What Women Need to Know

Being female puts you at risk of developing osteoporosis and broken bones. Here are some facts:

• Of the estimated 10 million Americans with osteoporosis, about eight million or 80% are women.
• Approximately one in two women over age 50 will break a bone because of osteoporosis.
• A woman's risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.

There are multiple reasons why women are more like to get osteoporosis than men, including:

• Women tend to have smaller, thinner bones than men.
• Estrogen, a hormone in women that protects bones, decreases sharply when women reach menopause, which can cause bone loss. This is why the chance of developing osteoporosis increases as women reach menopause.

Now the good news:

People used to think that osteoporosis was an inevitable part of aging. Today we know a lot more about how to prevent, detect, and treat the disease. You are never too young or old to take care of your bones. Good lifestyle habits can help you protect your bones and decrease your chance of getting osteoporosis. And, if your healthcare provider hasn’t talked to you about your bone health, it’s time for you to bring it up!

In the five – seven years following menopause, a woman can lose up to 20% of her bone density.

What’s Your Risk?

Osteoporosis and bone health issues vary for girls and women of different ages and ethnic backgrounds. Caucasian women, and older women, are most at risk for osteoporosis; however, osteoporosis and low bone density are common among other groups as well. And not only are women at risk; men can develop osteoporosis as well.

Are you …
Caucasian Women
African-American Women
Asian-American Women
Latina Women

Caucasian Women

• Twenty percent of Caucasian women age 50 and older are estimated to have osteoporosis.
• More than half of all Caucasian women age 50 and older are estimated to have low bone mass, which means their bones are getting weaker but they don’t yet have osteoporosis.
• Between the ages of 20 and 80, Caucasian women lose one-third of the bone mineral density in their hip.
• About 15 percent of Caucasians are lactose intolerant, which can make it difficult to get enough calcium.

 African-American Women

• Five percent of African American women older than 50 are estimated to have osteoporosis.
• Another 35 percent are estimated to have low bone mass, which means their bones are getting weaker but they don’t yet have osteoporosis.
• Recent research shows that even among African American women who do have risk factors for osteoporosis, few are screened for the disease.
• About 70 percent of African Americans are lactose intolerant, which can make it difficult to get enough calcium.
• Many African American women don’t get enough vitamin D, which can make it hard for the body to absorb calcium.
  In the United States, African American women are more likely than many other racial or ethnic groups to have diseases that can lead to osteoporosis, such as lupus.

Asian-American Women

• About 20 percent of Asian American women age 50 and older are estimated to have osteoporosis.
• More than half of all Asian American women age 50 and older are estimated to have low bone density, which means their bones are getting weaker but they don’t yet have osteoporosis. 
• About 90 percent of Asian American adults are lactose intolerant, which can make it difficult to get enough calcium.

Latina Women

• Ten percent of Latinas have osteoporosis.
• Half of all Latinas older than 50 have low bone mass, which means their bones are getting weaker but they don’t yet have osteoporosis.
• Many Latinas are lactose intolerant, which can make it difficult to get enough calcium.
• Hip fractures among Latinas in the United States appear to be on the rise. 

Menopause: A Time for Action

When a woman reaches menopause, her estrogen levels drop and can lead to bone loss. For some women, this bone loss is rapid and severe.

Two major factors that affect your chance of getting osteoporosis are:

• The amount of bone you have when you reach menopause. The greater your bone density is to begin with, the lower your chance of developing osteoporosis. If you had low peak bone mass or other risk factors that caused you to lose bone, your chance of getting osteoporosis is greater.
• How fast you lose bone after you reach menopause. For some women, bone loss happens faster than for others. In fact, a woman can lose up to 20% of her bone density during the five - seven years following menopause. If you lose bone quickly, you have a greater chance of developing osteoporosis. 

What about taking estrogen?

If you have menopausal symptoms, such as hot flashes, your healthcare provider may prescribe estrogen therapy (ET) or estrogen with progesterone hormone therapy (HT).  In addition to controlling your menopausal symptoms, these therapies can also help prevent bone loss. Some women are advised not to take ET or HT because of the possible risks that may include breast cancer, strokes, heart attacks, blood clots and cognitive (mental) decline. It’s important to discuss the risks and benefits of your treatment options with your healthcare provider.

For more comprehensive information, download NOF’s resource Hormones and Healthy Bones

Teens: What YOU Can Do Now

Osteoporosis is the disease that is most likely to cause weak bones. It is more common in older people, especially women. But it is doesn’t have to happen to YOU when you get older. That’s because, for many people, osteoporosis can be prevented.

Most people don’t have the opportunity that you have right now: YOU can actually build denser, stronger bones now in a way that isn’t possible later. This will make you healthier, and it will set you up to have stronger bones when you are older – when weak bones can be serious.

The recipe for bone health is simple:

• Get enough calcium and vitamin D, and eat a well balanced diet. Read more
• Exercise - Read more
• Don’t smoke or drink 

Eating Disorders and Other Warning Signs

The eating disorders anorexia and bulimia can weaken your bones and increase your risk of osteoporosis when you are older. If you have anorexia you become very thin, but you don’t eat enough because you think you are fat. Bulimia involves periods of overeating followed by purging, sometimes through vomiting or using laxatives.

You should talk to a parent, doctor, or health professional immediately if you have one of these disorders or if you stop getting your period for more than three months in a row (and you are not pregnant). This is a condition called amenorrhea and it is also bad for your bones.

Young Adult Women

While osteoporosis is most common in older people, it sometimes affects young people, including premenopausal women in their 20s, 30s and 40s. The term “premenopausal” refers to women who are still having regular menstrual periods and have not yet reached menopause. While it is uncommon for premenopausal women to have osteoporosis, some young women have low bone density which increases their chance of getting osteoporosis later in life. 

Low Bone Density and Osteoporosis in Young Adult Women

Young women who have low bone density, often caused by low peak bone mass, are at an increased risk of getting osteoporosis later in life.

Often, when premenopausal women have osteoporosis, it may be due to an underlying medical condition or a medicine that causes bone loss. Osteoporosis that is caused by a medical condition or a medicine is called secondary osteoporosis. Sometimes premenopausal women have osteoporosis for no known reason. This is called idiopathic osteoporosis. The term “idiopathic” just means that the osteoporosis is unexplained and we cannot find a cause for it.

Diagnosing Osteoporosis in Young Women

Diagnosing osteoporosis in premenopausal women is not straightforward and can be quite complicated. First of all, bone density tests (jump link to below) are not routinely recommended for young women. Here are some reasons why:

• Most premenopausal women with low bone density do not have an increased risk of breaking a bone in the near future. Therefore, having information about their bone density may only cause unnecessary worry and expense.
• Some premenopausal women have low bone density because their genes (family history) caused them to have low peak bone mass. Nothing can or should be done to change this.
• DXA tests can underestimate bone density in women who are small and thin. Therefore, a DXA test may indicate that a small person has low bone density, but the bone density is actually normal for the person’s body size
• Osteoporosis medicines are not approved or advised for most premenopausal women. Bone density tests are used to help guide decisions about treatment.

Diagnosing osteoporosis in young women usually involves several steps. While these steps may differ for each person, they may include:

• Your medical history
• Physical exam
• Bone mineral density (bone density) testing
• Lab  tests
• X-rays

Bone density testing. A bone density test shows the amount of bone a person has in the hip, spine or other bones. It is routinely recommended for postmenopausal women and men age 50 and older and is how osteoporosis is diagnosed in older people. Bone density tests are usually only done for premenopausal women if they break several bones easily or break bones that are unusual for their age, such as bones in the hip or spine. Also, if you have a condition or take a medicine that causes secondary osteoporosis, your healthcare provider may order a bone density test. This test should be done on a DXA machine. DXA stands for dual energy x-ray absorptiometry.

One or two years after an initial bone density test,  a second bone density may be done and  will determine if you have low peak bone mass that is staying the same or if you are losing bone. If your bone density drops significantly between the first and second test, you may be losing bone and further evaluation by a healthcare provider is needed.

Understanding your bone density test results. A bone density test result shows a Z-score and a T-score. T-scores are used to diagnose osteoporosis in postmenopausal women and men age 50 and older, but not in premenopausal women. A Z-score compares your bone density to what is normal for someone your age. While a Z-score alone is not used to diagnose osteoporosis in premenopausal women, it can provide important information. Read some tips to help you understand your Z-score.

• If your Z-score is above -2.0, your bone density is considered within the ranges expected for your age or normal according to the International Society for Clinical Densitometry (ISCD). For example, a Z-score of +0.5, -0.5 and -1.5 is considered normal for most premenopausal women.
• If your Z-score is -2.0 or lower, your bone density is considered below the expected range. Examples are -2.1, -2.3 and -2.5. If your Z-score is in this range, your healthcare provider will consider your health history and possible causes of bone loss, including secondary osteoporosis, before making a diagnosis of osteoporosis.
• If your Z-score is normal, but you’ve broken one or more bones from a minor injury, your healthcare provider may diagnose you with osteoporosis because some people with normal bone density break bones easily. As mentioned above, a bone density test will also show a T-score. A T-score compares bone density to what is normal in a healthy 30-year-old adult.

Treating Osteoporosis in Young Women

Most of the osteoporosis medicines available at this time are not approved by the FDA for use in premenopausal women. But, for women who have taken steroid medicines for a long time, three osteoporosis medicines are approved for the prevention and treatment of osteoporosis. In very rare cases, a healthcare provider may recommend that a premenopausal woman consider taking an osteoporosis medicine for other reasons. Examples include when a woman breaks a bone because of low bone density or has severe bone loss due to a medical condition.

Expecting Women

If you are pregnant or breastfeeding, be sure to get enough calcium and vitamin D. Calcium and vitamin D are good for you and for your baby’s growing bones. If you don’t get enough of these nutrients, your baby’s calcium needs will be met by taking calcium from your bones.

Most studies show that while some bone loss may occur during pregnancy, a woman usually regains it after giving birth. In fact, studies show that having children, even as many as 10, does not increase a woman’s chance of getting osteoporosis later in life. Research even suggests that each additional pregnancy provides some protection from osteoporosis and broken bones.

Pregnancy-associated osteoporosis. Some women develop a temporary type of osteoporosis during pregnancy. While we do not fully understand what causes this type of osteoporosis, it is extremely rare and usually goes away shortly after a woman gives birth.

Breastfeeding. Like pregnancy, breastfeeding may cause some temporary bone loss. However, bone density appears to recover over time and should not cause long-term harm to a woman’s bone health. All women who are pregnant or nursing need to get enough calcium, vitamin D and appropriate exercise to keep their bones healthy. If you’re breastfeeding exclusively, ask your child’s pediatrician if you need to give your baby supplemental vitamin D.