What is osteoporosis and how does it affect bone health after age 50?

Osteoporosis is a medical condition in which bones become weak and brittle, increasing the likelihood of fractures. This occurs when bone mineral density and mass decrease, or when the structure and strength of the bone change [1]. Osteoporosis is often known as a silent disease because it usually has no obvious symptoms, and a person may not realize they have it until they suffer a bone fracture [2]. Fractures can occur in any bone, but they are most common in the hip, the vertebrae of the spine, and the wrist [1].

How does osteoporosis develop?

Bones are made of living tissue that the body breaks down and replaces with new bone to maintain strength. Osteoporosis develops when the rate of breaking down old bone is faster than the rate of replacing it with new bone, leading to bone mass loss and changes in the structure of the bone tissue [1]. This change becomes more common with advancing age, especially after age 50 [1].

Risk factors after age 50

The risk of osteoporosis increases with age, and postmenopausal women are among those most at risk [1]. In addition to age and sex, other risk factors that may increase the likelihood of developing osteoporosis after age 50 include [2]:

• Body size: Thin people with thin bones are more susceptible to the condition.
• Family history: If a parent has osteoporosis or has suffered a hip fracture, this may increase the risk.
• Hormonal changes: Low levels of certain hormones, such as estrogen in postmenopausal women and testosterone in men, can increase the risk [2].
• Diet: A diet lacking in calcium and vitamin D or one that does not contain enough protein increases the risks [1].
• Certain medications: Long-term use of certain drugs such as corticosteroids, proton pump inhibitors (which treat acid reflux), and anti-seizure medications [1].
• Certain medical conditions: Endocrine diseases, some gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV, and anorexia nervosa [1].
• Lifestyle: Smoking, long-term excessive alcohol consumption, and lack of physical activity or prolonged bed rest [1].

Diagnosing osteoporosis

Osteoporosis is often diagnosed through routine screening, especially for women aged 65 and older, and postmenopausal women under 65 who have additional risk factors [1]. The most common and accurate test is the bone density test (DEXA or DXA), which is a type of low-dose X-ray that measures calcium and other minerals in the bones [3]. This test helps determine the strength and thickness (bone density) of the bones [3].

DEXA bone density test results

Bone density test results are usually given as T-scores and Z-scores. The T-score is used for postmenopausal women and men aged 50 or older, and it compares your bone density to that of a healthy adult of the same sex [3]:

• T-score of -1.0 or higher: Considered normal bone density.
• T-score between -1.0 and -2.4: Indicates low bone density (osteopenia) and may indicate a risk of developing osteoporosis.
• T-score of -2.5 or lower: Indicates a likelihood of osteoporosis [3].

If results show low bone density, the doctor may recommend steps to prevent further bone loss, such as increasing physical activity, adding calcium and vitamin D to the diet, and taking prescribed medications to increase bone density [3]. To learn more about preventing fractures and strengthening bones, you can visit Osteoporosis: Preventing Fractures and Strengthening Bones After 50 (Arabic).

Medical references

• Osteoporosis
• Osteoporosis
• Bone Density Scan