faster than before. Over the first five to 10 years after menopause, women can lose up to one-third of their bone mass. Men also lose bone mass as they age, but overall, women have a lower peak bone mass and tend to lose bone mass faster than men.

Bones that have less mass are weaker and more likely to break or fracture, even with a minor fall. Because osteoporosis develops over the years, the first sign in many people is a broken bone.

Bone loss usually occurs without any symptoms long before you have a fracture. This is why osteoporosis is called a “silent disease.” Tooth loss might be a warning sign that osteoporosis has affected the jawbone. About one-third of American women lose all their teeth by their late 60s, in part due to osteoporosis.

Prevention, early detection and treatment are important because once you bones are porous enough to cause one fracture, you’re likely to have several more.

Risk Factors

The amount of bone mass you have as a young adult, and the rate at which you lose it as you age determine your risk for osteoporosis. It is more common in:

• Women, especially those past menopause, or of advanced age

• Women who go through menopause early (before age 45) or who have very irregular or missed menstrual periods

• Women who have had their ovaries removed through a hysterectomy

• People who are thin or have small body frames

• People with a family history of osteoporosis (many fractures or hunched posture), or Caucasian or Asian ancestry, indicating hereditary risk factors for osteoporosis

• People with a history of bone fractures after a minor injury

• People with an inflammatory form of arthritis, such as rheumatoidarthritis or lupus

• People with a type of spondyloarthropathy, such as ankylosing spondylitis, reactive arthritis (including Reiter’s syndrome), psoriatic arthritis, or inflammatory bowel disease-associated spondyloathropathy)

• People who take drugs that reduce bone strength such as corticosteroids (cortisone, prednisone or methylprednisolone), anticonvulsant medications (anti-seizure medications), or heparin

• People who eat diets with few calcium-rich foods, such as dairy products

• People with celiac disease, inflammatory bowel disease (IBD), hyperthyroidism, chronic obstructive pulmonary disease (COPD), Crohn’s disease, ulcerative colitis or multiple myeloma (bone marrow cancer)

• People who have had bariatric surgery

• People who have thyroid or parathyroid disease

• Smokers

• People who drink more than two alcoholic beverages a day

• People with a history of anorexia nervosa or other eating disorders

• Women who don’t exercise regularly, or who exercise so much so that menstrual periods stop

• Men with low levels of testosterone

• People who have had long periods of immobility or bed rest

If you have one or more of these risk factors, you are at greater risk of osteoporosis and of breaking a bone. Talk to your doctor about ways to reduce your risk and about whether you should have your bone density tested.

The Arthritis-Osteoporosis Connection

Inflammatory arthritis is a group of disorders that cause inflammation of the joints and sometimes the internal organs. Inflammatory forms of arthritis, such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis or lupus, lead to the overproduction of normal body chemicals that can cause bone loss. The hastened bone loss increases risk of developing osteoporosis. The risks may be magnified because those with inflammatory arthritis:

• Are typically women

• May not exercise regularly, and in fact, may not be able to exercise at all

• May use corticosteroid medications

Each of these factors increases the risk of osteoporosis.