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As a person ages, so does their risk of fractures due to osteoporosis. Risk factors include high alcohol intake, long-term use of certain drugs, and physical inactivity. Fall prevention and lifestyle changes can reduce fracture risk.

Just as a twig is easier to break than a branch, so it goes with thin bones versus thick.

If you’re living with osteoporosis, you’ve learned that your bones are thinner than ideal. This puts you at greater risk of experiencing bone fractures or breakages. But knowing that you’re at risk for breaking a bone and actually breaking one are very different things.

Taking measures to strengthen your bones after an osteoporosis diagnosis can help reduce the risk of future fractures.

The incidence of certain fractures dramatically increases as a person ages. These include fractures to the hip, vertebrae, and forearm and are most often due to osteoporosis. Consider these facts related to osteoporosis and fracture risk:

  • An estimated 37 million fractures happen in people over 55 years. This is the equivalent of 70 fractures per minute.
  • An estimated 1 in 2 women and 1 in 4 men over age 50 will break a bone due to osteoporosis. A 2021 National Osteoporosis Foundation report found that in 2016, 1.8 million Medicare beneficiaries experienced an estimated 2.1 million osteoporotic fractures. The fracture rate for female beneficiaries was 76% higher than for males.
  • A 10% loss in bone mass in a person’s vertebrae doubles their risk for a vertebral fracture. Losing 10% of bone mass in the hip increases a person’s risk for fracture by 2.5 times.

These statistics support the knowledge that having osteoporosis increases the risk of hip fractures. Women ages 65 and older are especially vulnerable: They’ve gone through menopause, so their bones tend to be thinner than men’s.

However, having osteoporosis doesn’t mean that breaking a bone is inevitable.

Osteoporosis is only one part of the puzzle that helps a person with the condition understand their fracture risk. In addition to low bone density, examples of fracture risk factors include:

  • a high alcohol intake, such as three drinks per day, which increases the risk for hip fractures, according to a 2022 meta-analysis
  • long-term use of proton-pump inhibiting drugs, such as omeprazole (Prilosec, Prilosec OTC), aspirin and omeprazole (Yosprala), and lansoprazole (Prevacid, Prevacid IV, Prevacid 24-Hour)
  • low body weight
  • physical inactivity or a sedentary lifestyle
  • prolonged use of corticosteroid medications to reduce inflammation, such as methylprednisolone
  • smoking
  • use of certain medications, such as anxiety-relieving drugs, sedatives, and antidepressants

If you’ve received an osteoporosis diagnosis, talk with your doctor about ways to help reduce bone fracture risk. These may include medications for treating the condition as well as lifestyle changes.

There are three types of fractures that people living with osteoporosis commonly experience: vertebral, forearm and wrist, and hip fractures.

Vertebral fractures

A vertebral fracture is a common type of fracture for people with osteoporosis that they may not know about. According to the American Academy of Orthopaedic Surgeons, spinal fractures occur 1.5 million times in the United States annually.

Vertebral fractures are twice as common as broken hips and wrists. They occur when you break one of the bones in your spine, known as a vertebra. Symptoms associated with a vertebral fracture include:

  • difficulty moving around
  • height loss
  • pain
  • stooped posture

Some people don’t experience any pain at all when a vertebral fracture occurs. However, others may start to lose height or experience a curve in their spine known as kyphosis.

Most often, falls cause vertebral fractures. However, they can occur from everyday tasks, such as reaching, twisting, or even sneezing. Certain actions that transmit enough force to the spine may also cause vertebral fractures, such as driving across railroad tracks.

Forearm and wrist fractures

Often the result of a fall, wrist and forearm fractures are another common fracture type for women with osteoporosis. For white women age 50 years and older, the lifetime risk of forearm fracture is 16%.

Hip fracture

Age increases your risk of hip fractures. Of all the people hospitalized for hip fractures, 80% are 65 years or older. A 2020 study found that most people hospitalized due to a hip fracture were over age 75, and 62.3% of these were female.

Osteoporosis already signifies weakened bones. When the impact of a fall affects the hip joint of a person with osteoporosis, a fracture can occur.

Hip fractures require surgery as well as postsurgical rehabilitation to heal and restore mobility.

Hormones in the body can greatly affect bone building and strength. Three of the most important hormones related to bone growth and maintenance include estrogen, parathyroid hormone, and testosterone. However, testosterone doesn’t affect bones as much as the other two hormones.

Estrogen is thought to stimulate osteoblasts, which are bone-growing cells. Estrogen also seems to inhibit osteoclasts, which are cells that break down bone.

After menopause, a female’s ovaries stop making estrogen. Although the body makes estrogen in other places, such as fatty tissue, the ovaries are typically a primary source of estrogen for females.

The dramatic drops in estrogen that occur after menopause can lead to significant bone loss.

Some risk factors for bone fractures are unavoidable — such as being older than 65, being female, or having a family history of osteoporosis. However, there are some lifestyle changes you may be able to make to decrease your risk of bone fractures, such as quitting smoking.

Here are a few other tips to reduce risks for bone fractures when you have osteoporosis:

Fall prevention

Because falls are a contributing factor to osteoporosis-related fractures, it is important for anyone living with osteoporosis to take measures to help prevent falls. These can include:

  • Providing sufficient lighting in the home and placing nightlights in hallways and rooms.
  • Keeping a flashlight near your bed to help light a pathway.
  • Keeping electric cords out of the way of common pathways through your home.
  • Removing clutter from living areas, such as books, magazines, or small pieces of furniture that are easy to trip over.
  • Installing “grab bars” on the bathroom walls near your bathtub and toilet.
  • Refraining from walking in socks, stockings, or slippers. Instead, wear rubber-soled shoes to help prevent falls.
  • Placing carpet runners or plastic runners on slippery floors.
  • Walking on grass instead of sidewalks slippery from rain, snow, or fallen leaves.
  • Removing throw rugs in your home that might slip.

Dietary changes

Calcium and vitamin D are two important components of strong bones. Low intakes of either can be harmful to bone health. According to the National Institutes of Health, insufficient calcium intake is a contributing factor to bone fractures.

Women ages 51 years and older should consume at least 1,200 milligrams of calcium each day. Calcium-containing foods include low fat dairy options, such as milk, yogurt, and cheese. Other non-dairy calcium sources include:

  • broccoli
  • bok choy
  • collard greens
  • tofu
  • calcium-fortified foods, such as orange juice, cereal, and bread

Vitamin D is important for enhancing calcium absorption, yet there are few natural sources of the vitamin. These include:

  • egg yolks
  • liver
  • saltwater fish

However, many foods are fortified with vitamin D, including orange juice, cereals, and whole grain breads.

Reducing alcohol intake can help decrease the risks of falls as well as the effects of alcohol on bone loss.

Exercise

Physical activity can enhance strong bones as well as improve balance, reducing the risk of falls. Those with osteoporosis don’t need to refrain from exercising for fear of falling.

Resistance exercises can help build strength and can include using exercise bands or small hand weights. Flexibility exercises, such as yoga, tai chi, or gentle stretching, can improve range of motion and balance.

Always talk with your doctor before beginning any exercise program. If you have osteoporosis, avoid activities that require twisting or bending forward from your waist. Such movements may place too much strain on your back and increase the risk of falling. Examples include full sit-ups and toe touches.

Osteoporosis can increase bone fracture risk. However, there are many ways people living with the condition can help reduce fracture risk and live healthily. In addition to lifestyle measures to prevent falls and strengthen bones, medications are available to treat osteoporosis.