Osteoporosis 101
What Everyone Needs to Know About Bone Health
I'll be honest with you. As a rheumatologist, osteoporosis wasn't my favorite topic. It felt obscure, like something that took time away from treating my patients' more pressing rheumatoid arthritis flares or lupus complications. I saw it as a necessary evil of practice, not something I was passionate about.
You might be wondering why a rheumatologist is even talking about osteoporosis. While I'm not the doctor who typically manages osteoporosis as a primary focus, I encounter it regularly in my patients. Many rheumatic diseases and their treatments significantly increase osteoporosis risk. But honestly, I've dedicated myself to learning more about this topic for a deeply personal reason: When my mom was diagnosed with severe osteoporosis.
Suddenly, this "boring" bone disease became personal. I felt like I needed to know more to help the person I cared about most navigate her diagnosis, treatment options, and daily concerns. That moment sparked a journey into understanding osteoporosis.
Here's what I discovered: there's an enormous amount of misinformation circulating about osteoporosis. Here are some things people have been told:
Drinking bone broth 🦴 is all they need to rebuild their bones
Taking massive doses of calcium 💊 is better (it can actually be dangerous)
Expensive supplements 🌿 with zero proven benefit are worth the money
Meanwhile, the interventions that actually work often get overlooked.
This post will give you the real deal about what's happening and what actually helps.
So, What is Osteoporosis?
Osteoporosis is a skeletal disorder where your bones get weaker, more brittle, and more likely to break. As simple as that.
Your bone strength depends on two things:
How much bone you have (bone mass)
How well that bone is built (bone quality)
Here's the kicker: osteoporosis is completely silent until something breaks.
No symptoms. No warning signs. No "my bones feel weak today." Many people find out they have it only after a fracture. That's why we call it the silent disease.
The most common first sign? A spine fracture.
But get this: Two-thirds of spine fractures don't even hurt. Your bones can be quietly breaking without you knowing it.
The Numbers Don't Lie
The reality is stark:
40% of women and 20% of men will have an osteoporotic or fragility fracture in their lifetime
1 in 3 people over 65 dies within a year of a hip fracture
Women are 4x more likely than men to develop osteoporosis
These numbers represent millions of people facing serious complications that could often be prevented.
Spoiler alert: it's not normal, and it's often preventable.
Um…What’s a Fragility Fracture?
Fragility fractures happen from minimal trauma. We're talking about:
Falling from standing height (or less)
Coughing or sneezing hard
Lifting something light
Sometimes just moving wrong
The most common spots:
Spine vertebrae
Hips
Wrists
Upper arms
But here's what's scary: once you have osteoporosis, you're at risk for fractures anywhere.
The domino effect:
Loss of height
Hunched posture (dowager's hump)
Chronic pain
Reduced lung function
Permanent disability
Higher death risk
So…Who's at Risk?
There are some factors that put you at risk for osteoporosis and, subsequently, for fragility fractures. Some are non-modifiable (things you can’t change) and some are modifiable (things you can change or that are under your control).
Things You Can't Change
Age (biggest factor)
Being a woman (menopause is rough on bones)
Race (Caucasian and Asian women get hit hardest)
Early menopause (before 45)
Being small-framed (under 125 pounds)
Family history of fractures (especially if your mom had a fracture)
Things You CAN Change
Sedentary lifestyle (your bones need action)
Smoking (destroys bones faster than almost anything)
Too much alcohol (more than 2 drinks daily)
Excessive caffeine (more than 2 cups daily)
Poor nutrition (especially calcium and vitamin D)
Crash dieting (rapid weight loss weakens bones)
Medical Stuff That Matters
Conditions that increase risk:
Rheumatoid arthritis
Kidney disease
Thyroid problems
Previous weight loss surgery
Medications that hurt bones:
Steroids (prednisone, cortisone)
High-dose thyroid meds
Blood thinners (warfarin)
Acid blockers (PPIs)
Why Women Get Hit Harder
Let's talk about the elephant in the room: menopause.
When estrogen crashes during menopause, bone loss goes into overdrive. Between 40-50% of postmenopausal women will break a bone because of osteoporosis.
Key facts every woman needs to know:
Bone density peaks at ages 19-20
It starts declining in your 30s
Menopause accelerates the decline dramatically
If you're approaching menopause, bone health should be on your radar NOW
Younger women aren't immune either. Low estrogen from any cause can trigger early bone loss:
Surgery (hysterectomy with ovary removal)
Medications (certain breast cancer treatments)
Eating disorders
Over-exercising with missed periods
How Do I Know I Have Osteoporosis?
Three ways to diagnose osteoporosis:
1. You Break Something from Minor Trauma
If you break something from minor trauma, that's osteoporosis by definition. No other test needed.
2. DEXA Scan (The Gold Standard)
This measures your bone density with minimal radiation. Results come as T-scores for menopausal women and Z-scores for pre-menopausal women:
Above -1.0: Normal bones
-1.0 to -2.5: Osteopenia (getting weaker)
Below -2.5: Osteoporosis (time for action)
3. FRAX Score (Risk Calculator)
Estimates your 10-year fracture risk:
3%+ risk for hip fracture: High risk
20%+ risk for major fracture: High risk
It’s important to note that the FRAX score underestimates certain risk factors, like prednisone or glucocorticoid use, which is very common in women with rheumatoid arthritis or lupus. This means that the FRAX score may be even higher than what the calculator reports.
Who Needs Testing?
Not everyone has to (or should) get testing for osteoporosis. Currently, the recommendations are that certain patient populations should get a DEXA scan:
Women 65+ and men 70+
Anyone with multiple risk factors
People taking steroids long-term
Anyone being treated (to see if it's working)
Let's Address Some Myths
(Because I'm Tired of the Nonsense)
Myth: "Bone Broth Will Save My Bones"
👉🏻Reality: The evidence is weak at best. One animal study doesn't translate to human bone building. You're better off focusing on proven interventions.
Myth: "More Calcium = Stronger Bones"
👉🏻Reality: Too much calcium can cause kidney stones and potentially heart problems. You need enough (1,000-1,200mg daily), not excessive amounts.
Myth: "I Need Expensive Vitamin K2 Supplements"
👉🏻Reality: Despite the marketing hype, evidence for K2 supplementation in osteoporosis is inconclusive. Guidelines don't recommend it. Save your money.
Myth: "Osteoporosis Is Just Part of Getting Old"
👉🏻Reality: While some bone loss happens with age, significant osteoporosis isn't inevitable. The right approach can prevent or slow it dramatically.
Myth: "Exercise Will Break My Fragile Bones"
👉🏻Reality: The opposite is true. The right exercise is one of the most powerful bone-building tools we have. (More on this in upcoming posts.)
The Bottom Line
Osteoporosis isn't something that happens overnight, and it's not something you have to accept. But you need accurate information, not the latest supplement fad or miracle cure.
What matters most:
Understanding your personal risk
Getting proper testing when appropriate
Following evidence-based interventions
Working with healthcare providers who know what they're doing
Your Next Moves
If osteoporosis is on your radar, here's what to do:
Talk to your doctor about risk factors and testing
Review your medications for bone effects
Honestly assess your current diet and exercise and optimize them
Document family history of fractures
Stay tuned for the nutrition and exercise deep-dives coming up
What's Coming Next
This is just the foundation. In upcoming posts, we'll cover:
Part 2: The nutrition guide for bone health (with free download)
Part 3: The LIFTMOR study - why heavy lifting might save your bones
Part 4: Exercise options for every fitness level
Part 5: Your bone health action plan and next steps
Here's the truth: Your bones are living tissue that responds to how you treat them. It's never too early or too late to start taking better care of them. But you need to know what actually works, not what sounds good in a Facebook ad.
Ready to build stronger bones?
Just a kind reminder: This content is for educational purposes only and does not constitute medical advice. Always consult with your healthcare provider for personalized medical guidance. The views expressed are my own and do not reflect those of my employer.
📚References:
Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. European Journal of Rheumatology. 2017;4(1):46-56.
Cheng CH, Chen LR, Chen KH. Osteoporosis due to hormone imbalance: an overview of the effects of estrogen deficiency and glucocorticoid overuse on bone turnover. International Journal of Molecular Sciences. 2022;23(3):1376.
North American Menopause Society. Management of osteoporosis in postmenopausal women: the 2021 position statement of the North American Menopause Society. Menopause. 2021;28(9):973-997.
Gosset A, Pouillès JM, Trémollieres F. Menopausal hormone therapy for the management of osteoporosis. Best Practice and Research Clinical Endocrinology and Metabolism. 2021;35(6):101551.
Xue S, Kemal O, Lu M, Lix LM, Leslie WD, Yang S. Age at attainment of peak bone mineral density and its associated factors: The National Health and Nutrition Examination Survey 2005-2014. Bone. 2020 Feb;131:115163.
Agostini D, Zeppa Donati S, Lucertini F, et al. Muscle and bone health in postmenopausal women: role of protein and vitamin D supplementation combined with exercise training. Nutrients. 2018;10(8):1103.