Bone density

For most people, the term “bone density” is a medical buzzword, vaguely understood but rarely thought of in day-to-day life. However, it’s a crucial factor in the health of our skeletal system, with low bone density linked to a greater risk of fractures and a condition known as osteoporosis. Let’s dive into the concept of bone density and the role it plays in these health issues.

What is Bone Density?

Bone density, also known as bone mineral density (BMD), refers to the amount of bone mineral in bone tissue, often measured via DEXA scans. Healthy bones are dense, containing more bone tissue in a given volume. The higher the density, the stronger and more robust the bones are1.

The Age Factor in Bone Density

Age has a significant impact on bone density due to the natural processes of bone formation and bone resorption.2

During our childhood, adolescence, and early adulthood, our bodies create new bone faster than old bone is broken down, leading to an increase in bone mass. Bone mass, and thus bone density, generally peaks around our late twenties. At this point, we have the highest amount of bone tissue we’ll ever have, which translates to strong and healthy bones.

However, as we age, this balance shifts. From our 30s onward, most people start to slowly lose bone mass as bone resorption begins to outpace bone formation. This process speeds up in women after menopause due to a decrease in estrogen, a hormone that protects against bone loss.

This decrease in bone density with age can lead to osteoporosis, a condition where the bones become weak and brittle. Osteoporotic bones are more prone to fractures, even from minor falls or, in severe cases, from simple actions like bending over or coughing.

It’s also important to note that certain lifestyle factors can influence the rate of bone loss with age. These include dietary habits (especially calcium and vitamin D intake), physical activity levels, alcohol consumption, tobacco use, and certain medications.

Osteoporosis: When Bone Density Decreases

When this breakdown occurs more rapidly than normal or the formation of new bone can’t keep up, it leads to osteoporosis. This is a condition characterized by porous, fragile bones due to decreased bone density3.

How Osteoporosis Leads to Fractures

Osteoporosis leads to fractures by weakening the structure of the bones. When a person has osteoporosis, their bones lose density and become porous and brittle. This happens because the body’s natural process of bone remodeling – breaking down old bone and replacing it with new bone – becomes imbalanced. The body may remove too much old bone without replacing it, or it might not create enough new bone.

This weakened, porous structure makes the bones much more likely to fracture or break, even from minor falls or impacts that would not harm a person with healthy bones. Fractures associated with osteoporosis can occur in any bone, but they are most common in the hip, wrist, and spine.

Spinal or vertebral fractures can be particularly problematic because they can occur even without a fall or injury. The weakened vertebrae can start to compress under the normal pressure of everyday movements, leading to a ‘compression fracture’. This can cause a range of issues, from pain to height loss or even changes in posture.

It’s worth noting that osteoporosis itself isn’t typically painful, but the fractures it can cause lead to pain and other complications. Therefore, early detection and treatment of osteoporosis are vital to help prevent these fractures.4

Preventing Osteoporosis and Fractures

Diet, exercise, and lifestyle changes can improve bone health and decrease the risk of osteoporosis and fractures. Regular weight-bearing exercises, a diet rich in calcium and vitamin D, and limiting alcohol and tobacco can help maintain bone health5.

Diagnosing and Treating Low Bone Density

DEXA scans are used to measure bone mineral density. If you’re at risk for osteoporosis, a medical professional may recommend a DEXA scan to check your bone health6.

Several classes of medications are used to treat osteoporosis, some of which can slow or even reverse bone loss. These include:

  1. Bisphosphonates: These are the most common medications prescribed for osteoporosis. They slow the rate at which bone is broken down, helping to maintain or increase bone density. Examples include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast).
  2. Hormone Replacement Therapy (HRT): This is sometimes used to treat osteoporosis in postmenopausal women. HRT can help maintain bone density by compensating for the decrease in estrogen levels that occurs after menopause. However, HRT is not often the first line of treatment due to associated risks, including blood clots, heart disease, and some types of cancer.
  3. Selective Estrogen Receptor Modulators (SERMs): These drugs mimic the effects of estrogen on bone density in postmenopausal women without some of the risks associated with estrogen. An example is raloxifene (Evista).
  4. Parathyroid hormone-related protein analogs: An example is abaloparatide (Tymlos). This medication mimics the effects of parathyroid hormone, which stimulates bone formation.
  5. Monoclonal Antibody Medications: Drugs such as denosumab (Prolia) and romosozumab (Evenity) work by inhibiting the proteins that promote the formation of cells responsible for bone loss, thus reducing the rate of bone resorption and potentially increasing bone density.
  6. Calcitonin: This hormone, which is involved in bone metabolism, can slow bone loss and is sometimes used as a treatment for osteoporosis.

It’s important to note that each of these medications has potential side effects and risks, which need to be weighed against the benefits. Patients should discuss these factors with their healthcare provider to decide on the most appropriate course of treatment for their specific situation. Lifestyle changes, including diet, exercise, and stopping smoking, are also a crucial part of managing osteoporosis.


Understanding bone density is crucial in preventing and managing conditions like osteoporosis and the associated risk of fractures. Regular check-ups, a balanced diet, and an active lifestyle are key to maintaining bone health. If you have concerns about your bone health, it’s never too late to discuss them with a healthcare provider.

Note: This article is meant for informational purposes only and does not constitute medical advice. Always consult a healthcare professional for personalized advice.


  1. MedlinePlus: Bone Density Test
  2. National Institutes of Health (NIH): Osteoporosis and Aging
  3. Mayo Clinic: Osteoporosis
  4. Harvard Health Publishing: Osteoporosis
  5. International Osteoporosis Foundation: Prevention
  6. National Osteoporosis Foundation: Diagnosis