Here's what you need to know about bone density

Strong bones carry you throughout life, helping you move, bend, flex, and engage in activities you enjoy. Maintaining good bone health in your older years is one of the best ways to stay healthy and prevent fractures. Dense bones are healthy bones.

While much of your bone density is established in childhood, there is still a lot you can do to support your bone health, no matter your age.

What is bone density?

Bone density is the concentration of minerals, particularly calcium and phosphorus, contained within your bone. The more minerals bone contains, the denser and stronger it is. When bones are strong, this lowers the risk of fractures, helps you stay mobile, and protects your internal organs from injury. 

However, for many people, bones begin to weaken over time. The minerals that keep bones strong start to get pulled out of the bone and holes form. The advanced form of bone disease, when there are visible holes in the bones, is called osteoporosis. Unfortunately, osteoporosis does not have any symptoms until a fracture occurs. If the fracture is severe, this could mean a permanent loss of mobility or could even be fatal.

How is bone density measured?

While you can’t feel if your bones are getting weaker, a bone density test can help measure the strength of your bones. The DEXA (dual-energy X-ray absorptiometry) procedure is the gold standard for measuring the bone density of the spine, hip, or total body. 

Women over 65 and men over 70 should have a DEXA scan. Your provider may also recommend a scan if you have had a broken bone or have an illness that impacts bone health.

The DEXA scan provides two scores to assess your bone health, including:

  • T-score: a comparison of healthy young people of the same sex. A T-score of -2.5 defines osteoporosis.
  • Z-score: a comparison of bone density to others of the same age and sex. A Z-score of -2.5 or less may indicate another underlying cause of osteoporosis.

If you are concerned about your bone health, speak to your healthcare provider about whether you need a DEXA scan.

Risk factors for low bone density

Many lifestyle and genetic factors put you at risk for low bone density and osteoporosis. A few of the risk factors you cannot control include:

  • Age: The older you are the greater your risk of osteoporosis.
  • Family history: Genetics play a role in your bone strength.
  • Hormones: Low estrogen levels, such as during menopause, increase risk. Low testosterone increases the risk for men.
  • Sex: Women are more likely to have weak bones than men.
  • Smaller body frame size: A smaller frame means less bone mass.
  • Thyroid or adrenal disease: Imbalanced hormones can lead to bone loss.

There are many lifestyle factors and medical conditions that also increase your risk of osteoporosis. These include:

  • Eating disorders
  • Excessive alcohol consumption
  • Gastrointestinal surgery
  • Illnesses like cancer or digestive diseases
  • Low calcium intake
  • Malabsorption disorders
  • Medications like steroids
  • Sedentary lifestyle
  • Smoking

If you have any of these risk factors for low bone density, speak to your provider about next steps.

Complications of osteoporosis

Osteoporosis may cause some significant complications related to mobility and quality of life. One of the more serious complications is a bone fracture. One in two women with osteoporosis and one in four men will break a bone due to a fall or other injury. Fractures can even occur with regular activities such as bending over or sneezing if the bones are weak. The most common fracture is a vertebral compression fracture, where one of the bones in the spine collapses, leading to significant pain and reduced height.

While osteoporosis itself doesn’t cause pain, fractures and a condition caused by weak bones called kyphosis can cause significant, long-term pain. Kyphosis is a curving of the spine forward, which leads to back pain from strained muscles and tendons. This condition can also press on the internal organs making it difficult to eat and breathe.

Fractures and pain caused by osteoporosis significantly limit mobility and quality of life. Limited mobility can lead to weakness in other areas of the body due to an inability to exercise or even be involved in day-to-day movement. Lack of mobility can also lead to isolation and depression.

Complications of osteoporosis significantly impact the ability to live the life you want, so it is essential to take steps to keep your bones strong and healthy.

Ways to improve bone density

A healthy lifestyle can help protect your bones and keep them strong. The body will pull calcium out of the bones if you are not getting enough from your diet, weakening them. Therefore it is important to get enough calcium in your diet.

The daily requirement for calcium is 1,000 mg for those under 50 and 1,200 mg for women over 50 and men over 70. Ideally, your calcium needs are met by eating foods high in calcium, such as dairy products, green leafy vegetables, and calcium-fortified cereals. 

Calcium requires vitamin D for absorption. Vitamin D is made when our skin is exposed to the sun. Many of us spend too much time indoors or live in areas where it is too cold to get enough vitamin D for much of the year. Speak to your healthcare provider about whether you need a vitamin D supplement to meet your needs.

Finally, keeping bones strong requires actively working to strengthen them through regular exercise. Weight-bearing exercises, like weight lifting, help strengthen bones and muscles. Aim to exercise at least 150 minutes per week.

Medications for improving bone density

Medication is only recommended based on the results of your DEXA scan or other risk factors that estimate your chances of breaking a bone in the next decade. If your provider determines you need medication to support your bone health, a few options include:

  • Bisphosphonates (Alendronate, Risedronate, Ibandronate, Zoledronic acid)
  • Denosumab (Prolia, Xgeva)
  • Hormone therapy: Estrogen replacement can help with hormone-related bone loss.
  • Raloxifene (Evista)

These medications are either taken orally as daily pills or as monthly or annual IV infusions. Many of these medications have side effects or may not work for everyone; always speak to your provider about which is best for you.

Bone density: The takeaway

Taking proactive steps to keep your bones healthy is an essential part of living a long, healthy life into your golden years. Our caring providers at our urgent care centers can help you keep your bones healthy and provide any necessary referrals to our wide network of specialists.

To get started, find your closest center and walk in or save your spot online. We also offer Virtual Visits to discuss any concerns from the comfort of your home. We are here to help you feel better and stay healthy. 



Written by Sarah Thebarge, Physician Assistant on June 25th 2024