Causes of Osteoporosis

Causes of Osteoporosis

Did a doctor ever explain to you the causes of osteoporosis? You’re lucky and probably unusual if the answer is yes. In our currently broken medical system it’s easier to pull out a pad and write a prescription for osteoporosis medications than to take the time to explain its causes and help you prevent or treat it with a holistic medicine approach. So let’s take the next few moments together to review its causes and what you can do about it.

To some extent, decreasing bone density is normal as we grow older. Studies of women just after menopause show that a large percentage of normal healthy women by the end of their 50’s have significant osteopenia (thinning of the bones without meeting complete diagnostic criteria for osteoporosis). So while I support the use of bone density screening after midlife routinely (the DXA), it’s important not to jump straight from a finding of low bone density to a prescription. The “low bone density” is usually a comparison to young healthy women before menopause, but may be quite normal for your age. Using an online resource to help calculate the actual risk of fracture can be a helpful way to put this finding into perspective. But while it can be seen as a normal part of aging, it does increase risk of fractures, and doing everything you can to minimize the bone loss is still important.


What are some other causes of osteoporosis? Vitamin D deficiency comes to mind immediately. If you are not living south of Atlanta Georgia (in the northern hemisphere), you cannot get enough vitamin D from sun exposure year round. So take a daily supplement of vitamin D3 (cholecalciferol); I recommend 1000 IU (international units) for anyone over the age of 12. And 15 minutes of direct sun exposure (swimsuit or similar attire) at mid-day without sunscreen also will give you a good dose except in winter.

Another vitamin is important, but for a different reason. Some studies have shown that taking a synthetic vitamin A supplement (retinol or retinyl palmitate) can lead to increased bone loss. That’s one of the reasons why I always recommend that my patients look for a multivitamin with only the natural carotenoids as the vitamin A source instead. These are harder to find, a little more expensive, but worth it.

There are some chronic medical conditions that are also important causes of osteoporosis. The long term use of thyroid hormone replacement medication adds to risk of osteoporosis; and if you have a chronic medical condition which requires long term use of corticosteroids (e.g. prednisone or cortisone), this will also make bone thinning more likely. I am not advocating that you stop these medications, they are often critically important for disease management. But their long term use makes it even more important that you take other prevention steps. And whenever you can minimize their long term use and dosage if possible, all the better for the bones.

And last, but absolutely not least of the causes of osteoporosis, is lack of weight bearing exercise. Our bones need exercise against resistance in order to stay healthy. Some stress is actually a good thing for bones. That’s why astronauts lose bone density while in space; and even being bedridden for an illness will do the same thing. So whatever else you do for your bones, always remember that getting out for a walk, going to the gym, dancing, gardening, jogging, hiking, tennis, or whatever else you enjoy that puts your muscles to work against gravity is good for your bones. In plain language, exercise is the single most important determinant of healthy bone density. Consider it a prescription.


With those in mind, you should be equipped now to better understand the causes of osteoporosis, and to take steps to prevent it. And please, start now… every day makes a difference.




To your health and wellness,




Robert Pendergrast, M.D. 

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