“Hard as a bone”—that’s an expression we’ve all heard. But what does it really mean?

Healthy bones are indeed hard. Your skeletal system does yeoman’s work in supporting your body and facilitating your movements. But when you have osteoporosis (literally “porous bone”), you can no longer count on your skeleton to be sturdy enough to withstand even routine stress. A twist, a bend, an unexpected jolt—all can snap a dangerously weak bone. Sadly, many people have no inkling that they have been losing bone mass for years until a painful fracture of the wrist, spine, or hip brings the problem into sharp focus.

More than 10 million Americans currently live with osteoporosis, and another 43 million show early signs of bone loss. And those numbers are expected to grow as baby boomers age. According to the National Osteoporosis Foundation, an estimated 64 million Americans over age 50 are expected to have low bone density or osteoporosis by 2020. That number will jump to more than 71 million by 2030, resulting in more bone fractures. Osteoporosis can be intimidating and inhibiting.

The prospect that a simple fall could break your hip or wrist can make you watch every step you take. Fear can replace the freedom to do all the things you love.

The two major risk factors for osteoporosis are being a woman and having passed through menopause. In the years after menopause, women can lose up to one-fifth of their bone mass.

And… still, there is always good news!

First, understanding the problem is an essential part of its solution, so let´s explore some insights about osteoporosis.

What causes osteoporosis?

Multiple factors can cause osteoporosis, some of them are susceptible to change, others are beyond your control.

Let´s refer to those factors that you cannot control, but you can consider keeping on top of them:

  • For a variety of reasons, women are at higher risk than men, though men can develop it, too.  Women are more likely than men to develop osteoporosis because they have smaller skeletons, their bone loss begins earlier. It occurs more rapidly, and they have a lower peak bone density to start with. About 80% of the 10 million Americans with osteoporosis are women. The Study of Osteoporotic Fractures— a landmark National Institutes of Health study of almost 10,000 women ages 65 and older—found that, on average, bone mass fell by approximately 5% every five years in women over 65.
  • Advancing years inevitably bring a higher risk for osteoporosis—,, particularly for women. The Centers for Disease Control and Prevention (CDC), reported that 16% of women and 4% of men ages 50 and over have osteoporosis as measured at the neck of the femur (near where the upper leg bone connects to the hip) or the lumbar spine (the vertebrae of the lower back). People in this age group also show signs of low bone strength in the spine or femoral neck, making them more likely to eventually develop osteoporosis.
  • Family history of the disease. The genetic traits you inherit strongly influence your risk. Between 70% and 80% of bone structure is genetically determined. Both men and women whose first-degree family members (parents, siblings) have had fractures are at higher risk. In fact, a woman whose mother or father had a breach is at twice the risk of a break— regardless of her measured bone density.
  • Caucasian and Asian women face the highest osteoporosis risk because their bones tend to be thinner and smaller than those of African American and Hispanic women. Asian women also tend to have a lower dietary intake of calcium because many of them are lactose intolerant. Yet surprisingly, despite having thinner bones, Asian women are less likely to fracture a hip than white women. This lower risk may be due to anatomical differences in the hip bone.

There are other factors that you can turn simply by introducing changes in your lifestyle.

A poor diet, lack of exercise, smoking, and alcohol use can all hasten the onset of osteopenia or osteoporosis as you age. If you were diagnosed with bone loss, addressing these risks can help protect and preserve the integrity of your bones for as long as possible.

  • Inadequate calcium and vitamin D levels. Insufficient intake of calcium from your diet—as well as conditions that may interfere with calcium absorption by the intestines—leads to lower calcium levels in the blood. The body compensates by releasing calcium from the bones, which weakens them. Your body needs vitamin D to properly absorb calcium, so adequate amounts of this vitamin are also necessary.
  • Sedentary lifestyle. When you are at rest, bone formation slows; when you are physically active, bones bulk up and become stronger. The research to date suggests that leading a physically active life can decrease the risk of having a fracture in the spine or hip by 30% to 50%.
  • Smokers tend to lose bone faster than nonsmokers. Smoking may both interfere with the absorption of calcium and lower the amount of bone protective estrogen the body produces. Several studies, some of them quite large, have found that men and women who smoked were at higher risk of breaking a hip or other bone. In fact, a report from the U.S. Surgeon General on osteoporosis noted that smokers are 55% more likely than nonsmokers to break a hip.
  • Excess alcohol consumption. The amount of alcohol you drink can affect your bone health. Alcohol may interfere with the body’s ability to convert inactive vitamin D into its active form. It also appears to hamper bone formation and increase losses of calcium and magnesium from the body. Excessive drinking may be accompanied by poor nutrition and an increased tendency to fall. People who consume more than two drinks per day may be at a moderately higher risk of low bone density and fractures, compared with nondrinkers.
  • Also, people who take certain drugs that contribute to bone loss may be at higher risk for osteoporosis. If you have a condition or you’re taking a medication known to affect bone density, talk to your doctor about what steps you may need to take to keep your bones healthy.

Now let´s talk solutions!

If your doctor told you that you have osteopenia or osteoporosis, he or she likely recommended you develop a plan to slow bone destruction and even gain back some of the bone you’ve lost. That plan will likely include four main strategies: diet, exercise, medication, and fall prevention.

If it is osteopenia (T-score ranging from -1 to -2.5), where bone density is lower than usual, but your fracture risk isn’t as high as that of someone with osteoporosis. You may not need medication at this point, but these adjustments to your lifestyle will promote your bone health and prevent you from progressing to osteoporosis.

  • Exercise. The stress on bones from weight-bearing activity causes your body to keep reinforcing bone. Staying active slows bone loss strengthens the muscles that support your skeleton, and improves your coordination and balance, so you’re less likely to fall. A combination of strength training (weight training) and weight-bearing exercises (walking, tennis, stair climbing) is ideal for preserving bones.
  • Get enough calcium and vitamin D. These nutrients are essential for both fall and fracture prevention. Ask your doctor whether you can get enough calcium and vitamin D from your diet alone or if you need to take a supplement.
  • Quit smoking. This habit, which is also bad for your heart, lungs, skin, and other organs, can increase your fracture risk. Ask your doctor about nicotine replacement products, medicines, or contact your health coach for different strategies to help you kick the habit.
  • Stay away from binge alcohol. Excess alcohol consumption can decrease bone mass, and heavy alcohol use can also make you more apt to fall.

Take additional measures to help avoid a fall. Remove clutter that might cause you to trip and be careful about using sedative medications and sleep aids that can make you uneasy on your feet.

While experts recommend getting your nutrients from foods instead of supplements, you may find that it just isn’t practical or possible for you to get all the calcium you need from your diet. In that case, a supplement can shore up your calcium intake and your bones. In fact, one analysis of several studies of postmenopausal women found that the women who took calcium and vitamin D supplements for at least two years were 23% less likely to suffer a spinal fracture. A dizzying array of calcium supplements are available, including pills, chewable tablets, flavored chews, and liquids at Dr. Gala Dispensary. When deciding, it’s wise to consider cost, convenience, and how well your body tolerates the supplement.

Purchase products through our Fullscript virtual dispensary.


Harvard Medical School. Osteoporosis: A guide to prevention and treatment. SPECIAL HEALTH REPORT.


About Dr. Angela Gala (Angie)

I was born in Cuba, a beautiful Caribbean island. I am an exponent of a unique culture, with nuances of Africa and indigenous customs that stand out in a very "Cuban" style. I graduated as a doctor in 1991, and for more than 28 years worked hard to improve the local and international public health. A little over a year ago, I decided to start a health training initiative for middle-aged women. My goal is to close the prevention gap in our care system. With my transformation method that integrates the mind, body, and spirit, I will help you master change your habits and your lifestyle to achieve a total balance.

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