Many of us start to think about osteoporosis as we approach our senior years. After all, that's when bone loss occurs, right?
Wrong. Doctors tend to treat patients with osteoporosis in their 60s, 70s and older–but bone loss begins much earlier.
Our bone mass peaks around age 20. "By even 25 to 30 years of age, the average woman already has lost 10 percent of her peak bone density," says Nelson B. Watts, M.D., professor of medicine at the University of Cincinnati and director of its Bone Health and Osteoporosis Center.
When bone loss goes unchecked for years, the result is fractures—often of the hip, spine, wrist or leg bones. Menopause speeds the process. That's why 80 percent of the more than 10 million Americans with osteoporosis are women past menopause. In the first few years after menopause, bone loss accelerates; after that, it continues, but at a slower rate. Osteoporosis can strike men, too, but usually at a later age because they start with more bone. One in four men over 50 will end up with a fracture related to osteoporosis.
To learn who needs help, the U.S. Preventive Services Task Force urges routine osteoporosis screening for all healthy women 65 and older. High-risk women should seek screening at age 60.
Dr. Watts says the best screening method is a dual-energy X-ray absorptiometry (DEXA) scan. Medicare covers this non-invasive test for women 65 and older once every two years if their doctor says it's needed. "Screening can detect a problem earlier and we can begin treatment with medication and lifestyle changes sooner," Dr. Watts says.
Several medications have been approved to treat osteoporosis, including calcitonin, bisphosphonates, such as alendronate and risedronate, parathyroid hormone, and selective estrogen-receptor modulators, such as raloxifene. According to the Task Force, each of these treatments has potential benefits and harms.
Prevention includes getting enough calcium and vitamin D. Weight-bearing exercise helps, too.
Who's at high risk?
Women older than 65
White or Asian women
Women with small bones
Women who are sedentary
Post-menopausal women
People with a family history of osteoporosis
Smokers
Adults who are very thin
People who break bones after age 45 because of "low trauma," such as a fall while standing
Long-term corticosteroid users
People who drink alcohol to excess
People with overactive thyroids
People taking certain medications, such as phenytoin, gonadotropin-releasing hormone, antacids containing aluminum, cancer treatments, and thyroid hormone
Our calcium needs
The National Academy of Sciences and the National Osteoporosis Foundation recommends:
Age: Birth to 65 months
Daily calcium need: 210 mg
Age: 6 months to 1 year
Daily calcium need: 270
Age: 1-3
Daily calcium need: 500 mg
Age: 4-8
Daily calcium need: 800 mg
Age: 9-18
Daily calcium need: 1,300 mg
Age: 19-50
Daily calcium need: 1,000 mg
Age: 51-70 and older
Daily calcium need: 1,200 mg
Age: 70+
Daily calcium need: 1,000 mg
