Osteoporosis is often brushed aside as an unavoidable consequence of getting older, but that assumption is both false and dangerous. Bone mass naturally reaches its peak in the late 20s and declines with age, yet the metabolic bone disease is not guaranteed.

People can take meaningful steps to prevent or slow bone loss. That matters because osteoporosis may quietly progress for years before its first visible consequence exposes the damage.

Clinicians classify osteoporosis as a “silent disease” because declining bone density and deteriorating bone tissue usually cause no pain, aching or physical warning. As bones become increasingly fragile, the first sign may be a fracture from a minor fall or even an ordinary daily activity.

The consequences can extend far beyond the broken bone itself. Vertebral fractures can cause chronic pain, while hip fractures among older adults are associated with a substantial risk of complications and death.

Mortality following a hip fracture can approach 30% within one year in some studies. Even when a fracture is not fatal, it can reduce mobility and independence, making it more difficult for someone to continue living alone.

Fear can deepen the damage after a fracture or fall. People who become frightened of falling may exercise less, abandon activities they enjoy and grow socially isolated as ordinary tasks become more difficult.

Postmenopausal women are among those facing the highest risk, but osteoporosis does not affect women alone. Men can also develop the disease, and anyone who has experienced a previous fragility fracture faces a higher risk of suffering another.

A fragility fracture is caused by a low trauma event, such as a minor fall. Low BMI, low body weight and significant weight loss can also increase risk, while people of smaller stature may begin with smaller bones and less bone mass.

Family history is another major consideration, particularly for hip fractures. Having a parent who fractured a hip can significantly raise a person’s risk of a hip fracture or another major osteoporotic fracture.

Several endocrine disorders can harm bone health, including hyperthyroidism. Declining estrogen levels increase women’s risk during menopause, while low testosterone can also contribute to bone loss.

Cushing’s syndrome causes the body to produce too much cortisol and can increase osteoporosis risk. Rheumatoid arthritis, other inflammatory conditions and chronic diseases affecting the kidneys, liver or gastrointestinal tract can also lead to osteoporosis and bone loss through different mechanisms.

Some medications can affect bones as well. Drugs that suppress estrogen or testosterone and certain seizure medications may contribute to bone loss, meaning people treated for breast cancer, prostate cancer or epilepsy may need bone health monitoring.

Lifestyle choices remain important. Smoking and heavy alcohol consumption, defined here as more than two drinks daily for men and one for women, can increase the risk of bone loss, while a sedentary routine can further endanger bone health.

Nutrition is another critical part of prevention. Adults generally need about 1,000 to 1,200 milligrams of calcium each day, which can come from dairy products and fortified foods, along with a balanced diet containing vitamin D and protein.

Vitamin D can come from sunlight and foods such as salmon, mackerel, egg yolks and dairy products. Magnesium, potassium and vitamins K and C also play roles in supporting bone health.

Regular weight bearing exercise and strength training can help maintain and strengthen bones. Brisk walking, hiking, running, dancing and aerobics are weight bearing activities, while resistance training challenges muscles and bones against resistance.

Yoga, Pilates and tai chi can improve balance, flexibility and core strength, which may help reduce the risk of falls. However, they do not replace weight bearing or resistance exercise for building and preserving bone strength.

The goal is to build as much bone mass as possible during the early years of life and preserve it for as long as possible. Although some bone loss accompanies aging, healthy habits can maintain bone strength and reduce the risk of fractures later in life.

Dr. Susan Zweig is an endocrinologist, clinical professor and associate director of clinical affairs in the Holman Division of Endocrinology, Diabetes and Metabolism within the Department of Medicine at NYU Langone Health. She treats hormonal and metabolic conditions, including osteoporosis, at NYU Langone Diabetes & Endocrine Associates.

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