Osteoporosis: The Silent Disease That Steals Your Bones—How to Prevent Bone Loss

Osteoporosis affects about 20 percent of people worldwide—yet many don’t realize they have it until a fracture occurs.

Hip fractures from osteoporosis can cause lasting pain, mobility loss, and serious health risks—especially in older women. The Epoch Times/Shutterstock

Osteoporosis earns its reputation as a “silent disease” because it weakens bones gradually, often without warning signs until a fracture occurs. This condition makes bones so fragile that everyday activities—even something as simple as bending over to pick up groceries or bumping into furniture—can result in painful breaks.

While any bone can be affected, fractures most commonly occur in three key areas: the hip, spine, and wrist. These breaks can be life-changing, potentially leading to long-term mobility issues or requiring extended care.

Beyond the initial injury, osteoporosis complicates recovery by slowing bone healing, often leaving people with chronic pain and a reduced quality of life.

As the most common metabolic bone disease in the world, osteoporosis affects about 20 percent of the global population.

Osteoporosis causes bones to become porous and brittle, increasing the risk of fractures even with minor stress or injury. Illsutration by The Epoch Times

What Causes Osteoporosis?

The underlying cause of osteoporosis is a disruption in the balance between old bone breakdown and new bone formation, which results in decreasing bone mass.

Our bones contain essential minerals and constantly break down to release these minerals into the bloodstream, then rebuilding with new bone tissue. When new bone formation doesn’t keep up with the old bone loss, bones become porous, which can lead to osteoporosis.

Most people reach their peak bone mass—their largest bone size and density—between ages 25 and 30. After age 40, we typically lose bone mass faster than it is generated. At first, the rate of bone loss is approximately 0.3 percent to 0.5 percent per year in both sexes. However, in women after menopause, this rate escalates to 2 percent to 3 percent annually, then returns to a lower level after about a decade.

Osteoporosis occurs in two forms, both with the same underlying cause but different contributing factors.

The Epoch Times/Shutterstock

1. Primary Osteoporosis

Primary osteoporosis is the most prevalent form. It results from natural aging and declining hormone levels, such as estrogen and testosterone, which contribute to bone loss and a higher risk of fractures.

Primary osteoporosis includes two subtypes: postmenopausal osteoporosis and senile (age-related) osteoporosis.

Postmenopausal osteoporosis

Menopause causes a decline in estrogen and progesterone levels. Since estrogen inhibits bone-resorbing cells—the process involved in breaking down old bone—and progesterone promotes bone formation, their deficiency can lead to accelerated bone loss.

Due to the effects of these hormone changes and other factors, by the time a woman reaches age 70, there is typically a decline in bone mass of approximately 30 percent to 40 percent.

Senile osteoporosis

Also referred to as age-related osteoporosis, senile osteoporosis is characterized by a significant increase in bone marrow fat accumulation, which occurs at the expense of the formation of new bone cells. Elevated levels of bone marrow fat—which influence the activity of both bone-forming cells and bone-resorbing cells—are linked to decreased bone density and a higher prevalence of vertebral fractures.

In men, declining testosterone levels with age can also contribute to bone loss and increased risk of osteoporosis, as testosterone plays a crucial role in maintaining bone mineral density.

2. Secondary Osteoporosis

Secondary osteoporosis results from medical conditions or certain medications.

Diseases that can cause osteoporosis include:

• Genetic disorders such as cystic fibrosis
• Endocrine disorders such as Cushing’s syndrome, hyperparathyroidism, and Type 1 diabetes
• Gastrointestinal diseases such as inflammatory bowel disease and celiac disease
• Hematologic disorders such as hemophilia and leukemias
• Cancers that originate in or spread to the bones, including bone cancer
• Liver diseases such as liver cirrhosis
• Severe cases of COVID-19 that result in hospitalization, which may lead to secondary osteoporosis during recovery
• Mental health conditions such as depression

Common medications that can cause osteoporosis include:

• Glucocorticoids such as corticosteroids
• Proton pump inhibitors such as acid suppressants
• Aromatase inhibitors used in breast cancer treatment
• Selective serotonin reuptake inhibitors such as antidepressants
• Chemotherapy agents such as methotrexate

Risk Factors of Osteoporosis

Factors that can also increase the risk of developing osteoporosis include:

• Age: Older people have a higher risk of osteoporosis and are more likely to lack important nutrients such as calcium, vitamin D, and protein, which weakens bones.
• Sex: Women are more likely to develop osteoporosis, but men face a higher risk of dying within a year after a hip fracture.
• Race: White and Asian people are at greater risk than black and Hispanic people. While white women have more osteoporosis, black women have a higher risk of death following hip fractures.
• Body size: People who are small or thin have less bone mass and are more likely to develop osteoporosis.
• Family history: Having a family history of osteoporosis increases the likelihood of suffering from the condition, as it can run in families.
• Certain health conditions: Conditions such as low sex hormone levels, heart failure, epilepsy, multiple sclerosis, and rheumatoid arthritis can increase the risk of osteoporosis.
• Smoking: Smoking is linked to decreased bone density and a higher risk of fractures.
• Alcohol use: Heavy alcohol consumption interferes with calcium absorption and bone formation, leading to an increased risk of osteoporosis.
• Chronic kidney disease: Reduced kidney function affects calcium and phosphate levels, which can weaken bones over time.

What Are the Symptoms and Early Signs of Osteoporosis?

In the early stages of osteoporosis, there are usually no obvious symptoms or pain. Once bone density and strength have been significantly weakened, a person may experience the following:

• Gradual loss of height due to a broken or collapsed vertebra
• Postural changes such as stooping or a hunched back, caused by weakened spinal bones
• Sudden or chronic back pain that may result from compression fractures in the spine
• Brittle nails due to reduced estrogen levels, particularly after menopause
• Decreased hand-grip strength resulting from weaker muscles
• Shortness of breath caused by compressed spinal disks that reduce lung capacity

How Is Osteoporosis Diagnosed?

Because osteoporosis develops gradually, its first noticeable sign is often a bone fracture. If you experience any symptoms or have a family history of osteoporosis, consult your physician to assess your risk.

A health care provider will typically begin by reviewing your medical history, conducting a physical examination, and identifying potential causes of secondary osteoporosis. The evaluation may include blood and urine tests.

If osteoporosis is suspected, your doctor may order a bone density scan.

Tests

The most common diagnostic test is the dual-energy X-ray absorptiometry scan, which uses low-dose radiation to measure bone density in areas most prone to fractures—typically the spine, hip, or wrist. The scan takes about three to seven minutes and compares your bone density to that of a healthy 30-year-old, producing two scores:

T-Score: A T-score of -1 or higher is considered normal bone density. A score between -1 and -2.5 indicates osteopenia, and a score of -2.5 or lower indicates osteoporosis. Each one-point drop below zero doubles the risk of bone fracture.

Z-score: This score compares your bone density to others of the same age, sex, and race. Z-score is typically used for people under age 50.

Doctors may also use other tools, such as questionnaires or ultrasounds, to estimate your 10-year fracture risk based on lifestyle and family history.

The Fracture Risk Assessment Tool (FRAX) is a computerized calculator that estimates osteoporosis-related fracture risk with or without a bone mineral density test. FRAX helps guide further testing or treatment decisions.

What Are the Treatments for Osteoporosis?

Treating osteoporosis involves slowing or stopping bone loss, reducing the risk of fractures, and in some cases, rebuilding bone.

Approaches vary based on age, risk level, and other medical conditions.

1. Medication

When osteoporosis is severe enough that dietary changes alone are not effective, medications may be recommended.

• Bisphosphonates: Bisphosphonates are antiresorptive drugs that prevent bone loss by inhibiting the body’s reabsorption of bone tissue. They are typically taken for up to five years, after which benefits may continue even if treatment stops. Common side effects include flu-like symptoms, nausea, and mild kidney function impairment.
• Denosumab: Denosumab is a biologic drug administered by injection every six months, often used when other treatments are ineffective. Denosumab blocks a protein involved in bone resorption, reducing the risk of fractures. However, its long-term effects are still being studied. Side effects may include skin problems, headaches, back pain, and nausea.
• Romosozumab: Romosozumab is an anabolic agent that builds bone by stimulating formation and reducing breakdown. The treatment is administered as two injections given in a single sitting once per month, for up to one year. Due to a slightly increased risk of heart attack or stroke, it carries a black box warning and is not recommended for people with a history of cardiovascular conditions.

2. Hormone-Related Therapies

The following therapies may be used to address hormone-related causes of osteoporosis:

• Menopause hormone therapy: Menopause hormone therapy is often considered the primary option for preventing and treating osteoporosis. It can also relieve menopause symptoms. The therapy uses estrogen and progesterone and is generally recommended for women under age 60 or within 10 years of menopause. Possible side effects include breast cancer, coronary heart disease, stroke, and blood clots.
• Testosterone: Testosterone may be prescribed for men with low bone density caused by reduced testosterone levels.
• Raloxifene: Raloxifene is a selective estrogen receptor modulator that mimics the effects of estrogen on bones. It is often given to postmenopausal women to improve density and reduce the risk of spinal fractures.
• Calcitonin salmon: Calcitonin salmon, also known as calcitonin, works by inhibiting the cells that break down bone tissue. By reducing bone resorption, it helps improve bone density. Common side effects include upset stomach and skin rash with the nasal spray, and nausea, vomiting, and site reactions with the injectable form.
• Parathyroid hormone: Parathyroid hormone regulates calcium levels in bones. Medications like teriparatide, which mimic this hormone, stimulate bone-building cells to increase bone density and prevent fractures. Teriparatide is typically prescribed for people at very high risk of fracture or when other treatments are not suitable. Caution is advised for people who have undergone radiation therapy. In 2023, the Food and Drug Administration approved a generic teriparatide injection in a single-patient-use pre-filled pen.

3. Traditional Chinese Medicine (TCM)

Consult a qualified health care provider before using any herbs, as more research is needed to confirm their safety and effectiveness in humans.

A systematic review of 12 randomized controlled trials involving 1,816 patients found that some Chinese herbs were more effective than placebo or standard medications in increasing bone mineral density in the lumbar spine.

Three commonly used herbs in TCM for treating primary osteoporosis include:

Horny goat weed (yin hang huo): Icariin, a key compound in horny goat weed, may help improve bone mineral density and reduce osteoporosis-related pain.

Prepared rehmannia root (shu di huang): This herb is traditionally used to nourish the blood and strengthen bones.

Drynaria (gu sui bu): This herb is commonly used in TCM for its ability to repair bone and tissue damage.

Acupuncture

Acupuncture is commonly used to treat osteoporosis, particularly in China. Studies in animals have shown that acupuncture can improve bone strength, density, and structure. A recent systematic review suggests acupuncture may be more effective than some calcium and vitamin D supplements for postmenopausal women.

Another clinical review suggested that acupuncture may reduce pain and weakness by influencing hormone levels and supporting the body’s natural bone growth processes.

What Are the Natural and Lifestyle Approaches to Osteoporosis?

Lifestyle changes may help prevent osteoporosis or slow its progression. Modifying daily habits can improve bone health, reduce fragility, and help manage symptoms—often decreasing the need for medication. A qualified health professional should be consulted before beginning any new approach.

Nutrition

A healthy diet rich in whole foods—vegetables, fruits, whole grains, lean proteins, healthy fats, and some dairy—supports bone health and may help prevent osteoporosis. Avoiding processed foods, added sugars, unhealthy fats, and excess sodium can also benefit bone strength.

• Calcium: Research suggests it’s best to get calcium from food rather than supplements unless a deficiency is present. Excess calcium supplements may increase the risk of heart problems and kidney stones, and may not prevent fractures.
• Vitamin D: Sunlight and diet are preferred sources of vitamin D. Supplements may be helpful for people with osteoporosis or at high risk of falls. Moderate supplementation is recommended, as excessive intake can be harmful.
• Other nutrients: Diets such as the Mediterranean diet provide antioxidants and compounds that support bone health by reducing inflammation and promoting healthy gut bacteria. Nutrients including protein, unsaturated fats, magnesium, potassium, and vitamins K and C are also important for maintaining strong bones.

Exercise

Regular moderate weight-bearing, balance, and resistance exercises help strengthen bones and prevent falls and fractures. Different exercise types have been shown to reduce fall risk by varying degrees:

• 19 percent with tai chi
• 24 percent with balance and functional exercises
• 34 percent with combined approaches (balance, functional, and resistance exercises)

Other studies find mind-body exercises such as tai chi and yoga may reduce pain and improve quality of life for people with osteoporosis.

Sleep quality

Poor or insufficient sleep can negatively affect bone health. Restorative, high-quality sleep—ideally 7 to 9 hours per night—allows the body to reset and recover.

How Does Mindset Affect Osteoporosis?

Although osteoporosis is a physical condition, mindset can influence its development and progression. Mental outlook and coping strategies shape how we respond to stressors—and psychological stress is considered a risk factor for osteoporosis.

One Taiwanese study found that people diagnosed with post-traumatic stress disorder (PTSD) had a higher likelihood of developing osteoporosis than those without PTSD. Additionally, they were more likely to develop osteoporosis at a younger age. More research is needed to better understand the underlying mechanisms linking PTSD and osteoporosis and to inform treatment strategies.

Depression is also a known risk factor for osteoporosis. A cross-sectional study found that Caucasian girls and young women with both anorexia nervosa and depression had lower bone mineral density than peers with anorexia alone.

How Can I Prevent Osteoporosis?

A condition called osteopenia often precedes osteoporosis. It is characterized by lower-than-average bone mineral density for a person’s age. Depending on individual risk factors—such as lifestyle, diet, and exercise—osteopenia may or may not progress to osteoporosis.

Preventing osteoporosis is essential, as there are currently no safe and effective ways to fully restore lost bone structure. Many of the same lifestyle changes used to treat osteoporosis can also help prevent it. In addition, consider the following steps:

• Get the right nutrients: Aim to meet your nutritional needs through food rather than supplements. Adequate potassium intake also supports proper calcium metabolism and bone health.
• Incorporate the right exercises: Improve musculoskeletal strength with a combination of balance, weight-bearing (high or low impact), and muscle-strengthening exercises.
• Avoid tobacco use: Smoking disrupts bone turnover, reduces bone mass, and increases the risk of osteoporosis and fractures.
• Limit alcohol consumption: Keep alcohol consumption minimal. Drinking three or more alcoholic beverages daily can increase the risk of osteoporotic fractures.

Age-Specific Prevention

Supporting bone health early—and maintaining it through life—is key to preventing osteoporosis. Nutrient intake, hormonal changes, and lifestyle factors vary across life stages, making age-appropriate strategies essential.

Adolescents and young adults

Adequate intake of calcium, vitamin D, and other nutrients during adolescence and early adulthood is crucial, as these years are the foundation for adult bone mass.

Young people should also be aware of risk factors such as eating disorders (including anorexia and bulimia), excessive athletic training, and pituitary tumors. These conditions can cause estrogen deficiency and lead to reduced bone density.

Perimenopausal and postmenopausal women

Perimenopause refers to the transition phase in a woman’s life leading up to menopause. During this time, it is crucial for health care providers to assess a woman’s risk factors for osteoporosis as part of her medical history. Identifying these risks allows for lifestyle changes and potential treatments to help mitigate menopause-related bone loss.

Simply increasing calcium intake may not be enough to counteract the accelerated bone loss during this period. Estrogen therapy may be a suitable option for some women. A well-rounded approach—including moderate exercise and a balanced diet rich in calcium and vitamin D—can help slow the rate of bone loss during this critical time.

Besides, falling is the leading cause and strongest risk factor for osteoporotic fractures. Common-sense strategies to reduce fall risk include keeping floors free of clutter, removing small throw rugs, and installing grab bars in bathrooms—next to and inside the tub or shower, and beside the toilet.

What Are the Complications of Osteoporosis?

If left untreated, osteoporosis can progress to a more severe form, where bones become so fragile that even a cough or sneeze can cause a fracture. The most serious complications involve fractures of the spine and hip.

Spinal fractures can happen without obvious injury and may result in back pain, height loss, and a hunched posture. Hip fractures, often caused by falls, are particularly dangerous. They can lead to long-term disability and carry a high risk of death within the first year following the injury.

Fractures from osteoporosis are typically painful and slow to heal. Recovery may lead to additional health complications, particularly in older people. For example, extended bed rest after a hip fracture increases the risk of blood clots, pneumonia, and infections. In some cases, people may experience lasting pain or lose their independence after such injuries.