Osteoporosis is one of the most common bone diseases in the world, responsible for 9 million fractures every year [1]. What makes it so dangerous is that it gives no warning. It quietly weakens bones over decades until a sudden fracture, often from something as simple as a fall or a minor bump, makes the damage impossible to ignore.
When major bones are broken, like the hip, consequences can be life-changing, especially at older ages. The good news is that osteoporosis is largely preventable, and even when bone loss has already started, early action can make a real difference. The biggest barrier isn't a lack of treatment, but a lack of awareness and access to routine screening. By shifting the focus towards early screening and education, individuals can easily take control of their own bone health, intercepting the disease before a fracture ever occurs.
What is Osteoporosis?
Osteoporosis is a chronic, skeletal disease characterized by low bone mineral density and microscopic deterioration of bone tissue [2]. Healthy bones are dynamic, meaning they continuously undergo a self-renewal process known as bone remodeling to produce highly dense bones. This cycle is primarily governed by two types of specialized bone cells: osteoclasts and osteoblasts. Osteoclasts are responsible for bone resorption, meaning they break down bone and utilize its nutrients for other bodily functions. In contrast, osteoblasts are responsible for bone production. They create and deposit the needed materials where bone resorption had previously occurred. Throughout childhood and early adulthood, bone production naturally outpaces bone breakdown, creating a strong skeletal framework until peak bone mass is achieved in the late 20s to early 30s [3].
By age 35, a biological shift begins where bone mass begins to slowly decrease as a normal part of aging. For the average individual, a mild, baseline decline in subsequent years results in osteopenia, a mild thinning of the bone. But for individuals who develop osteoporosis, bone resorption is exponentially accelerated, rather than the entire bone remodeling process slowing down. This imbalance leaves the inner bone network hollow, resulting in highly porous and fragile bones for roughly 1 in 3 women and 1 in 5 men over the age of 50 globally [4].
Building Blocks of Bones
Bones are made up of several key nutrients that work together. Calcium provides the hardness and density of the skeleton (about 99% of the body's calcium is stored in bone) [5]. But calcium can't be absorbed without vitamin D, which signals the body to pull calcium from food into the bloodstream. Magnesium activates vitamin D so it can do its job. Vitamin K2 works alongside vitamin D to direct calcium into the bones where it belongs, rather than allowing it to accumulate in blood vessels. And collagen, a specific type of protein, forms the flexible framework that holds everything together, giving bones the ability to flex under pressure without snapping [5]. When any of these are missing from your diet over time, bones pay the price and become weak.
Who is At Risk?
Globally, osteoporosis disproportionately affects the aging female population, specifically postmenopausal women. Menopause typically triggers a sharp decline in estrogen levels, a vital female hormone that regulates bone remodeling. Estrogen is considered a “protective” hormone because it suppresses osteoclast (bone-resorbing) activity and promotes osteoblast (bone-building) activity. When this hormonal protection is lost, other pathways governing bone resorption become hyperactivated, allowing osteoclasts to live longer and break down more bone [2]. Furthermore, individuals with a family history of osteoporosis or are of Asian or Caucasian descent have an increased likelihood of skeletal breakdown as well [4].
Environmental factors, chronic illnesses, and medical treatments can also accelerate the chances of osteoporosis, becoming what is known as secondary osteoporosis. Secondary osteoporosis is bone loss caused by medical factors other than normal aging and menopause. It is commonly triggered by autoimmune disorders or inflammatory disorders like rheumatoid arthritis, Crohn’s disease, lupus, or inflammatory bowel diseases [4]. These conditions typically release inflammatory proteins throughout the body that disrupt bone remodeling. Osteoporosis can also be drug induced. Long-term use (>30 days in the past year) of glucocorticoids can directly induce cell death in osteoblasts [2]. But the most overlooked contributor to osteoporosis is poor dietary intake of micronutrients like calcium, vitamin D, magnesium, and more. In a metropolitan area like Los Angeles, this risk is compounded by socioeconomic barriers. Many low-income neighborhoods in South and East LA are considered food deserts, where affordable fresh produce and nutrient-rich foods are difficult to find and access [7].
How to Build Strong Bones Throughout Life
While certain risk factors like genetics and aging are unavoidable, skeletal strength can still be intentionally influenced through lifelong lifestyle habits. The primary goal of bone preservation is maximizing peak bone mass before it is too late. The easiest way to achieve this is a nutrient dense diet. Ensuring adequate calcium consumption should be the top priority since calcium provides the raw building block for the bone matrix. Dairy products are traditionally the “go-to” produce for calcium, but there are plenty of non-dairy alternatives. It is recommended to have a daily intake of 1,000 mg of calcium for adults, or 1,200 mg for postmenopausal women. Since calcium cannot be absorbed without vitamin D, magnesium, and vitamin K2, it is important to supplement your calcium intake with a well balanced diet of other nutrients.
Calcium | Vitamin D | Magnesium | Vitamin K2 |
|
|
|
|
Aside from nutrition, physical activity is essential for strengthening bones. Bones are dynamic, meaning they respond directly to physical stress. Regular weight-bearing exercises, therefore, are essential for maintaining bone density, but this does not have to mean lifting heavy weights. Simple exercises like a brisk walk, jogging, hiking, or stomping up the stairs also demand a healthy mechanical force to maintain bone density [4]. The cells inside the bone respond to the stress by stimulating osteoblasts to build new bone where it is needed most.
Treatment Options
Osteoporosis is an incurable condition. It is currently not possible to restore the pristine skeletal framework someone once had in their early twenties, so treatment options typically center on preventing symptoms from worsening and preventing future fractures. The ideal treatment plan relies on a mixture of daily habits and targeted medical treatments specific to the patient’s age and health history. The first step is to ensure the patient is consuming sufficient calcium and Vitamin D to prevent the body from further absorbing these nutrients from the bone with age.
For women in early menopause or have recently gone through it, hormone therapy is often considered to replace the estrogen lost during menopause that was protecting bone. For older adults who already have osteoporosis, doctors may prescribe medications that slow bone breakdown or stimulate new bone growth, such as bisphosphonates or injections like Teriparatide [6].
Getting screened is the first step. A DEXA scan is the standard test for bone density and is covered by Medi-Cal for women over 65 and others at risk. Many community health centers and FQHCs in LA and OC offer referrals for bone density screening. Ask your provider at your next visit. If you or a family member has been diagnosed, ask your doctor what options are covered under your insurance or Medi-Cal plan. There are effective treatments available at low or no cost for qualifying patients.
Sources
International Osteoporosis Foundation. Facts and statistics. https://www.osteoporosis.foundation/facts-statistics
Brown J. P. (2021). Long-Term Treatment of Postmenopausal Osteoporosis. Endocrinology and metabolism (Seoul, Korea), 36(3), 544–552. https://doi.org/10.3803/EnM.2021.301
Cleveland Clinic. (2024, October 21). Osteoporosis. https://my.clevelandclinic.org/health/diseases/4443-osteoporosis
Amin, U., McPartland, A., O'Sullivan, M., & Silke, C. (2023). An overview of the management of osteoporosis in the aging female population. Women's health (London, England), 19, 17455057231176655. https://doi.org/10.1177/17455057231176655
Clarke B. (2008). Normal bone anatomy and physiology. Clinical journal of the American Society of Nephrology : CJASN, 3 Suppl 3(Suppl 3), S131–S139.
https://doi.org/10.2215/CJN.04151206
Tella, S. H., & Gallagher, J. C. (2014). Prevention and treatment of postmenopausal osteoporosis. The Journal of steroid biochemistry and molecular biology, 142, 155–170. https://doi.org/10.1016/j.jsbmb.2013.09.008
Payán, D. D., Derose, K. P., Flórez, K. R., Branch, C. A., & Williams, M. V. (2020). The Food Environment in 3 Neighborhoods in South Los Angeles, California: Access, Availability, Quality, and Marketing Practices. Preventing chronic disease, 17, E61. https://doi.org/10.5888/pcd17.200028