Why Osteoporosis Isn't Just a Senior Problem Anymore

Los Angeles Times

02-05-2025

Osteoporosis is called the 'silent thief' because it quietly eats away at bone strength over time—until a fracture reveals the damage. Other risk factors like lifestyle and medical conditions also contribute to osteoporosis. This affects people across the lifespan from children with genetic bone disorders to adults with hormonal shifts and chronic inflammation.
Despite being so common, osteoporosis is often misunderstood, undertreated or ignored. But new science is changing that, giving us new insights into how bones weaken, how to catch it early and how to protect skeletal health for life.
At its core Osteoporosis is a disease of bone imbalance. Normally our bones are constantly renewing themselves—old tissue gets broken down and new tissue replaces it. But when this balance tips either by losing too much bone or making too little bones become porous, brittle and prone to break. As bone loss occurs individuals may lose bone mass and increase the risk of fractures.
According to Aging Clinical and Experimental Research (2021) this imbalance can come from a variety of factors including hormonal changes (menopause), aging and even immune dysfunction [1]. These changes affect how cells within the bone operate and tip the scale towards bone loss. Imbalances in certain hormones can also significantly impact bone health.
Children aren't immune either. Disorders like osteogenesis imperfecta or chronic malnutrition can cause pediatric osteoporosis. As stated in Seminars in Musculoskeletal Radiology (2021) when bone growth is disrupted in early life—during rapid growth spurts or due to genetic factors—the result is lifelong fragility [2].
Family history is another risk factor as individuals with a family history of osteoporosis are more likely to experience bone loss. Osteoporosis is a medical condition that requires a licensed physician for proper diagnosis and treatment. Routine screenings as recommended by the U.S. Preventive Services Task Force are essential for osteoporosis diagnosed early. Almost everyone is at risk of developing osteoporosis due to aging and lifestyle choices.
Here's where things get even more interesting: bone health isn't just about calcium and exercise. The immune system and gut microbiome are also involved. A 2020 EXCLI Journal review states that chronic inflammation and microbial imbalances can weaken bones—linking osteoporosis to broader systemic issues like autoimmune diseases and gut disorders [3].
Chronic inflammation plays a big role in many osteoporosis cases. Conditions like rheumatoid arthritis accelerate bone loss not just because of the disease itself but because of the inflammatory chemicals involved. These substances called cytokines disrupt the delicate balance of bone remodeling. Nature Reviews Drug Discovery (2012) says pro-inflammatory cytokines can increase bone destruction and shut down new bone formation [8].
Another often overlooked factor is bone quality. We focus on bone mineral density (BMD) but that only tells part of the story. A person can have normal BMD and still fracture due to poor bone microarchitecture. In 2021 Instructional Course Lectures stated that bone strength also depends on its internal structure—like how well the collagen and mineral components are arranged [4].
Think of it like two buildings made of the same materials but one will collapse faster if the internal framework is weak. Bones are living tissue undergoing continuous remodeling where old bone is broken down and replaced with new bone.
The gold standard for diagnosing osteoporosis is the DEXA (dual-energy X-ray absorptiometry) scan which measures bone mineral density. A bone density test is essential for identifying the disease early. But diagnosis goes beyond numbers. Clinicians look at a person's risk factors for osteoporosis: age, gender, history of fractures, medications like steroids and chronic illnesses.
According to Lancet (2019) secondary fracture prevention programs such as Fracture Liaison Services (FLS) are proving to be essential tools in identifying patients who may have osteoporosis but were never formally diagnosed—especially after their first fracture [10].
These services help close the gap between injury and intervention so patients get the care they need before another break occurs. Healthcare providers diagnose osteoporosis during routine screenings following guidelines from the U.S. Preventive Services Task Force.
Osteoporosis treatment isn't just about pills—it's a lifelong approach to treating osteoporosis. Preventive measures like being active, eating a diet rich in calcium and vitamin D, not smoking and being at a healthy weight can go a long way.
Weight-bearing exercises like walking, jogging and dancing are essential for building and maintaining strong bones. Taking a calcium supplement can help you meet your daily recommended intake especially if your dietary calcium is inadequate.
But for those already affected, medications play a big role. Endocrinology and Metabolism Clinics (2015) stressed the importance of patient education saying that understanding the condition improves long-term treatment outcome [5]. Here are the common treatment options:
To prevent osteoporosis you need to adopt a healthy lifestyle that includes a balanced diet and regular physical activity.
P&T Journal (2018) noted that while these treatments are effective doctors must also consider cost, side effects and the patient's ability to adhere to the regimen when choosing a therapy plan [9]. Preventing fractures involves maintaining bone health through adequate calcium and vitamin D intake, prescribed medications and avoiding falls.
Weight-bearing exercise is particularly beneficial in preventing bone loss and reducing the risk of fractures as we age. Treating osteoporosis effectively requires a balanced approach that includes medication, diet and exercise.
Children with bone disorders need a more tailored approach. Their bones are still growing so doctors must be cautious with medications that might affect that process. A 2023 Current Osteoporosis Reports article emphasized the need for nuanced care strategies in kids with developmental delays or skeletal disorders [7].
The future of osteoporosis care is moving beyond one-size-fits-all approaches. As the 2023 Endocrinology and Metabolism Clinics review said, age, genetics, environment and lifestyle all play a role in determining bone health risk and treatment plan [6].
Achieving peak bone mass by 30 is key to reducing the risk of osteoporosis later in life. Maintaining bone mass over time is also crucial to reducing osteoporosis-related fractures.
That means looking at bone health from childhood to old age. Early-life interventions especially for children with chronic illnesses can build more bone for the future. In older adults, early screening and multidisciplinary care including primary care, endocrinology and geriatrics can prevent devastating fractures that often lead to disability or loss of independence.
Strategies to keep bones strong are a balanced diet rich in calcium and vitamin D and regular physical activity. Keeping bones healthy is weight-bearing exercise and preventing falls.
Osteoporosis isn't just a disease of aging—it's a lifelong concern that requires early awareness, proactive prevention and tailored treatment especially for those at high risk and increased risk. By understanding the complex interplay of inflammation, bone quality and individual risk factors we're moving towards more effective care for every stage of life. Osteoporosis risk is influenced by many medical conditions and lifestyle choices so preventive measures are key. The science is clear: strong bones start with strong strategies and the earlier we act the better the outcome.
[1] Barnsley, J., Buckland, G., Chan, P. E., Ong, A., Ramos, A. S., Baxter, M., Laskou, F., Dennison, E. M., Cooper, C., & Patel, H. P. (2021). Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging clinical and experimental research, 33(4), 759–773. https://doi.org/10.1007/s40520-021-01817-y
[2] Testini, V., Eusebi, L., Tupputi, U., Carpagnano, F. A., Bartelli, F., & Guglielmi, G. (2021). Metabolic Bone Diseases in the Pediatric Population. Seminars in musculoskeletal radiology, 25(1), 94–104. https://doi.org/10.1055/s-0040-1722566
[3] Föger-Samwald, U., Dovjak, P., Azizi-Semrad, U., Kerschan-Schindl, K., & Pietschmann, P. (2020). Osteoporosis: Pathophysiology and therapeutic options. EXCLI journal, 19, 1017–1037. https://doi.org/10.17179/excli2020-2591
[4] Dimar, J. R., Lane, J. M., Lehman, R. A., Jr, & Anderson, P. A. (2021). The Basics of Bone Physiology, Healing, and Osteoporosis. Instructional course lectures, 70, 527–536. https://pubmed.ncbi.nlm.nih.gov/33438933/
[5] Lupsa, B. C., & Insogna, K. (2015). Bone Health and Osteoporosis. Endocrinology and metabolism clinics of North America, 44(3), 517–530. https://doi.org/10.1016/j.ecl.2015.05.002
[6] Khandelwal, S., & Lane, N. E. (2023). Osteoporosis: Review of Etiology, Mechanisms, and Approach to Management in the Aging Population. Endocrinology and metabolism clinics of North America, 52(2), 259–275. https://doi.org/10.1016/j.ecl.2022.10.009
[7] Raimann, A., Misof, B. M., Fratzl, P., & Fratzl-Zelman, N. (2023). Bone Material Properties in Bone Diseases Affecting Children. Current osteoporosis reports, 21(6), 787–805. https://doi.org/10.1007/s11914-023-00822-6
[8] Redlich, K., & Smolen, J. S. (2012). Inflammatory bone loss: pathogenesis and therapeutic intervention. Nature reviews. Drug discovery, 11(3), 234–250. https://doi.org/10.1038/nrd3669
[9] Tu, K. N., Lie, J. D., Wan, C. K. V., Cameron, M., Austel, A. G., Nguyen, J. K., Van, K., & Hyun, D. (2018). Osteoporosis: A Review of Treatment Options. P & T : a peer-reviewed journal for formulary management, 43(2), 92–104. https://pubmed.ncbi.nlm.nih.gov/29386866/
[10] Compston, J. E., McClung, M. R., & Leslie, W. D. (2019). Osteoporosis. Lancet (London, England), 393(10169), 364–376. https://doi.org/10.1016/S0140-6736(18)32112-3