En español | Bone density isn’t something most of us think about — until that moment when, out of the blue, we break something. “Probably 50 percent of women and 25 percent of men are expected to have an osteoporosis-related fracture in their lifetime,” explains Joy Wu, M.D., associate professor of medicine and endocrinology at Stanford Health Care. But there are ways to know, long before you break a bone, whether you’re losing skeletal mass — and to take steps to protect yourself. “Ultimately, we are most worried about hip fractures,” Wu says. But simple lifestyle changes can help reduce your fracture risk, and effective medications are available if needed. The earlier you can get diagnosed and start a treatment protocol, the better the outcome. Here are five things to look out for.
1. You use your arms to get out of a chair
If you need to use your arms to push off, it may be a sign of weakening muscles, which are a good predictor of weakening bones. “Our bones and our muscles work as a unit; they get stronger as a unit and tend to get weaker as a unit,” explains Bess Dawson-Hughes, lead scientist in the Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Difficulty getting into or out of a chair is a result of reduced muscle mass in the thighs. And lower muscle mass is a strong predictor of bone problems. “It is also a strong predictor of falling,” she explains. “When you have weak leg muscles, you are more likely to fall and therefore have a fracture.”
Incorporating muscle-strengthening exercises into your daily routine can help to improve bone quality, says Stephen Honig, M.D., director of the NYU Langone Osteoporosis Center.
2. You’re taking thyroid medication
High levels of thyroid hormone can interfere with the formation of new bone mass. While some people may have naturally overactive thyroids, hypothyroidism (low thyroid activity, often caused by an autoimmune issue) is more common. It’s also common for those with underactive thyroids to receive higher than necessary doses of replacement hormones, says Kendall Moseley, M.D., medical director of the Johns Hopkins Metabolic Bone & Osteoporosis Center. “It is important that doctors find the correct thyroid hormone dose to satisfy the body’s metabolism needs, but not to overtreat, which can lead to bone loss.”
3. You’re noticing some hearing loss
One study of nearly 144,000 women found that osteoporosis and low bone density were independently associated with up to a 30 percent higher risk of developing moderate or severe hearing loss. That means any decrease in your ability to hear may signal an underlying issue.
Why the two are related is unclear, says Sharon Curhan, M.D., physician and epidemiologist with the Channing Division of Network Medicine at Brigham and Women’s Hospital. “Possibly, the aging-related changes in the composition and function of the bones that surround the ear, which protect the nerves and structures that play important roles in hearing and balance, may lead to hearing loss,” she says.
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4. Your lower back hurts
Maybe you just pulled a muscle reaching for a high shelf. But if the pain persists for more than a few days, consider having it looked at: Pain in your lumbar region could mean you’ve experienced an osteoporosis-related fracture. “I have seen people fracture their spine while stooping to pick something up, such as a newspaper, or leaning over to brush their teeth,” says Daniel G. Arkfeld, M.D., a rheumatologist with Keck Medicine of USC at the University of Southern California. The result, he says, can range from a mild pull to incapacitating pain.
Adding insult to injury, these fractures can, over time, make you shorter. Anyone who’s lost 1½ inches or more in height should be evaluated for osteoporosis.
5. You’re frequently bloated or constipated
Digestive conditions such as colitis and Crohn’s disease can lead to malabsorption of bone-essential nutrients like vitamin D and calcium. Conditions like these are also inflammatory — and “systemic inflammation can increase the rate of bone loss,” says Stuart Weinerman, M.D., an endocrinologist and assistant professor of medicine at the Zucker School of Medicine at Hofstra/Northwell. Steroids like hydrocortisone or prednisone, which are often used to treat these conditions, can further affect bone health. And many patients with digestive issues cut out dairy or follow restrictive diets that may cause them to miss out on key nutrients responsible for bone health. If you’re experiencing gut symptoms, Weinerman recommends asking your doctor: Can my gut problem worsen bone problems? And should I have a bone density scan?
Nicole Pajer writes on health for The New York Times and other publications.