Osteoporosis Risk: How to Stop Bone Density Loss and Prevent Fractures

At 65, Mary from Concord started noticing her back hurt more after bending over to pick up her grandkids. She thought it was just aging-until she fell in the kitchen and broke her wrist. A DXA scan showed her bone density had dropped to -3.1. She had osteoporosis. And she wasn’t alone. In the U.S., 1 in 3 women over 50 will break a bone because of it. The scary part? Most people don’t know they’re at risk until it’s too late.

Why Your Bones Are Losing Density

Your bones aren’t static. They’re alive, constantly breaking down old tissue and building new stuff. Up until your mid-20s, your body builds bone faster than it loses it. That’s when you hit peak bone mass. After that, it’s a slow decline-about 0.3% to 0.5% per year. But for women after menopause, that rate jumps to 2% to 3% a year for the first five to seven years. That’s because estrogen, which helps protect bone, drops sharply.

Men aren’t immune. About 1 in 5 men over 50 will suffer an osteoporosis-related fracture. And while men don’t have the same hormonal crash as women, they still lose bone as they age-especially if they’re inactive, smoke, or don’t get enough calcium and vitamin D.

The real danger isn’t just low bone density. It’s how fragile your bones become. A simple stumble, a sneeze, or even bending over can lead to a fracture. Hip fractures are the worst: 20% to 24% of people who break a hip die within a year. Many never walk the same way again.

What You Can’t Change (But Need to Know)

Some risks you can’t fix. But knowing them helps you act smarter.

• Age: After 65, your fracture risk is over four times higher than if you’re under 50.
• Gender: Women are four times more likely to get osteoporosis than men.
• Race: White and Asian women have higher risk than Black or Hispanic women.
• Family history: If a parent broke a hip, your risk goes up by 60% to 80%.
• Early menopause: Going through menopause before 45 doubles your risk.

These aren’t warnings to panic about. They’re flags. If any of these apply to you, you need to be proactive-starting now.

What You Can Change (And Should)

The good news? Most of your risk is in your hands.

Calcium isn’t optional. Adults need 1,000 mg a day. Seniors need 1,200 mg. That’s not a suggestion-it’s a medical baseline. Most people get less than half that from food. Dairy is the easiest source: one cup of milk = 300 mg. But you don’t have to rely on it. Canned salmon with bones, kale, bok choy, fortified tofu, and almonds all add up. If you can’t get enough from food, take a supplement. But don’t take it all at once. Your body absorbs 500-600 mg best at a time. Split your dose: one with breakfast, one with dinner.

Vitamin D is the key that unlocks calcium. Without it, your body can’t use the calcium you eat or take as a pill. The CDC says 42% of U.S. adults are deficient. If your levels are below 20 ng/mL, you’re at higher risk for fractures. Most people need 800-1,000 IU a day. If you’re deficient, you might need 2,000 IU until your levels climb above 30 ng/mL. Get tested if you’re over 50, especially if you live in a northern state or spend most of your time indoors.

Stop smoking. Smoking cuts calcium absorption and messes with estrogen. One pack a day increases your fracture risk by 55%. Quitting doesn’t reverse all the damage-but it stops the bleeding. Every year you stay smoke-free, your bone health improves.

Limit alcohol. More than two drinks a day increases hip fracture risk by 41%. One glass of wine? Fine. Two bottles of beer every night? That’s a problem.

Move your body. If you’re sedentary, your fracture risk is 25% to 30% higher. Weight-bearing exercise-walking, hiking, dancing, stair climbing-tells your bones to get stronger. Resistance training with bands or weights twice a week adds even more protection. Studies show people who stick with this routine for a year reduce their fracture risk by 30% to 40%. Balance training matters too. Tai chi, yoga, or simple heel-to-toe walks reduce falls by nearly half.

Fractures Are a Warning Sign-Not a Final Outcome

Here’s something most people don’t know: if you’ve already had one fragility fracture, your chance of another skyrockets. A broken spine? Your risk of another vertebral fracture goes up by 86%. A broken hip? That risk jumps 200%. Dr. Ethel Siris from Columbia says, “A single fracture is the strongest predictor of the next one-even more than low bone density.”

That means if you broke a wrist after a minor fall, you’re not just unlucky. You’re in the danger zone. You need a bone density test, even if you’re under 65. And you need a plan-not just medication, but lifestyle changes.

Testing and Treatment: What Actually Works

The gold standard test is a DXA scan. It’s quick-15 to 20 minutes. The radiation? Less than you get from a three-hour flight. It gives you a T-score:

• Normal: -1.0 or higher
• Osteopenia: -1.0 to -2.5
• Osteoporosis: -2.5 or lower

But here’s the catch: up to half of people who fracture have T-scores in the osteopenia range. That’s why doctors now use the FRAX tool. It doesn’t just look at bone density. It factors in age, gender, weight, smoking, steroid use, and past fractures to calculate your 10-year fracture risk. If your risk is high enough, treatment is recommended-even if your T-score isn’t in the osteoporosis range.

Medications like bisphosphonates (alendronate, risedronate) are common. They slow bone loss. But many people stop taking them because of stomach upset or jaw pain. Newer drugs like romosozumab (Evenity) actually build new bone while reducing breakdown. It’s given as monthly injections for a year, then switched to another drug to maintain gains. It cuts new spine fractures by 73% compared to older meds.

But drugs aren’t magic. They work best with movement, calcium, and vitamin D. No pill can replace a strong body.

Preventing Falls Is Just as Important as Strengthening Bones

You can have perfect bone density-but if you fall, you still break a bone. That’s why fall prevention is part of every real osteoporosis plan.

• Remove rugs and clutter from floors.
• Install grab bars in the bathroom.
• Use non-slip mats in the shower.
• Improve lighting-especially stairs and hallways.
• Get your vision checked yearly.
• Review your meds with your doctor. Some drugs (like sleep pills or blood pressure meds) make you dizzy.

Balance training isn’t just for seniors. Start with standing on one foot while brushing your teeth. Work up to heel-to-toe walking. Do it every day. It’s free, and it saves lives.

It’s Not Too Late-But You Need to Start Now

The idea that osteoporosis is just an old person’s disease is wrong. Peak bone mass by age 30 sets the stage for the rest of your life. That’s why childhood nutrition and activity matter. But even if you’re 60, 70, or 80, it’s not too late to build strength, reduce fall risk, and protect your bones.

Mary, from Concord, started walking 30 minutes a day, took calcium and vitamin D, and joined a fall-prevention class at her community center. A year later, her repeat DXA scan showed her bone density had stabilized. She hasn’t fallen since. She still picks up her grandkids.

Your bones don’t need perfection. They just need consistent care. Calcium. Vitamin D. Movement. No smoking. Less alcohol. Fall-proof your home. Get tested if you’re at risk. Don’t wait for a fracture to wake you up.

What to Do Next

Start with three simple steps:

1. Take a calcium and vitamin D supplement if you’re not getting enough from food.
2. Walk 30 minutes five days a week. Add light weights twice a week.
3. Ask your doctor if you should get a bone density test-especially if you’re over 50 and have any risk factors.

Bone health isn’t about quick fixes. It’s about daily habits. The next fracture might be yours. Or your parent’s. Or your partner’s. But you can change that. Start today.