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Lose bone density: What causes bone loss? : MedlinePlus Medical Encyclopedia

What causes bone loss? : MedlinePlus Medical Encyclopedia

Osteoporosis, or weak bones, is a disease that causes bones to become brittle and more likely to fracture (break). With osteoporosis, the bones lose density. Bone density is the amount of calcified bone tissue that is in your bones.

A diagnosis of osteoporosis means you are at risk for bone fractures even with everyday activities or minor accidents or falls.

Your body needs the minerals calcium and phosphate to make and keep healthy bones.

  • During your life, your body continues to both reabsorb old bone and create new bone. Your entire skeleton is replaced about every 10 years, though this process slows as you get older.
  • As long as your body has a good balance of new and old bone, your bones stay healthy and strong.
  • Bone loss occurs when more old bone is reabsorbed than new bone is created.

Sometimes bone loss occurs without any known cause. Some bone loss with aging is normal for everyone. Other times, bone loss and low bone density run in families and the disease is inherited. In general, white, older women are the most likely to have bone loss. This increases their risk of breaking a bone.

Brittle, fragile bones can be caused by anything that makes your body destroy too much bone, or keeps your body from making enough bone.

Weak bones can break easily, even without an obvious injury.

Bone mineral density is not the only predictor of how fragile your bones are. Consuming alcohol, smoking, and a sedentary lifestyle all increase the risk of having fragile bones. There are other unknown factors related to bone quality that are as important as bone quantity. Most bone density tests only measure the bone quantity.

As you age, your body may reabsorb calcium and phosphate from your bones instead of keeping these minerals in your bones. This makes your bones weaker. When this process reaches a certain stage, it is called osteoporosis.

Watch this video about:Osteoporosis

Many times, a person will fracture a bone before they even know they have bone loss. By the time a fracture occurs, the bone loss may be serious.

Women age 50 and older and men age 70 and older have a higher risk for osteoporosis than younger women and men.

  • For women, a drop in estrogen at the time of menopause is a major cause of bone loss.
  • For men, a drop in testosterone as they age can cause bone loss.

Your body needs calcium and vitamin D and enough exercise to build and keep strong bones.

Your body may not make enough new bone if:

  • You do not eat enough high-calcium foods
  • Your body does not absorb enough calcium from the foods you eat
  • Your body removes more calcium than normal in the urine

Certain habits can affect your bones.

  • Drinking alcohol. Too much alcohol can damage your bones. It can also put you at risk of falling and breaking a bone.
  • Smoking. Men and women who smoke have weaker bones. Women who smoke after menopause have an even higher chance of fractures.

Younger women who do not have menstrual periods for a long time also have a higher risk of bone loss and osteoporosis.

Low body weight is linked to less bone mass and weaker bones.

Exercise, especially weight-bearing exercise, is linked to higher bone mass and stronger bones.

Many long-term (chronic) medical conditions can keep people confined to a bed or chair.

  • This keeps the muscles and bones in their hips and spines from being used or bearing any weight.
  • Not being able to walk or exercise may lead to bone loss and fractures.

Other medical conditions that may also lead to bone loss are:

  • Rheumatoid arthritis
  • Long-term (chronic) kidney disease
  • Overactive parathyroid gland
  • Diabetes, most often type 1 diabetes
  • Organ transplant

Sometimes, medicines that treat certain medical conditions can cause osteoporosis. Some of these are:

  • Hormone-blocking treatments for prostate cancer or breast cancer
  • Some medicines that are used to treat seizures or epilepsy
  • Glucocorticoid (steroid) medicines, if they are taken by mouth every day for more than 3 months, or are taken several times a year

Any treatment or condition that causes calcium or vitamin D to be poorly absorbed can also lead to weak bones. Some of these are:

  • Gastric bypass (weight-loss surgery)
  • Cystic fibrosis
  • Other conditions that prevent the small intestine from absorbing nutrients well

People with eating disorders, such as anorexia or bulimia, are also at higher risk for osteoporosis.

Talk to your health care provider about your risk for bone loss and osteoporosis. Find out how to get the right amount of calcium and vitamin D, what exercise or lifestyle changes are right for you, and what medicines you may need to take.

Osteoporosis – causes; Low bone density – causes

  • Vitamin D benefit
  • Calcium source

De Paula FJA, Black DM, Rosen CJ. Osteoporosis: basic and clinical aspects. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 30.

Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019;104(5):1595-1622. PMID: 30907953 pubmed.ncbi.nlm.nih.gov/30907953/.

Weber TJ. Osteoporosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 230.

Updated by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Low Bone Density > Fact Sheets > Yale Medicine


Our bones provide the scaffolding that holds our bodies upright. Contrary to popular belief, healthy bones are not solid. Their interiors are made of a honeycomb structure with tiny holes to keep them light and springy. 

However, bones that have lost a lot of mineral density have much larger holes as well as thin outer walls, which can increase their risk of breaking. So bone density is important.

Age and lifestyle can lower bone density and increase risk for conditions such as osteoporosis (dangerously low bone density) and osteopenia, which is not as extreme as osteoporosis. Low bone density is a widespread problem: Each year an estimated 1.5 million individuals suffer a fracture due to bone disease.

At Yale Medicine, our endocrinologists specialize in metabolic bone disease. These are conditions caused by deficiencies in minerals such as calcium, phosphorus, magnesium or vitamin D or problems with the hormones that regulate our blood minerals. Sometimes metabolic bone disease can be due to problems in the proteins and chemicals that make up the bones themselves. “With our depth of knowledge and reputation as a major referral center, we’ve seen the whole spectrum of cases,” says Karl Insogna, MD, director of the Yale Medicine Bone Center.

Why should you care if your bone density is low?

Low bone density can lead to serious medical conditions that could result in bone fractures.

The most worrisome condition is osteoporosis, where low bone density causes holes inside the bone to widen and the outer walls of the bone (the cortex) to thin. This causes the bone to be more fragile. 

People with osteoporosis are at a much greater risk for fracture with little or no trauma. For example, an older person can get a hip fracture as a result of a simple fall from a standing position. Hip fractures are the most serious of all osteoporotic fractures and can cause loss of mobility and independence and even death.

Osteopenia is similar to osteoporosis but where the bone density is not as low.  People with osteopenia are at increased risk for developing osteoporosis.

What are the risk factors for low bone density?

The following can lead to bone loss and an increased risk of fracture:

  • Smoking
  • Drinking excessive amounts of alcohol
  • Low physical activity
  • Poor diet, low in vitamins and calcium
  • Changes in hormones (from smoking or menopause)
  • Age
  • Medical conditions like rheumatoid arthritis, chronic kidney disease, overactive parathyroid gland or celiac sprue
  • Certain medications like glucocorticoids or hormone blockers
  • Multiple myeloma—a cancer that causes bone to weaken and fracture easily

What are symptoms of osteopenia or osteoporosis?

Early warning signs of low bone density are subtle. A stooped back or decreasing height can be a sign of decreasing bone density in your spine. A loss of two inches or more of height may indicate that you have osteoporosis. 

If you experience stress fractures in your feet with normal activity or fracture a rib with no particular trauma, you should ask a doctor to check for osteoporosis or osteopenia. If you suffer an arm, wrist or a hip fracture with a fall from a standing position, you are very likely to have fragile bones and definitely need a bone density test.

How are osteoporosis and osteopenia diagnosed?

Doctors use X-rays to measure bone mineral density (BMD) and check for your risk of  developing osteopenia or osteoporosis. Your BMD number will be compared to the BMD number of healthy, young, adult individuals of the same sex, and, in some cases, the same racial background. If your BMD is 2.5 units lower than that reference number, you have osteoporosis. If your BMD is between 1 and 2. 5 units lower than the standard BMD, then you have osteopenia.

How are osteoporosis and osteopenia treated?

Although there is no cure for osteoporosis or osteopenia, there are ways doctors can help slow bone loss and sometimes improve bone density. Most commonly, doctors will recommend that patients supplement their vitamin D and calcium intake. Doctors may also prescribe medications like bisphosphonates or denosumab, which slow bone breakdown. 

Estrogen supplements for post-menopausal women can slow bone breakdown and are effective at relieving other menopausal symptoms. However, estrogen can have side effects, including a higher risk for breast cancer, blood clots and heart disease.

What’s special about how Yale Medicine treats low bone density?

The doctors at the Yale Medicine Bone Center specialize in hard-to-diagnose cases. We offer a wide range of diagnostic tools that not only measure bone density, but other biochemical measures such as vitamin D levels.

Much of our diagnosis is done in-house at the Yale Medicine Mineral Metabolism Lab.

The physicians in the Yale Medicine Bone Center are recognized nationally and internationally for their expertise in osteoporosis and metabolic bone disease. Dr. Insogna is on the Board of Trustees of the National Osteoporosis Foundation.

To make a diagnosis, our doctors work across departments and disciplines. “We often put our heads together and recognize that what we’re seeing is not necessarily run-of the-mill and, therefore, requires something more than a run-of-the-mill treatment,” says Dr. Insogna.

In addition, patients at the Yale Medicine Bone Center get access to treatments through clinical trials that are not yet available to the wider public.

Densitometry – Hippocrates Medical Center

To determine the cause of bone fragility and to conduct an early diagnosis of osteoporosis and an increased likelihood of fractures, the specialists of the Hippocrates Medical Center perform a highly informative diagnostic procedure – densitometry. The sooner you seek qualified help, the sooner we can help you.

What is osteoporosis

Osteoporosis is a condition in which bones become brittle and you are at risk of fracture due to reduced bone density and other degenerative processes. The disease progresses gradually over several years and is often only diagnosed when a fall or sudden blow causes a bone fracture.

Bone tissue is constantly updated: a new one is formed, and the old one is destroyed. Bone mass increases until about age 30, and then you start losing it faster than it can be created. This is a natural process, however, there are factors that can speed up this process, namely: hormonal imbalances, including thyroid problems, calcium deficiency, eating disorders, certain diseases and medications, and an unhealthy lifestyle. Also, women with a burdened heredity and low body weight are more susceptible to the occurrence of osteoporosis.

Osteoporosis may not show itself until you have a fracture. You may experience back pain, shortness of height, difficulty keeping your back straight and good posture.

What is densitometry

Densitometry is a diagnostic method that is designed to determine the mineral density of bone tissue. The procedure allows you to assess the risk of bone fractures. With the help of the study, the content of inorganic compounds in the bone tissue (for example, the level of calcium), the general density and structure of the bones are determined. Today, examinations of the spine, hip joints, limbs, jaws and teeth are possible.

Indications for densitometry

The sooner the diagnosis is made, the sooner treatment can be started to improve the patient’s condition or prevent it from getting worse. The doctor may prescribe the performance of densitometry:

  • men over the age of 70
  • women over 65
  • postmenopausal women under 65 with risk factors
  • fracture due to osteoporosis
  • in pathology that is accompanied by a decrease in bone mass or loss of bone
  • when prescribing certain medications
  • people with low body weight

Preparation for densitometry

The specialist will tell you in detail about how to prepare for the procedure. If you are scheduled for densitometry, a few days before the procedure, you should refuse foods containing a large amount of calcium, and also do not take drugs with calcium and phosphorus.


Ultrasonic densitometry has no limitations. X-ray densitometry is not recommended during pregnancy.

If you have metal implants, this may be a limitation to the magnetic resonance imaging.

Your doctor will ask you about any recent procedures (such as a CT scan with contrast).

How densitometry is done

Densitometry can be done in several ways. Which type of procedure is right for you, the doctor will decide based on your individual indications. Densitometry is a completely painless study that does not require anesthesia. The execution time depends on the type of diagnosis and can be about 10–30 minutes.

Ultrasonic densitometry. Ultrasound allows you to assess the condition of the bone tissue and its general loss. Bone density is determined based on the rate at which ultrasound travels through tissues after it has been compared to normal values. This is a highly informative safe study that allows you to quickly make a diagnosis. The procedure can be performed even by pregnant women.

CT and MRI examinations. Bone assessment can be performed using computed tomography or magnetic resonance imaging. The methods make it possible not only to calculate the bone density, but also to obtain a three-dimensional image of the structures. Radiation exposure to the patient during CT densitometry in our clinic is minimal. Studies may be scheduled before surgery.

X-ray densitometry. This is an x-ray study. The denser the bone tissue, the less the X-ray beam passes through it. It is also a highly accurate procedure that detects even the smallest reduction in bone density at a very early stage. The dose of radiation that the patient receives in the process is minimal.

After the test, the results will be interpreted and interpreted by certified professionals who have received appropriate training.

Benefits of undergoing densitometry at the Hippocrates Clinic

  • Doctors with extensive experience in densitometry
  • Modern techniques that detect pathology at an early stage
  • Expert Equipment
  • Individual approach to each patient
  • Comfort

Early diagnosis of osteoporosis can help reduce the risk of bone fractures and complications. Complications from fractures can be quite severe, especially in the elderly. Densitometry at the Hippocrates Clinic is a safe and accurate procedure that will allow you to quickly assess your health, prescribe treatment and restore a high standard of living.


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11 ways to maintain and improve bone density – Altermedica LLC

Information for patients

Bone density is important for human health. If there is loss of bone density, they can break easily.

Bone density changes over time. During childhood, adolescence, and early adulthood, bones absorb nutrients and minerals, increasing strength.

However, once a person is in their 20s, they reach their maximum bone mass, which means that bone density will no longer increase.
Bones can lose density as a person continues to age. In particular, after menopause, a woman becomes susceptible to osteoporosis, a disease that can weaken the bones so much that they can easily break.

However, there are many ways to help increase and maintain bone density.

1. Weightlifting and strength training

Studies have shown that both weightlifting and strength training promote new bone growth and maintain bone structure.
For example, a study of bone density in children with type 1 diabetes found that participation in physical activity during periods of peak bone growth improved bone density. Another study in children showed similar results.

Strength training benefits include:

  • increased bone mineral density
  • bone growth
  • inflammation reduction
  • protection against bone loss
  • increase in muscle mass

    2. Eating a lot of vegetables

    Vegetables are low in calories and provide the body with vitamins, minerals and fiber. One study found that vitamin C may help protect bones from damage. Consuming yellow and green vegetables can benefit most people. In children, these vegetables promote bone growth; in adults, they help maintain bone density and strength. One study found that children who ate green and yellow vegetables and few fried foods experienced increases in healthy fat and bone density.

    In another study, participants in postmenopausal women who consumed 9 servings of cabbage, broccoli and other vegetables and herbs for 3 months saw bone renewal and reduced calcium loss. The researchers attribute the results to the increased polyphenol and potassium content of the vegetables.

    3. Daily calcium intake

    Calcium is an essential nutrient for bone health. Since bones break down and grow every day, it is very important that people get enough calcium in their diet.
    The best way to absorb calcium is to consume a small amount throughout the day, not in one meal.

    The best way to get calcium is through diet, unless your doctor advises otherwise.

    Foods rich in calcium:

  • milk
  • yogurt
  • some leafy greens such as cabbage
  • beans
  • sardines

    4. Eating foods rich in vitamins D and K

    Vitamin K-2 plays an important role in bone health by reducing calcium loss and helping minerals bind to bones.

    Products containing vitamin K-2:

  • sauerkraut
  • cheese
  • natto – soy cheese

    Vitamin D helps the body absorb calcium. People with vitamin D deficiency have a higher risk of bone loss.
    A person can absorb vitamin D with moderate sun exposure. Without enough vitamin D, a person has a higher risk of developing bone diseases such as osteoporosis or osteopenia.

    5. Maintaining a healthy weight

    Healthy weight is important for bone density. Underweight people have a higher risk of developing bone disease, while being overweight puts extra stress on the bones.
    People should avoid rapid weight loss and cycles between weight gain and weight loss. When a person loses weight, they may lose bone density, but the density is not regained when the person gains weight. This decrease in density can lead to weakening of the bones.

    6. Elimination of a low-calorie diet

    Very low calorie diets can lead to health problems, including loss of bone density.
    Discuss calorie needs with your doctor before dieting to determine a safe amount of calories to consume. Any diet should include a balanced level of proteins, fats, vitamins and minerals.

    7. Protein intake

    Protein plays an important role in bone health and density, and everyone should make sure they have enough protein in their diet.
    A study of about 144,000 postmenopausal women found that those who ate higher amounts of protein experienced an increase in overall bone density. Collectively, participants who ate more protein were less likely to have forearm fractures.

    Be sure to check with your doctor before changing your protein intake.

    8. Eating foods rich in omega-3 fatty acids

    Numerous older studies have shown that omega-3 fatty acids play an important role in maintaining bone density.

Omega-3 fatty acids are found in a variety of foods such as salmon, mackerel, nuts and seeds. People can consume these fatty acids through diet or supplements.

9. Eating foods rich in magnesium and zinc

Both calcium, magnesium and zinc are minerals that provide important support for bone health and density.
Magnesium helps activate vitamin D, promoting calcium absorption. Zinc exists in the bones and it promotes their growth and also helps prevent their breakdown.

Foods rich in magnesium and zinc:

  • nuts
  • Legumes
  • seeds
  • whole grains

10. Stop smoking

Smoking is a well-known health hazard. Many people link smoking to lung cancer and breathing problems, but smoking can also cause bone disease such as osteoporosis and increase the risk of bone fractures.
To maintain healthy bone density, a person should not smoke, especially during adolescence and early adulthood.

11. Avoid excessive alcohol consumption

Drinking alcohol in moderation is unlikely to affect a person’s bone health. However, chronic alcohol use can lead to poor calcium absorption, decreased bone density, and the development of osteoporosis later in life.
Young women who drink heavily in their teens and 20s are most at risk for bone loss.