Osteoporosis: Bone Density, Risk Factors and Prevention

Osteoporosis: Bone Density, Risk Factors and Prevention

Osteoporosis is a bone disease in which bone density and strength drop, so bones break more easily, often from a minor fall or even a cough. It is diagnosed with a bone density scan called a DXA, which gives you a T-score: -2.5 or lower means osteoporosis. You can lower your risk with enough calcium and vitamin D, regular weight-bearing exercise, fall prevention, not smoking and limiting alcohol, and medicines can cut fracture risk if you already have it.

This article is for general information and is not medical advice.

Key takeaways

  • Osteoporosis is usually "silent": most people have no symptoms until a bone breaks, which is why screening matters.
  • A DXA scan T-score of -1.0 or higher is normal, between -1.0 and -2.4 is low bone density (osteopenia), and -2.5 or lower is osteoporosis.
  • The U.S. Preventive Services Task Force recommends screening for all women 65 and older and for younger postmenopausal women at increased risk.
  • Most adults need 1,000 to 1,200 mg of calcium and 600 to 800 IU of vitamin D a day, ideally mostly from food.
  • Bisphosphonates are the main first-line medicines, and several other drug classes exist for people at higher risk.

What is osteoporosis?

Osteoporosis is a condition in which your bones lose mass and their inner structure weakens, raising the risk of fractures. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), it is often called a silent disease because it usually causes no symptoms until a bone breaks.

The fractures that matter most are in the hip, the spine (vertebrae) and the wrist, as NIAMS notes. A spine fracture can happen with no fall at all. It may show up as sudden back pain, loss of height or a stooped posture, which doctors call kyphosis.

Osteoporosis is common. The U.S. Preventive Services Task Force (USPSTF) reports that about 12.6% of U.S. adults 50 and older have it, rising to 27.1% of women and 5.7% of men aged 65 and older. Hip fractures are especially serious: only 40% to 60% of people who break a hip regain the mobility and independence they had before.

What do bone density and T-scores mean?

A bone density test measures how much mineral is packed into your bones, and the T-score compares your result with a healthy young adult of the same sex. The lower the number, the thinner your bones and the higher your fracture risk.

The standard test is a DXA (dual-energy x-ray absorptiometry) scan, sometimes written DEXA. MedlinePlus explains that it is a low-dose x-ray of the hip and lower spine. A central scan usually takes 10 to 30 minutes, the radiation dose is very low, and you may be asked to stop calcium supplements 24 to 48 hours beforehand.

Your report will include one of two scores:

  • T-score: used for postmenopausal women and men 50 and older. It compares you with a healthy young adult.
  • Z-score: used for premenopausal women, men under 50 and children. It compares you with people of your own age, sex and body size. A low Z-score can point to another cause of bone loss.
T-scoreCategoryWhat it usually means for you
-1.0 or higherNormalBone density is in the healthy range. Focus on prevention habits.
Between -1.0 and -2.4Low bone density (osteopenia)Bones are thinner than ideal. Your doctor may estimate your 10-year fracture risk to decide whether you need treatment.
-2.5 or lowerOsteoporosisFracture risk is high. Medicine is usually discussed along with lifestyle steps.

A T-score is not the whole story. Doctors often add a risk calculator such as FRAX, which estimates your 10-year chance of a hip or other major fracture, as described by the USPSTF.

What raises your risk of osteoporosis?

The biggest risk factors are being female, getting older, low estrogen after menopause and a family history of hip fracture. Many others, such as smoking, heavy drinking, inactivity and some medicines, are things you can change or discuss with your doctor.

NIAMS groups the main risk factors like this:

  • Factors you cannot change: female sex, older age, a small body frame, race (risk is highest in non-Hispanic white and Asian women), and a family history of osteoporosis or hip fracture.
  • Hormones: low estrogen after menopause or from missed periods for a long time, and low testosterone in men. The drop in estrogen is one reason bone loss can speed up around perimenopause and the years after it.
  • Diet: low calcium or vitamin D, too little protein, and repeated strict dieting.
  • Medical conditions: rheumatoid arthritis, some hormone and digestive disorders, certain cancers, HIV and anorexia nervosa.
  • Medicines: long-term glucocorticoids (steroids such as prednisone), some anti-seizure drugs, some cancer hormone therapies, proton pump inhibitors, SSRI antidepressants and thiazolidinediones.
  • Lifestyle: low physical activity, chronic heavy drinking and smoking.

Men are not immune. The USPSTF lists age, low body weight, smoking, excess alcohol, long-term steroid use, a previous fracture, a fall in the past year, low testosterone, stroke and diabetes as risk factors for men. Losing muscle also matters, because weaker muscles mean more falls; if you have noticed this, read about why muscle mass declines with age and how to reverse it.

Who should be screened for osteoporosis?

The USPSTF recommends bone density screening for all women 65 and older and for postmenopausal women under 65 who have an increased risk. For men, it found the evidence insufficient to recommend for or against routine screening.

In its January 2025 recommendation, the task force concluded that screening these women gives a moderate net benefit. In the studies it reviewed, screening-based programs prevented about 5 hip fractures and 6 major osteoporotic fractures per 1,000 people over about 3.7 to 5 years.

For postmenopausal women under 65, the task force suggests first using a risk assessment tool to decide who needs a scan. Factors that raise risk in this group include low body weight, a parent who broke a hip, current smoking, excess alcohol, insulin-treated diabetes and steroid use.

For men, "insufficient evidence" is not a recommendation against screening. If you have risk factors, ask your doctor whether a DXA scan makes sense.

How can you prevent osteoporosis?

You protect your bones by getting enough calcium and vitamin D, doing weight-bearing and muscle-strengthening exercise, preventing falls, not smoking and keeping alcohol moderate. These habits help at any age, even after a diagnosis.

Calcium and vitamin D

Calcium is the main mineral in bone, and vitamin D helps your body absorb it. The NIH Office of Dietary Supplements lists these daily targets for adults, from its calcium fact sheet and vitamin D fact sheet:

AgeCalcium (women)Calcium (men)Vitamin D (both)
19 to 501,000 mg1,000 mg600 IU (15 mcg)
51 to 701,200 mg1,000 mg600 IU (15 mcg)
71 and older1,200 mg1,200 mg800 IU (20 mcg)

More is not better. The upper limit for calcium is 2,000 mg a day after age 50 (2,500 mg for ages 19 to 50), and the upper limit for vitamin D is 4,000 IU a day for adults. Get most of your calcium from food, and use a supplement only to fill gaps.

Supplements are not a guaranteed fix. The ODS notes that research on calcium supplements and fractures is mixed, and the USPSTF concluded that daily doses of 1,000 mg or less of calcium with 400 IU or less of vitamin D do not prevent fractures in postmenopausal women. Food, exercise and enough daily protein for your age and activity level work together.

Exercise

Bones respond to load. MedlinePlus recommends weight-bearing activity such as walking, jogging, tennis or dancing for at least 30 minutes, three times a week, plus free weights, machines or resistance bands, and balance work such as tai chi or yoga. NIAMS also lists staying active, especially with weight-bearing exercise, as a core prevention step.

For specific moves and how to do them safely if your bones are already thin, see our guide to exercises that strengthen bones. If you are new to lifting, a simple strength training plan for beginners over 40 is a good place to start.

Fall prevention, alcohol and smoking

Fragile bones break most often in falls, so preventing falls is bone protection. Use this checklist:

  1. Do balance and leg-strength exercises at least a few times a week.
  2. Remove loose rugs and clutter, and add grab bars and night lights.
  3. Ask your doctor or pharmacist to review medicines that cause dizziness or drowsiness.
  4. Get your eyes checked and keep glasses up to date.
  5. Wear supportive, non-slip shoes indoors and out.
  6. Quit smoking, and keep alcohol moderate, since heavy drinking both weakens bone and raises fall risk.

Our article on fall prevention for older adults covers home safety and balance training in more detail.

How is osteoporosis treated?

Treatment combines the prevention habits above with medicine for people at high fracture risk. Bisphosphonates are the main first-line medicines, and other classes are used when risk is very high or bisphosphonates are not a good fit.

MedlinePlus describes these drug classes:

  • Bisphosphonates: the main medicines for preventing and treating osteoporosis in postmenopausal women. They are taken by mouth or given by IV.
  • Denosumab: an injection under the skin that reduces bone loss and increases bone density.
  • Teriparatide and abaloparatide: lab-made forms of a hormone that builds new bone, usually for people at high risk.
  • Romosozumab: a newer bone-building medicine for more severe bone loss.
  • Selective estrogen receptor modulators: such as raloxifene, which act like estrogen on bone.
  • Calcitonin: a hormone treatment used mainly for pain from a spine compression fracture.

Treatment does not always last forever. MedlinePlus notes that women at lower fracture risk may take oral medicine for about 5 years (or IV therapy for 3), while those at high risk may continue for 10 years oral (or 6 years IV). Your doctor will recheck your risk over time.

Common mistakes people make with bone health

  • Waiting for symptoms. Osteoporosis is silent. If you meet screening criteria, ask for a DXA scan.
  • Megadosing supplements. Going over the upper limits for calcium or vitamin D adds risk without extra benefit.
  • Only walking. Walking helps, but bones and muscles also need resistance training and balance work.
  • Ignoring a "minor" fracture. A wrist or spine fracture from a small fall after 50 is a warning sign that deserves a bone health workup.
  • Assuming men are safe. Men get osteoporosis too, and they often underestimate their risk.

When to see a doctor

See a doctor promptly, or get urgent care, if you notice any of these red flags:

  • A broken bone from a fall from standing height or less, or from bending, lifting or coughing.
  • Sudden, severe back pain without a clear injury, which can signal a spine fracture.
  • Losing height, or a back that is becoming rounded or stooped.
  • Hip or groin pain after a fall, especially if you cannot put weight on the leg (seek emergency care).
  • Long-term steroid use, an eating disorder, early menopause or missed periods for many months.
  • New or troubling side effects after starting a bone medicine.

Frequently asked questions

Can osteoporosis be reversed?

Bone loss can often be slowed, and some medicines increase bone density over time. Bone-building drugs such as teriparatide, abaloparatide and romosozumab add new bone, while lifestyle steps help protect what you have. The goal of treatment is fewer fractures.

Is osteopenia the same as osteoporosis?

No. Osteopenia means your T-score is between -1.0 and -2.4: lower than normal but not in the osteoporosis range. It is a signal to focus on prevention, and your doctor may use a fracture risk tool to decide if you need medicine.

How often should I have a bone density scan?

It depends on your result, your risk and whether you are on treatment. Ask your doctor what interval fits you.

Should I take calcium supplements?

Only if you cannot meet your daily needs from food. Add up what you eat first, then make up the difference. Stay under the upper limit, and tell your doctor about any supplements you take.

What to do next

Start with three steps this week. First, check whether you meet screening criteria and ask your doctor about a DXA scan if you do. Second, estimate your daily calcium and vitamin D from food and compare it with the table above. Third, add two short strength and balance sessions to your week. For the bigger picture, see the habits that matter most for aging well after 50 for the rest.

Sources

Last reviewed: November 2026.

Comments

Post a Comment

Popular Posts

Top 10 Exercises to Help You Sleep Longer and Better

Image
The best exercises for sleep are the ones you'll do most days: brisk walking, yoga, swimming, cycling, strength training and gentle evening stretching all have research linking them to falling asleep faster and sleeping more deeply. Moderate activity can fit almost any time of day. Hard, sweaty workouts are usually best kept away from the last couple of hours before bed. This guide is for you if you lie awake at night, wake up unrefreshed, or want a drug-free way to sleep better, and you'd like to know which kind of movement to try first. Key takeaways Regular activity over weeks matters more than any single workout. Expect gradual change, not an overnight fix. Morning walks outdoors pair movement with daylight, which helps set your body clock. Slow, breath-focused practices such as yoga, tai chi and stretching are the best fit for evenings. Save high-intensity workouts for morning or early afternoon if late sessions keep you up. Exercise helps most sleep problems but...
Read more

Muscle Gain Diet: What Actually Works, Kept Simple

Image
To build muscle, most people who lift regularly need about 1.4 to 2.0 grams of protein per kilogram of body weight a day, spread over meals of roughly 20 to 40 grams each, plus enough total food to fuel training. Add consistent strength training and decent sleep, and that covers most of the results. Everything else is fine-tuning. This guide is for anyone who has started lifting and feels buried in conflicting advice about meal timing, shakes and supplement stacks. Here's the short, evidence-based version. Key takeaways The International Society of Sports Nutrition (ISSN) says 1.4 to 2.0 g of protein per kg per day is enough for most exercising people building muscle. Spread protein across the day, about 20 to 40 g per meal, every 3 to 4 hours. Exact timing around your workout matters less than total daily intake. Eating before or after training both work. Creatine monohydrate is the best-supported supplement. Protein powder is a convenience, not a requirement. If you...
Read more

Plant Protein Powder for Acne-Prone Skin: What to Know

Image
If your skin broke out after you started whey protein shakes, switching to a plant-based protein powder is a reasonable experiment. Cow's milk has been linked with acne, and case reports describe acne flares that cleared after whey was stopped. A pea protein powder can support muscle growth, and one trial found results similar to whey. This guide is for people who lift or train and want to keep building muscle without guessing about their skin. It covers what the evidence does and doesn't show, how to choose a powder and how to run a fair test. Key takeaways The milk link is real but not fully explained: the American Academy of Dermatology (AAD) says studies link cow's milk with acne, though the reason isn't clear. Whey evidence is limited: it comes mostly from small case reports and observational studies, not large trials. Pea protein can build muscle: in a 12-week trial, pea and whey produced similar gains in muscle thickness. Sugar matters too: high-gly...
Read more

Calorie Deficit and Insomnia: Why Dieting Keeps You Awake

Image
Yes, a calorie deficit can cause insomnia. Eating less than you burn lowers overnight blood sugar, raises the hunger hormone ghrelin and nudges cortisol up, and together those signals can wake you at 2 or 3 a.m. The bigger and faster the deficit, the more likely your sleep suffers. This guide is for anyone who started a diet and suddenly sleeps worse. You'll learn how to recognize diet-related sleep trouble, and how to adjust your plan so you keep losing fat without lying awake staring at the ceiling. Key takeaways Diet-related sleep trouble usually looks like waking in the second half of the night, not trouble falling asleep. Large, fast deficits disrupt sleep more than small, steady ones. Keeping protein adequate and saving some carbohydrate for the evening often helps. Poor sleep makes dieting harder: it raises hunger and can shift weight loss away from fat and toward muscle. Loud snoring, gasping, or insomnia that started before the diet needs a medical check, not a ...
Read more

Can Pinworms Last for Years? Why Infections Keep Coming Back

Image
No, a single pinworm can't live in your body for years. Adult worms live for only a few weeks. What makes an infection seem to last for months, or even years, is reinfection: eggs get swallowed again and start a new cycle before the old one ends. Break that cycle and the infection clears. This is for parents who've treated a child, seen the itching come back a few weeks later, and started to wonder whether something more serious is going on. Key takeaways Pinworms live for weeks, not years. Long-running "infections" are almost always repeated reinfections. Treatment is two doses of medicine, two weeks apart, because the medicine kills worms but not eggs. Everyone in the household needs treating at the same time, even people with no symptoms. Eggs can survive on bedding, clothes and surfaces for around two to three weeks, so cleaning matters as much as medicine. Pinworm rarely causes serious harm, but see a doctor for babies under 2, during pregnancy, or if t...
Read more

Why Am I Losing Muscle Mass? Causes, Signs and Fixes

Image
Most unexplained muscle loss comes from using your muscles less, getting older, or eating too little protein and energy. Less often, it's a sign of nerve damage, a hormone problem or another illness. The good news is that the common causes respond well to regular strength training and enough protein at each meal. Maybe your legs look thinner after a few months at a desk job, or the stairs feel harder than they did last year. This guide is for anyone who has noticed that change and wants to know what's behind it and what to do next. Key takeaways Disuse is the most common cause: muscles shrink when they aren't worked regularly, and this type can often be reversed with exercise and better nutrition. Age plays a part: Cleveland Clinic says age-related muscle loss (sarcopenia) starts in your 30s or 40s and speeds up between ages 65 and 80. Strength training is the main fix: adults should do muscle-strengthening activity on at least 2 days a week, according to the CD...
Read more

No-Sugar Diet: How to Cut Added Sugar Step by Step

Image
A no-sugar diet means cutting added sugars, not the natural sugar in whole fruit, vegetables and plain dairy. You drop soda, sweets and sweetened snacks first, then hunt down hidden sugar in sauces, bread, yogurt and cereal. Most people get through the hardest cravings within one to two weeks. It sounds simple until you start reading labels and find sugar in pasta sauce, salad dressing and "healthy" granola. This guide is for anyone who wants to cut back without a miserable, all-or-nothing approach that collapses by week two. Key takeaways The target is added and free sugars: table sugar, syrups, honey, fruit juice and sweeteners added to processed food. The WHO advises keeping free sugars under 10% of daily calories, with extra benefit below 5%, about 25 grams or 6 teaspoons a day. The CDC reports that US adults average about 17 teaspoons of added sugar a day. Expect cravings, irritability or low energy for the first few days; they usually ease within one to two we...
Read more

Fruits That Help Reduce Cholesterol and What to Avoid

Image
Avocado, berries, oranges and an apple, fruits that fit a cholesterol-friendly diet Fruits that are rich in soluble fiber, such as apples, pears, oranges, bananas and prunes, can help lower LDL ("bad") cholesterol as part of an overall heart-healthy diet. Avocado can help too when it replaces saturated fat. Fruit alone won't fix high cholesterol, but it's one of the easiest changes to stick with. This guide is for anyone who's just seen a high cholesterol result and wants to know what to put on the plate, and what to watch out for, especially if you take a statin. Key takeaways MedlinePlus lists apples, bananas, oranges, pears and prunes as fruit sources of soluble fiber, which helps lower cholesterol. The suggested target is 10 to 25 grams of soluble fiber a day, from fruit, oats, beans and other foods. In a small controlled study, a moderate-fat diet with one avocado a day lowered LDL more than a similar diet without avocado. Grapefruit, Seville ora...
Read more

Soursop Benefits and Risks: Fruit, Leaves and Tea

Image
Soursop fruit is a healthy, fibre-rich tropical fruit that's safe to enjoy in normal amounts. Its leaves and tea have traditional uses with some early lab and animal evidence, but no human trials show soursop treats or cures cancer. High-dose leaf extracts and supplements also raise real concerns about nerve damage, so they deserve caution. This is for anyone who enjoys soursop, has been told to drink the leaf tea for a health problem, or has seen posts claiming it beats chemotherapy and wants a straight answer. Key takeaways The fruit pulp offers fibre, vitamin C and potassium, and fits well in a varied diet. Soursop extracts kill some cancer cells in lab dishes, but that hasn't been shown in people. No reputable cancer organisation supports it as a treatment. Compounds in soursop, especially concentrated in leaves, seeds and bark, can harm nerve cells. Heavy long-term use has been linked to Parkinson-like symptoms. Occasional leaf tea is different from daily concentr...
Read more

Why Sleep Earbuds Cause a Sore Spot on Your Ear Cartilage

Image
A sore spot on your ear after sleeping with earbuds is a small pressure injury, not an infection. The outer ear has almost no fat padding, and its cartilage has no blood vessels of its own. When an earbud is trapped between your head and the pillow for hours, it squeezes the tiny vessels that feed that cartilage, and the tissue complains by morning. If you use audio to fall asleep, you probably know the pattern: the sound helps, but one ear wakes up tender, and the tenderness sits on the rim rather than deep in the canal. That pattern is predictable, and it's worth understanding before it turns into a lump that lingers for months. Key takeaways Morning ear soreness from earbuds is caused by sustained pressure on thin skin over cartilage with a limited blood supply. Simple pressure soreness fades within hours. A firm, painful lump that lasts weeks may be chondrodermatitis nodularis helicis (CNH) and needs a doctor's look. A red, hot, swollen outer ear with a normal ear...
Read more