Breaking News: 8 Silent Signs Your Bones Might be at Risk

Breaking a bone hurts – a lot. But the bone-thinning conditions osteoporosis and its precursor, osteopenia, are often called ‘silent diseases’ because they have few signs before you develop a fracture.

That said, subtle changes may alert you that your bone health could be at risk. And sometimes, part of your medical history or a current lifestyle habit boosts your chances of a crack.

It’s important to pay attention to these harbingers, because proactively addressing bone health can help preserve your function and independence as you age, says Dr Heidi Prather, a sports and lifestyle medicine physician.

Why bone strength declines with age

You might think of your bones as solid structures, but they’re living tissue, just like your muscles and tendons. Throughout life, they’re constantly breaking down and repairing.

The balance of those two activities changes with age. Until about 20 or 30, your body rebuilds bone faster than it’s resorbed, allowing you to reach what’s called your peak bone mass. From 30 to 50 or so, the process plateaus, so your bones stay at about the same strength.

And then, after 50, the construction process slows, a drop-off that’s especially steep in women. Menopause brings declines in the female sex hormone oestrogen, which in turn leads bone-building cells called osteoblasts to die off. “You can get this really rapid, dramatic bone loss within those first five to seven years in that transition into menopause,” Dr Prather says.

All this means that a decline in bone density is entirely predictable – it happens to pretty much everyone, says Dr Adam Rivadeneyra, a sports medicine physician. But staying alert for the signals that it’s accelerating particularly quickly can give you time to take bone-boosting actions before you sustain a break.

Here are some useful signs to look for.

Your vitamin D levels are low.

The so-called ‘sunshine vitamin’ helps your body absorb the mineral calcium, which builds strong bones. And it’s easy to fall short – according to the Australian Bureau of Statistics, one in five Aussie adults has a vitamin D deficiency, with levels below 50nmol/L, the minimum Healthy Bones Australia recommends for bone health.

To find out if you’re among them, ask your doctor for a blood test to check your levels. If needed, you can raise your vitamin D levels with a few strategic minutes in the sun, foods like fatty fish and mushrooms, or supplements.

You’re always at the dentist.

For the most part, you can’t see what’s happening to your bones, since they’re buried underneath your skin. But if you – or your dentist – spot problems in your mouth, it may reveal more about what’s going on beneath the surface. People with poor oral health have a greater risk of getting a fracture, according to a systematic review in the journal Ageing Research Reviews.

Though they’re both hard and white, teeth and bones are made of different stuff. Still, some of the underlying processes that affect bone health – including shifting hormone levels and low levels of calcium and vitamin D – can contribute to conditions like gum disease and missing teeth, the review authors note.

You missed periods long before you reached menopause.

Maybe you grew up playing soccer or doing athletics and cross-country. Or, perhaps you got into marathons or triathlons as an adult. At some point, if you were really training hard, you might have noticed that your periods were farther apart – or maybe even disappeared altogether.

Contrary to what some coaches have told women athletes, missing periods isn’t a sign of dedication, Dr Prather says – it’s actually a warning sign of low energy availability, which occurs when athletes or active people don’t eat enough to replace the energy they’re expending through their workouts.

When your body’s starved for energy, it shuts down non-essential functions, including reproduction. As a result, you lose bone-boosting oestrogen, leaving you at risk of tiny cracks in the bone called stress fractures while it’s happening. And – especially if it occurred during your peak bone-building years – low energy availability raises the risk of osteopenia and osteoporosis for years down the line, notes a review in the journal Physiological Research.

You don’t eat much dairy (or other sources of calcium).

Your mum wasn’t lying when she told you to drink calcium-rich milk for your bones. Your body can’t produce this vital mineral, which forms a key building block of a strong skeleton. After age 50, you should aim for between 1,000 and 1,200 milligrams per day.

While milk, yoghurt and cheese are particularly good sources of calcium, you can also find calcium in leafy green veggies, fish like sardines and canned salmon, and fortified cereal, tofu or fruit juices. If you’re having trouble meeting your needs through diet alone, talk to your doctor about supplements.

You skip strength training.

Weight-bearing cardio workouts, like walking and running, are beneficial for bone health. But to truly mount your best defence against osteoporosis and fractures, you also need to pick up heavy stuff once in a while.

“Bone responds to pressure by getting harder and more resilient the more you use it,” Dr Rivadeneyra says. As you lift a dumbbell or pull on a resistance band, your muscle tugs on your bone, stimulating osteoblasts to build new bone. Moves like bodyweight squats, step-ups and wall push-ups target important – and particularly vulnerable – areas like the hips, spine and wrists.

And strength training also improves balance and stability, which reduces fall risk. That means even if your bones are weaker, you can reduce your risk of a fracture, he says.

You have more than the occasional glass of wine.

By now, it’s not news that drinking too much is bad for your liver, heart and brain. But excessive alcohol might also wreak havoc on your bones, Dr Prather points out.

According to a systematic review and meta-analysis in the journal Drug and Alcohol Dependence, people who had a drink or two per day had a 34 per cent greater risk of osteoporosis than those who didn’t imbibe. Downing more than two alcoholic beverages daily, meanwhile, boosted the risk to 63 per cent greater.

Why? Booze can interfere with your body’s ability to absorb calcium and vitamin D, as well as further suppress hormones like oestrogen and testosterone, notes another review, in the International Journal of Environmental Research and Public Health. And, of course, inebriation can increase your risk of falling, which can lead directly to fractures.

You’re taking steroids for a medical condition.

For some medical conditions – including lupus, asthma, eczema and rheumatoid arthritis – medications called corticosteroids are important for improving health and quality of life, Dr Rivadeneyra says.

But there’s a trade-off. As many as half of people who use these medications for more than three months will develop osteoporosis, in part because the drugs both speed up the breakdown of old bone and slow the building of new tissue, according to a review in Open Access Rheumatology.

While the biggest risk comes when you first start taking them, there’s some evidence the effects linger even after you stop. That doesn’t mean you shouldn’t take these drugs, Dr Rivadeneyra notes – but as with any other medication, you should be aware of the risks as well as the benefits.

Your back suddenly aches.

You might think you’d automatically notice when you’ve broken a bone. However, breaks called vertebral compression fractures – small cracks in the bones of your spinal column – often occur without any identifiable trauma, Dr Prather says.

If you have osteoporosis, even everyday movements like coughing, sneezing or getting out of a car can cause these fractures. Afterwards, you may notice back pain that you never had before. Or, you might suddenly notice you’re a bit shorter, as the fracture causes the bone to collapse.

The bottom line

None of these signs means you’re doomed to develop a fracture – although backaches may mean you already have one. But they all do point to potential problems and should prompt a discussion with your doctor, who may suggest a DEXA scan to check your current bone density status, Dr Prather says.

From there, you can work together on a bone-health strategy, which might include exercise, diet, reducing risks like smoking and alcohol use, and, if needed, medications. “The years around menopause are a good time to figure out your baseline bone density, or quality of your bones,” she says. “Building strength and a plan around that early on can really protect you in the decades to follow.”