Osteoporosis weakens bones to the point that they can break easily. It is called a “silent disease” because people who develop it may not notice any changes until a bone breaks — usually a bone in the hip, spine, or wrist.

Bones are made of living tissue. To keep them strong, a healthy human body breaks down old bone and replaces it with new bone. Osteoporosis develops when more bone is broken down than replaced.

The inside of a bone looks something like a honeycomb. When someone has osteoporosis, the bone, which forms the “walls” of the honeycomb, get smaller, and the spaces between the bone grow larger. The outer shell of the bone also gets thinner. All of this makes a bone weaker.

In serious cases of osteoporosis, a simple motion such as a cough or minor bump can result in a broken bone, also called a fracture. People with osteoporosis also have a harder time recovering from broken bones, which can sometimes cause pain that does not go away. Broken hip and spine bones are especially serious, as these injuries can cause older adults to lose their mobility and independence.

While people of all races and ethnic groups can develop osteoporosis, certain groups are more likely to develop the disease. Osteoporosis affects about one in five women over age 50, but only one in 20 men. Among women, those of White and Asian descent are more likely to develop osteoporosis. Other risk factors for osteoporosis include:

• A family history of broken bones or osteoporosis
• History of a broken bone after age 50
• Previous surgery to remove the ovaries before menstruation periods stopped naturally
• Poor dietary habits, including insufficient amounts of calcium and/or vitamin D or protein
• Physical inactivity or prolonged periods of bedrest
• Smoking cigarettes
• Heavy use of alcohol
• Long-term use of certain medications, such as corticosteroids, proton pump inhibitors, and antiepileptic medications
• Altered levels of hormones, such as too much thyroid hormone, too little estrogen in women, or too little testosterone in men.
• Low body mass index or underweight

The risk of developing osteoporosis increases as people grow older. At the time of menopause, women may lose bone mass quickly for several years. After that, the loss slows down but continues. In men, the loss of bone mass is slower. By age 65 or 70, men and women lose bone mass at the same rate.

Bone health is often overlooked until problems arise. It doesn’t matter how old you are. You can take steps now to Know Your Bones.

Why bone health matters for women

Women are at higher risk of developing osteoporosis. Osteoporosis is about four times more common in women than men. Women are more likely to get osteoporosis because of:

• Hormonal changes: Estrogen, a hormone that helps maintain bone density decreases after menopause.
• Body size: Slender, thin-boned women are at greater risk of developing osteoporosis.
• Aging: Women often live longer than men. Bone loss happens naturally as we age.

Osteoporosis is most common in older women, but younger women can also get osteoporosis. Girls and women of all ages need to take steps to protect and maintain their bones. There are tests that use either X-rays or ultrasound (sound waves) to measure bone density and can help determine if you have osteoporosis. Health care providers may recommend osteoporosis screening for women aged 65 and older, or earlier for women with specific risk factors.

Prioritizing bone health at every age

Adolescence and young adulthood: Building strong bones during childhood and the teen years is important to help prevent osteoporosis later in life. Participate in regular physical activity including weight bearing exercises like yoga or walking and eat a calcium-rich diet with foods like dairy products, leafy greens and calcium fortified foods.

Childbearing years: Having a baby can be a joyous time but can also be demanding on the body. While in the womb, fetuses get their nutrients from their mother. If you don't get enough calcium from food or supplements, your fetus will use the calcium in your bones. Prenatal vitamins often contain calcium and vitamin D, which are important for both the mother and the fetus’s bone health. Your body also makes more of the hormone estrogen during pregnancy, which helps protect bones. You may lose some bone density during pregnancy and with breastfeeding, but any bone mass lost is temporary and usually restored after childbirth or after breastfeeding.

Perimenopause and menopause: As estrogen levels decline, women are at an increased risk of bone loss. Weight bearing exercise and getting adequate calcium and vitamin D may help. Osteoporosis screening is recommended for women younger than 65 who have risk factors for osteoporosis such as a family history of osteoporosis or who take certain medicines to treat long-term health problems. Talk with your health care provider about whether you need to be screened for osteoporosis. If you are found to have osteoporosis, your provider may recommend medicine to prevent more bone loss or build new bone mass.

Post-menopause: Continue to prioritize your bone health post-menopause to maintain bone strength and reduce the risk of fractures. Physical activity and diet are vital to bone health in older adults. Talk with your health care provider about osteoporosis screening, lifestyle changes, and possibly treatments to prevent more bone loss, help keep your bones strong or build new bone mass.

There is no way to cure osteoporosis. If you have been diagnosed with osteoporosis, there are prescription medicines you can take. Talk with your health care provider about your treatment options.

Nutrition and bone health

Nutrition can affect your bones. Not getting enough calcium, vitamin D and other important nutrients, may lead to weak bones. Eating disorders can affect bone and health because the body may not be getting the energy and nutrients it needs to stay healthy and strong.

People experiencing eating disorders like anorexia greatly reduce the number of calories and nutrients they consume, which can prevent important growing and healing processes from taking place. In girls and young women, lack of proper nutrition is especially harmful to bone health, as bones may not grow as dense or as strong as they should. Learn more about the effects of nutrition on bone health.

5 tips for maintaining strong bones

1. Eat a balanced diet. Get enough calcium and vitamin D in your diet.
2. Stay physically active. Engage in weight bearing exercise like walking.
3. Avoid smoking and excessive alcohol use.
4. Get regular check-ups.
5. Talk with your health care provider about your health care concerns and if you need osteoporosis screening before age 65.

It’s never too early or too late to make bone health a priority. By prioritizing bone health, you can build and preserve strong bones.

How does calcium help prevent osteoporosis?

Calcium is found in your bones and teeth. It helps build bones and keep them healthy. Your body also uses calcium to help your blood clot and your muscles contract. If you don't get enough calcium each day from the foods you eat, your body will take the calcium it needs from your bones, making your bones weak.

You can get calcium through food or calcium supplements.

How much calcium do women need each day?

How much calcium you need depends on your age:

• 9–18 years: 1,300 mg per day
• 19–50 years: 1,000 mg per day
• 51 and older: 1,200 mg per day

Pregnant or nursing women need the same amount of calcium as other women of the same age.

You can get the calcium you need each day from food and/or calcium supplements.

What foods contain calcium?

Calcium is found naturally in some foods:

• Milk
• Cheese
• Yogurt
• Leafy green vegetables, such as broccoli, kale, and mustard greens

Calcium is sometimes added to certain foods, such as:

• Breakfast cereals (some have up to 100% of the recommended daily value — or 1,000 milligrams — of calcium in each ¾ cup serving)
• Orange juice
• Tofu
• Soymilk
• Breads and pastas

What should I look for when buying food with calcium?

When buying food with calcium, look at the Nutrition Facts label to see how much calcium is in the food. Food labels show the amount of calcium as a percentage of the Daily Value (written as %DV). Foods providing 20%DV or more are high sources of calcium, but foods with lower percentages (5% or more) are still good sources of calcium.

What if dairy foods make me sick or I don't like to eat them? How can I get enough calcium?

If you have problems eating foods with dairy or don't like to eat them, try the following tips to make sure you get enough calcium:

• Try lactose-reduced or lactose-free products, such as milk or yogurt.
• Take a lactose supplement (in pill or liquid form) before eating dairy foods to help you digest them.
• Choose other food sources of calcium. Other good sources of calcium include tofu or orange juice with calcium added, and vegetables such as bok choy, kale, collard greens, mustard greens, and broccoli.
• Ask your doctor or nurse if you need to take calcium supplements.

Should I take a calcium supplement?

The answer depends on how much calcium you need each day and how much calcium you get from the foods you eat.

It's best to get the calcium your body needs from food. But if you don't get enough calcium from the foods you eat, you may want to consider taking a calcium supplement.

You can get calcium supplements at the grocery store or drug store. Talk with your doctor or nurse before taking calcium supplements to see which kind is best for you and how much you need to take.

How does vitamin D help prevent osteoporosis?

Vitamin D helps your body absorb calcium from the food you eat. Just eating foods with calcium is not enough. You also need to get enough vitamin D to help your body use the calcium it gets.

Your skin makes vitamin D when it is exposed to sunlight. In general, you need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a week to make enough vitamin D. The amount of time depends on how sensitive your skin is to light. It also depends on your use of sunscreen, your skin color, the season, the latitude (how far north or south) where you live, and the amount of pollution in the air.

You can also get vitamin D from foods such as milk or from vitamin supplements. The vitamin D you get from food or supplements is measured in international units (IU).

How much vitamin D do women need each day?

How much vitamin D you need each day depends on your age:

• Women up to age 70: 600 international units (IU)
• Women 71 and older: 800 IU each day

Pregnant and breastfeeding women need the same amount of vitamin D (600 IU) as other women of the same age.

What foods contain vitamin D?

Although it's hard to get enough vitamin D through food alone, foods with vitamin D include:

• Salmon
• Tuna fish
• Egg yolks

Vitamin D is often added to certain foods, including:

• Breakfast cereals
• Milk
• Orange juice

Regular physical activity of any type can help slow bone loss, improve muscle strength, and help your balance. But weight-bearing physical activity is especially important to build bone and help prevent bone loss. Weight-bearing physical activity is any activity in which your body works against gravity.

Weight-bearing activities you can try include:

• Dancing
• Gardening
• Lifting weights
• Tennis
• Tai chi
• Yoga
• Running
• Walking

Osteoporosis rarely has any symptoms. In fact, some people may not notice any changes until a minor bump or fall causes a bone to break. Don’t wait for a potential accident to determine if you have osteoporosis.

If you are a woman over age 65, the U.S. Preventive Services Task Force recommends that you get tested for osteoporosis. Women younger than 65 who are at greater risk should also get tested. The task force does not recommend regular screening for men. Men lose bone density more slowly than women but should still be aware of the possibility of developing osteoporosis. Older men who break a bone easily or who are at risk for osteoporosis should talk with their doctor about testing and treatment.

Health care providers can measure how strong bones are with a bone density scan. This test compares a person’s bone density to the bones of an average healthy young adult. The test result, known as a T-score, indicates whether a person has osteoporosis or osteopenia, which is low bone density that’s not as severe as osteoporosis. Your doctor may also use other screening tools, including questionnaires, physical exams, and ultrasounds, to predict your risk of having low bone density or breaking a bone.

There are things you can do at any age to prevent weakened bones. Here are some tips:

• Eat foods that support bone health. Get enough calcium, vitamin D, and protein each day. Low-fat dairy; leafy green vegetables; fish; and fortified juices, milk, and grains are good sources of calcium. If your vitamin D level is low, talk with your doctor about taking a supplement.
• Get active. Choose weight-bearing exercise, such as strength training, walking, hiking, jogging, climbing stairs, tennis, and dancing. This type of physical activity can help build and strengthen your bones.
• Don’t smoke. Smoking increases your risk of weakened bones. If you do smoke, here are tips for how to quit smoking.
• Limit alcohol consumption. Too much alcohol can harm your bones. Drink in moderation or not at all. Learn more about alcohol and aging.