Literally meaning porous bone, osteoporosis is characterized by reduced bone formation, excessive bone loss, or a combination of both, which leads to bone fragility and contributes to millions of fractures a year. Overall, the disease is estimated to affect two hundred million people worldwide.
Bone mineral density is used as a robust and consistent predictor of osteoporotic fracture. Although the bone density cutoff for an osteoporosis diagnosis is arbitrary, using the current definition, the disease may affect about one in ten women at age 60, two in ten by age 70, four in ten by age 80, and six or seven out of ten by age 90. Osteoporosis is typically thought of as affecting mostly women, but one-third of hip fractures occur in men. For 50-year-old white women and men, for example, the lifetime risks for osteoporotic fractures are 40 percent and 13 percent, respectively.
The good news is that osteoporosis need not occur. Based on a study of the largest twin registry in the world, less than 30 percent of osteoporotic fracture risk is heritable. Researchers concluded that “fracture-prevention efforts at older ages should be focused on lifestyle habits.” This is consistent with the enormous variation in hip fracture rates around the world, with the incidence of hip fracture varying tenfold, or even a hundredfold, between countries, suggesting that excessive bone loss is not an inevitable consequence of aging.
Rather than using drugs to try to treat osteoporosis, due to their lack of perceived efficacy and possible side effects, including osteonecrosis of the jaw and atypical femur fractures, or supplementing with calcium, which is not recommended by expert panels, the single most important thing we can do to prevent osteoporotic fractures is prevent injurious falls. And, based on dozens of randomized controlled trials, exercise is the single intervention most strongly associated with a reduction in falls rate. A recent meta analysis found that exercise interventions—ones mostly using a combination of resistance exercise to improve lower limb muscle strength training and balance training—cut fracture rates nearly in half.

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