Bad to the Bone(s)

Why and how osteoporosis occurs, and what you can do to improve your bone density


As a 30-something female, the impact of aging has become a not-so-distant reality. I’ve taken stock in my skincare routine, investing in a serum that promises to “give skin bounce,” and I try to exercise regularly and fill my diet with nutrient-dense foods.

One area I’ve seemingly overlooked, though, is bone health. Until now.

“Most people are gaining bone density up until about 20 years old,” says Dr. Patrick Jost, an orthopedic surgeon with Milwaukee Orthopaedic Group Limited and the Orthopaedic Hospital of Wisconsin. “… In your adolescence and even teenage years, people are actually building bone density. After that it’s usually a net loss for the rest of your life.” Yikes.

When I ask why this net loss occurs, Jost’s response is succinct: “It’s part of the natural physiology of aging.” It is possible to slow bone loss, he adds, through proper calcium and vitamin D intake, a healthy diet, weight-bearing exercises and by avoiding smoking
and drinking.

Conversely, Jost explains, rapid bone loss is often attributed to a hormonal imbalance or immobility; someone who is on crutches and not bearing weight on a leg, for example, is also losing bone density. “Bone is always in a constant state of breakdown and rebuilding,” he says.

Boning Up
While some risk factors for osteoporosis can’t be controlled — your age, race, sex, body frame and genetics — others conditions and treatments can contribute to brittle bones.

• Menopause
• Stomach or
intestine surgeries
• Celiac disease
• Inflammatory
bowel disease
• Kidney or liver disease
• Lupus
• Alcoholism
• Cancer and certain cancer treatments
• Multiple myeloma
• Rheumatoid arthritis
• Eating disorders

Source: Mayo Clinic

“There are two different types of cells that are taking down bone and putting it back up constantly, and it’s just a struggle between one or the other. If you’re off of a leg for a while or you have an hormonal imbalance, the breaking-down cells kind of win. In a person who’s healing a fracture or starting to put weight on a leg again, the building cells will start to work.”

Excessive bone loss can lead to osteoporosis, a disease most commonly marked by increased bone weakness and risk of fragility fractures. Early warning signs are nearly nonexistent, Jost says, so it’s important to be transparent with your primary care physician. “[Being osteoporotic] doesn’t really feel like anything ... unless you’re breaking something. You don’t develop pain,” he continues. “There are (also) several medical conditions that put you at a higher risk — a lot of them are endocrinal or hormonal.” The complete list of conditions is extensive, Jost says, but your doctor should know when — and if — to test you for osteoporosis.

Testing for the disease involves undergoing a DEXA scan, which measures bone density in specific areas. “Usually we’ll target the vertebral bodies in the spine and the hip,” says Jost. “Those are accepted areas that have standard numbers you can compare to.”

If an osteoporosis diagnosis is confirmed, Jost says treatment typically begins with bisphosphonates, a cost-effective class of drugs that target and slow down the body’s bone-eating cells. A second-line treatment — best suited for those with severe osteoporosis and/or recurrent fragility fractures, Jost notes — involves administering bone-building parathyroid hormones in a pulsed fashion. Although effective, Jost notes that the procedure is quite pricey.

The best approach to living life with brittle bones is perhaps one of balance — of remaining active, but proceeding with caution. “My personal philosophy is you can’t lie in bed all day because you’re afraid to break your hip,” adds Jost. “But, at the same time, if you know you have fragile bones, you don’t want to put yourself at high risk.” MKE