Written by: Rebecca Webb, PharmD, Pharmacy Clinical Services Manager

June is National Dairy Month and an appropriate time to talk about bone health and osteoporosis.  An estimated 10 million Americans aged 50 and older have osteoporosis.  Therefore, every adult should have a basic knowledge regarding this disease state, including its risk factors, screening recommendations, medication counseling, and how to reduce the risk of falls and fractures.   

 

Osteoporosis.  Bone tissue is constantly being broken down and replaced as part of a natural process in your body.  Osteoporosis occurs when more bone is broken down than is replaced.  Bone mineral density decreases and there is a loss of bone mass.  These changes to the structure and strength of bones causes them to become weak and fragile and thus, more likely to fracture.  

Osteoporosis does not typically cause any symptoms, until a bone suddenly breaks (even from a minor fall or bump).  Osteoporosis-related breaks are most common in the bones of the hip, spine, and wrists. 

 

Certain factors that may increase your risk of developing osteoporosis include:

• Risk factors you cannot change such as your age (over age 50), gender (women), race (white or of Asian descent), biological family history (parent or sibling) of osteoporosis or fractures, and body size (small body frame).

• Changes to hormones such as low levels of estrogen in women after menopause and low levels of testosterone in men.

• Dietary factors such as inadequate calcium or vitamin D intake, not eating enough fruits and vegetables, and poor protein consumption.

• Medications such as long-term use of corticosteroids (used to treat various conditions) and proton pump inhibitors (used to lower stomach acid).  Certain medications for cancers and seizures are also associated with an increased risk of osteoporosis. 

• Medical conditions such as endocrine disorders (thyroid disease, diabetes), gastrointestinal diseases (celiac disease, inflammatory bowel disease), autoimmune diseases (rheumatoid arthritis), certain types of cancer, HIV/AIDS, and anorexia.

• Lifestyle choices such as excessive regular alcohol consumption, being physically inactive, and cigarette smoking.

 

Osteoporosis screening.  To prevent osteoporotic fractures, the U.S. Preventive Services Task Force (USPSTF) recommends to/for:

• Screen women 65 years of age and older for osteoporosis. 

• Screen postmenopausal women younger than 65 years of age with one or more risk factors for osteoporosis. 

• Healthcare providers to use their clinical judgement when assessing men, as there is insufficient evidence to recommend for or against screening for osteoporosis to prevent osteoporotic fractures in men.  

 

Medication counseling.  Bisphosphonates are prescription medications used for the treatment and prevention of osteoporosis.  

• Oral bisphosphonates include alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva).  

• They work by slowing the breakdown and removal of bone tissue, thus helping to keep your bones strong and prevent fractures.  

• One common side effect of oral bisphosphonates is upper gastrointestinal issues, including heartburn, esophageal irritation, and upset stomach.  

• Typically, these medications are taken weekly or monthly as prescribed.  

• Oral bisphosphonates have specific directions for use and following them is especially important.  In general, they are to be swallowed whole first thing in the morning with a full glass of plain water on an empty stomach at least 30 minutes (60 minutes for ibandronate) before the first food, beverage (except plain water), or other medication(s) of the day.  You are also to remain upright (sitting or standing, not lying down) for at least 30 minutes (60 minutes for ibandronate) after taking these medications and until after the first food of the day.  This reduces irritation to the esophagus.

• Adhering to bisphosphonate therapy is critical for achieving the full fracture-prevention benefit.

 

Steps to take to lesson your risk of falls and fractures:

• Stay physically active with regular exercise to improve balance and strength.  This includes mild weight-bearing activities.  

• Have your vision and hearing checked routinely.  Replace eyeglasses when needed. 

• Have your feet checked regularly and wear proper footwear (well-fitted, nonskid, supportive shoes).

• Be aware of the side effects of any medications you take, as some may cause drowsiness or dizziness.  Review your medications (including any over-the-counter medicine) with your Food City Pharmacist. 

• Obtain adequate sleep to ensure you are well-rested and not tired. 

• Limit alcohol consumption. 

• Stand up slowly to help prevent dizziness or fainting when a drop in blood pressure occurs.

• Use devices to assist you in remaining steady when you walk (e.g., cane, walker).

• Fall-proof your home - remove clutter from walkways and stairs; remove small throw rugs or secure rugs to keep them from slipping; have grab bars installed in locations like the bathroom; use non-slip bathmats; keep areas well-lit and use nightlights; and utilize handrails, especially on staircases.

 

 

_References:

_{1. Osteoporosis to Prevent Fractures: Screening. U.S. Preventive Services Task Force website. Recommendation: Osteoporosis to Prevent Fractures: Screening | United States Preventive Services Taskforce. Accessed May 14, 2026.} 

_{2. Osteoporosis Workgroup. Healthy People 2030 website. Osteoporosis Workgroup - Healthy People 2030 | odphp.health.gov. Accessed May 14, 2026.}