When you have the bone-weakening disease, osteoporosis, the ultimate goal is to reverse bone loss and restore bone strength to make fractures less likely. Medications can increase bone mineral density and some can restore normal bone mass and microscopic structure. Yet these treatments come with some risks, and they’re not right for everyone.
Your doctor can help you understand your osteoporosis risk factors, and recommend next steps for preserving or restoring bone strength.
How Osteoporosis Affects Your Bones
Your bones aren’t set in stone. Healthy bones consist of living tissue that is constantly being broken down and rebuilt in a process known as remodeling. Cells called osteoclasts remove old or damaged bone, while osteoblasts replace it with new bone (International Osteoporosis Foundation, 2022).
In osteoporosis, aging and hormonal changes can upset the balance in bone remodeling. Too much bone is removed, too little is replaced, or a combination of both. The result is that you lose bone density.
Under a microscope, normal bones look like a honeycomb. Bones affected by osteoporosis are more porous. They have bigger holes and more spaces, which makes them more brittle. Weakened bones can fracture more easily from a fall or other pressure on them.
Who Is Most At Risk?
A few risk factors increase your likelihood of getting osteoporosis. Women are more likely to develop weakened bones as they age and go through menopause (Bone Health & Osteoporosis Foundation, undated).
Some risk factors, such as your genes and age, are out of your control. These can put you at increased risk of developing osteoporosis, which is especially prevalent in post-menopausal women. Other risk factors can be modified with lifestyle changes, such as diet and exercise.
Risk factors you can control include:
- Not getting enough nutrients such as fruits and vegetables, vitamin D and calcium in your diet
- Being inactive
- Drinking excessive amounts of alcohol
- Smoking cigarettes
- Losing too much weight or being obese (Pouresmaeili, 2018)
Risk factors you can’t control include:
- Being over 50 years old
- Being female
- Going through menopause
- Having a family history of osteoporosis
- Falling or getting a fracture
- Having certain underlying chronic diseases that increase risk such as diabetes, rheumatoid arthritis and celiac disease
- Needing to take some medications that have adverse effects on the bones such as glucocorticoids, anti-seizure medications, certain oncology medications and antidepressants
How Osteoporosis Is Assessed
Experts recommend getting screened for osteoporosis at least by the age of 65. If you’re younger than 65 and have any of the risk factors listed above, you should have a bone density screening test earlier (USPSTF, 2018).
While osteoporosis affects more women than men, most experts believe that men should also have bone density screening tests by the age of 70, or younger in men who have risk factors (LeBoff, 2022).
You’ll most likely get a bone density test called a dual x-ray absorptiometry (DXA, often referred to as a “dexa” scan) to check your bone mineral density (BMD). A DXA scan can show whether you’re at risk for, or if you have osteoporosis, and predict your odds of fracturing a bone. If you’ve already been diagnosed and have started on an osteoporosis treatment, a DXA scan can show how well your treatment is working (NIAMS, 2019).
During a DXA scan, you lie on a table while a scanner takes x-ray pictures of your bones — usually in your hip and spine. The test doesn’t hurt, is completely noninvasive, and it shouldn’t take more than a few minutes (NIAMS, 2019). The radiation exposure is extremely low, about the same as flying on an airplane from NY to Denver.
You’ll get the test result in the form of a T-score. This number represents how much your bone mineral density (BMD) differs from that of a healthy adult in their 20s.
This is what a typical hip BMD score means:
- -1 and higher: Normal
- Between -1 and -2.5: Osteopenia (low bone mass)
- -2.5 or lower: Osteoporosis (GRACE can you find a citation from BHOF for this?)
Can You Reverse Osteoporosis?
Actually, depending on the severity of the osteoporosis, there are now bone building medications that can restore bone strength to normal. This may not be true in patients who start with the most severe bone loss, but current regimens can make major improvements in bone health. All osteoporosis medications can boost your bone density enough to reduce the risk of fractures (Duke University, 2021) .
To maximize bone benefits and help maintain strong bones, pair medication with lifestyle changes such as exercise and nutrition.
Osteoporosis medications fall into two categories. Antiresorptive medications and anabolic agents.
Antiresorptive medications slow bone breakdown to preserve bone density. These include:
- Bisphosphonates like alendronate (Fosamax), risedronate (Actonel, Actelvia), ibandronate (Boniva), and zoledronic acid (Reclast)
- Estrogen therapy and estrogen/progestin combination hormone therapy
- Estrogen with bazedoxifene combination therapy (Duavee)
- Denosumab (Prolia)
- Raloxifene (Evista) (Endocrine Society, 2022; International Osteoporosis Foundation, 2022)
Anabolic agents stimulate new bone formation and rebuild bone density. These medications include:
- Abaloparatide (Tymlos)
- Romosozumab (Evenity)
- Teriparatide (Forteo)
Diet and regular exercise are also important contributors to bone health. Incorporating more bone-strengthening nutrients into your diet and fitting fitness into your week will help protect against progression of osteoporosis. Osteoporosis medication might work even better in patients who have adequate nutrition and physical activity.
Any type of exercise is good for your body, but a couple of types are particularly helpful for strengthening bones. Weight-bearing exercises such as walking, dancing, and stair climbing strengthen bones by making them work against the force of gravity. Strength-training exercises like lifting weights or using resistance bands strengthen the muscles that support your bones (Papadopoulou, 2021). Some people who have already had bone fractures or who have other underlying medical conditions might want to consult their doctor and/or a physical therapist before embarking on an exercise program.
Diet is the other essential ingredient for preserving bone strength, and for preventing the falls that could cause a fracture. While most well-known, making sure you get enough calcium is only part of the recipe for strong bones. These are a few of the nutrients to include in a bone-healthy diet, and which foods contain them:
- Dairy products (milk, yogurt, and cheese)
- Canned sardines and salmon with bones
- Leafy green vegetables
- Fortified plant-based milks (almond, soy, rice)
- Lean meat
- Dairy products (milk, yogurt, and cheese)
- Fortified orange juice and cereal
- Egg yolks
Potassium and magnesium are minerals that help your body use calcium more efficiently. You’ll find them in leafy green vegetables and beans (Muñoz-Garach, 2020). While it is usually best to get your nutrition from food, depending on your health history, your doctor may also recommend supplements such as calcium supplements to be paired with diet.
Can You Reverse Osteopenia?
Osteopenia is when your bone density is lower than that of an average young healthy woman or man of the same gender, but not low enough to qualify you for an osteoporosis diagnosis. Having weaker bones doesn’t mean that you’ll definitely progress to osteoporosis, but you are at higher risk (Bone Health & Osteoporosis Foundation, undated).
Nutrition and exercise are also important at this early stage of bone loss. A diet rich in nutrients such as calcium and vitamin D, coupled with weight-bearing and strengthening exercises, will help preserve the bone density you still have and prevent further bone loss.
Medication can also be used to help slow the rate of bone loss but this is certainly not necessary or even recommended in all individuals. Because osteoporosis medications can cause side effects, your doctor will weigh the risks against the benefits before prescribing treatment for you.
If you’ve been diagnosed with osteopenia or osteoporosis, be sure to work closely with your healthcare providers to make sure you have a plan to prevent further loss of bone density and promote bone growth.