Osteoporosis weakens your bones, making it easier for them to break. As you age, you lose bone density. Your bones then become thinner and develop small holes, or pores. Osteoporosis can affect people of all races and ethnicities.
In the United States, more than 50 million people have osteoporosis. Understanding the causes helps you prevent them and lower your risk of fractures after diagnosis.
Osteoporosis: How and Why It Develops
Your bones renew themselves throughout life by making new cells and tissue. But starting in your 30s and 40s, you lose bone mass faster than you rebuild it. You also lose calcium and other minerals that keep bones strong.
As a result, your bones become more fragile and more likely to break, especially in the hips, wrists, and spine.
If you didn’t build strong bone density when you were younger, you’re more likely to face fractures as you age. But it’s never too late to care for your bones. Weight-bearing exercise after 30 can help you maintain bone mass and strength.
“Many people think osteoporosis is part of natural aging, and that’s not necessarily true. The fact is that osteoporosis is a disease, and not everyone who reaches a certain age has it,” says Aldo Marcelo Riesgo, MD, an orthopedic surgeon at Baptist Health Orthopedic Institute in Miami.
What Are the Causes of Osteoporosis?
The aging process is a big part of why osteoporosis happens. But certain diseases, hormonal changes, and medications can also affect the natural bone rebuilding process.
Diseases that can raise your risk for osteoporosis include:
- Thyroid problems and diabetes (endocrine)
- Celiac disease and irritable bowel syndrome (digestive)
- Rheumatoid arthritis, lupus, multiple sclerosis, and ankylosing spondylitis (autoimmune)
- Leukemia and multiple myeloma (blood cancers)
- Kidney disease and biliary cholangitis (kidney and liver)
- Stroke, spinal cord injury, and Parkinson’s disease (neurological)
- Breast cancer and prostate cancer
Certain medical procedures, such as gastrointestinal surgery, gastrectomy, and organ transplants, can also raise your risk.
Long-term use of certain medications can also affect your bones, such as:
- Diuretics (lower blood pressure)
- Corticosteroids (treat inflammation)
- Anticonvulsants (control seizures)
- Hormonal medicines (treat breast and prostate cancer)
- Anticoagulants (prevent blood clots)
- Antacids with aluminum (treat acid reflux)
Hormonal changes
Sex hormones, such as estrogen and testosterone, help keep your bones strong. When their levels drop, you can begin to lose bone mass. Some examples include:
- In women: Estrogen and testosterone levels drop during menopause.
- In men: Sex hormone levels also decline with age, though some men develop low testosterone (hypogonadism) earlier.
- In both sexes: Cancer treatments — such as for prostate cancer in men or breast cancer in women — lower hormone levels and speed up bone loss.
“In many cases, even if you stay active, bone density declines with age and with changes in hormones and other treatments. There are many cancer treatments, including chemotherapy and radiation, that can affect this,” Riesgo says. “In those cases, treatment with a special osteoporosis medication should be considered.”
What Raises Your Risk for Osteoporosis?
In addition to specific causes, certain factors can increase your risk of osteoporosis. You can’t change some of them, but others can be managed with lifestyle choices. Knowing these factors helps you prevent osteoporosis and lower its impact on your life.
If you’re over 50, your risk of osteoporosis may increase. Other factors that play a role include:
Sex: You’re at higher risk if you’re a woman, especially during and after menopause.
Race: You’re more likely to develop osteoporosis if you’re White or of Asian descent.
Family history: Your risk of developing osteoporosis increases if you have relatives who have a history of the condition.
Body size: Having a small frame means less bone mass to start with and a bigger impact when you lose bone.
Riesgo says that there are key risk factors for osteoporosis that you can change:
Lifestyle: Smoking and drinking too much alcohol raise your risk for osteoporosis. Bone health is highly sensitive to diet, alcohol consumption, smoking, and daily habits, including physical activity.
Physical activity: Exercise may feel optional when you’re young, but it becomes essential as you get older. Research shows that strength training and weight-bearing exercises help you maintain bone density by strengthening both your muscles and your bones.
Diet: Eating foods rich in calcium and vitamin D helps protect your bones and lower your risk of osteoporosis.
“If dietary calcium intake is poor or not at an adequate level, it’s your own body that steals calcium from your bones,” Riesgo says.
This is seen not only in women going through menopause, but also during pregnancy. “A lot of calcium is lost because the body needs it to produce breast milk. Calcium is not only important for older women, but also for young women raising their babies.”
How Osteoporosis Affects the Hispanic Community
It is a common belief that Hispanic people have a lower risk of osteoporosis compared to the non-Hispanic White population. But recent data have shown that Hispanic people may have a similar or even higher prevalence of osteoporosis.
Risk factors for osteoporosis in the Hispanic community include:
- Eating traditional diets low in calcium, vitamin D, and zinc.
- Living a sedentary lifestyle, smoking, or drinking alcohol — behaviors noted in some Hispanic communities studied.
- Facing cultural barriers, such as limited English proficiency or reduced access to health care in low-income areas.
- Having limited knowledge about osteoporosis. Some studies found greater concern about other chronic diseases, such as heart disease and diabetes.
- Lacking education about bone health, the value of physical activity, and ways to prevent osteoporosis early.
How to Prevent and Treat Osteoporosis
Ways to prevent and manage osteoporosis include:
- Avoid alcohol and smoking.
- Stay physically active regularly.
- Know if anyone in your family has had osteoporosis.
- Eat a healthy diet rich in calcium, vitamin D, and protein.
- See your doctor to check for changes in bone density.
- Ask your doctor about a personalized exercise and nutrition plan and, if needed, treatment with medicines or supplements
“If someone has osteoporosis and doesn’t know it and starts exercising very intensely, it can have negative consequences. They can experience fractures and other orthopedic injuries such as tendonitis, or tendon ruptures and tears,” Riesgo says.
Your doctor or therapist should supervise everything. “It’s very important to start with something very mild. In life, we should always start slowly and then gradually progress to a level we can tolerate because not everyone is the same, and we all have to go at our own pace,” Riesgo says.
Show Sources
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SOURCES:
Aldo Marcelo Riesgo, MD, orthopedic surgeon, Baptist Health Orthopedic Institute, Miami, Florida.
International Osteoporosis Foundation: “What is Osteoporosis?”
Mayo Clinic: “Osteoporosis.”
Cleveland Clinic: “Osteoporosis.”
American Academy of Orthopedic Surgeons: “Osteoporosis (Introduction to Osteoporosis).”
Journal of Bone and Mineral Research: “Prevalence of Osteoporosis and Low Bone Mass Among Puerto Rican Older Adults.”
Cureus Journal of Medical Science: “Bridging Bone Health: Osteoporosis Disparities in the Rio Grande Valley.”
National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Osteoporosis.”
Bone Health & Osteoporosis Foundation: “What is Osteoporosis and What Causes It?”
FDA: “Osteoporosis.”
