Many of the women we see at the Center for Better Bones come to us because they’re
scared they’ll fracture a hip. And considering what the popular media messages
say about women’s fracture risk, it’s not surprising they’re worried!
Hardly a second goes by on television without some celebrity telling you that your
bones will whittle away to nothing unless you take this pill or that one, or a prominent
expert warning you not to become “one out of every two women... over 50 [who]
will have an osteoporosis-related fracture in their lifetime.”
But I’m happy to be able to dispel these bone health myths, because these
statistics that sound so frightening leave out a lot of information that women need
to know if they’re to get an accurate sense of how likely such an injury really
is for them.
There’s a great joke about statistics that sums up what women need to keep
in mind, and I want you to think about this every time you hear a new osteoporosis
Statistics are like bikinis — they reveal a lot, but cover up the
really important parts.
When it comes to osteoporosis statistics, the “important parts” are
the pieces of information that you need to know if you’re to make informed
decisions about your health. It’s crucial to dig deeper and learn the whole
truth behind the sound bites!
So let’s look more closely at some commonly cited osteoporosis statistics,
and gain a better sense of what’s truly important — the factors
that affect your real fracture risk, right now, today — so you can
use that knowledge to improve your bone health.
Statistic #1: One out of two women over 50 will suffer an osteoporosis-related fracture
in her lifetime.
What about spinal fractures?
Where does this “1 in 2” number come from? It largely derives from what
are called “silent” vertebral or spinal fractures — currently
estimated at about 500,000 per year, but likely higher since many go undiagnosed
(the majority are found by accident, on an x-ray looking for something else).
Many women who experience such spinal fractures do not report pain — or even
realize they’ve had a fracture. And most recover and continue to go unnoticed
without any intervention at all.
Such fractures do become meaningful, though, when they are associated with pain
and deformity. Multiple vertebral fractures can start to deform the spine, cause
a loss of height and the so-called “dowager’s hump.”
But don’t be fooled — a stooped appearance does not necessarily mean
multiple spinal fractures. Chances are better a dowager’s hump is due to loss
of muscle strength and weakened posture, rather than osteoporotic fractures.
The above statistic is commonly cited by the National Osteoporosis Foundation and
manufacturers of osteoporosis drugs. Many credible US scientists, however, do estimate
that 40% of Caucasian women will experience an osteoporosis-related fracture during
the remainder of their lifetime. Meanwhile, the International Osteoporosis Foundation
states that 1 in 3 women over 50 will experience an osteoporotic fracture during
the remainder of her lifetime. Whether the real figure is 30%, 40% or 50%, one has
to ask, “What does this statistic really mean?” Does every second or
even third woman in her 50’s land in the hospital with a broken hip or other
serious osteoporotic fracture? Of course not. Here are some important details
to keep in mind:
- These statistics relate to any and all fractures. Importantly, they include spinal
fractures, which are by far the most common but generally less debilitating than
other fracture locations, such as breaking a hip or wrist. Spinal fractures often
go undetected and resolve on their own.
- When it comes to hip fractures, the Surgeon General estimates that only 17% of women
over 50 will fracture her hip in her lifetime — a far cry from 50%. Casting
this in a more positive light, 83% of American women over 50 will NOT experience
a hip fracture! In consideration of those who can see the light better from the
shadows, the average age of hip fracture in the US is about 82, whereas the average
life expectancy for a woman in the US is around 80 — I think we can all do
- A small group of individuals with multiple risk factors are the ones who are more
likely to fracture a hip. Risk of a serious osteoporotic fracture can increase dramatically
with a co-existing illness, such as Alzheimer’s or a parathyroid imbalance;
a nutrient deficiency, such as vitamin K or D; or if a patient is taking corticosteroid
drugs like prednisone. But even people with medical complications can improve their
risk profile by addressing some of their risk factors or taking other steps to support
healthy bones. In Japan, for example, researchers dramatically reduced fracture
risk among Alzheimer’s patients simply by exposing them to sunlight for enhanced
vitamin D production.
- Here in the US, information on osteoporosis generally comes from studies done on
white women, so we need to put these study findings in context. Statistically speaking,
rates vary markedly among women of different ethnic groups: white women have the
highest risk, Hispanic women somewhat less than whites, Native Americans slightly
less than Hispanics, black women only half as much as white women, and Asian Americans
about a third as much as white women.
The majority of osteoporotic fractures aren’t the devastating event most people
envision, but they are a cautionary sign to pay greater attention to our
bone health — if we wish to avoid joining the unfortunate minority who do
experience a serious hip, pelvic, multiple spinal, or wrist fracture. Such flags
do warrant concern — but not panic. More importantly, if you are
in one of the high-risk groups, this knowledge can become an opportunity for action
rather than something fearsome. Even when you can’t change some of the factors
that increase your risk, you can take steps to offset them and improve your bone
health — without resorting to drugs (see my article about lifestyle changes
for better bones).
Statistic #2: In women ages 50 to 59, 58% have low bone mass, and this percentage
increases as we age
Whenever I see a measurement described as “low” or “high,”
the first question I ask is, Compared to what standard? If all women had
exactly the same build and body type, then the standard would be obvious —
but that’s clearly not the case. There are thin women and heavy-set women,
tall women and short women, and some women who naturally have denser bones than
When you have your bone mineral density (BMD) tested, your results are reported
in two numbers, the T-score and the Z-score. The T-score is calculated
by comparing your bones to those of the average young woman at peak bone density
— late 20’s to very early 30’s. Women of different body types,
racial backgrounds, exercise habits, and so forth will naturally vary from this
artificial “norm” of bone density, particularly as they age —
bone loss across the lifespan is perfectly normal. The Z-score is different —
it compares you to someone of your own age, gender, weight, and racial origin. But
when I talk with women, many tell me they were told by their busy healthcare providers
(or via form letter) that they had “bone loss” or “low bone mass,”
or “osteopenia,” with no explanation given about the difference between
the two different values or their significance.
Low bone density doesn’t always lead to fracture
In the absence of other risk factors, having low, or even very low bone density
doesn’t tell us a particular woman is going to fracture a bone.
Here are some other factors to take into account when assessing risk of fracture:
- vitamin D status
- evidence of prior fractures
- corticosteroid drug use
- vitamin K status
- muscle strength
- lack of physical activity
- urine pH (acidity vs. alkalinity)
- low mineral intake and an acidifying diet
What’s more, neither score offers much information about whether your bones
are capable of supporting you without breaking. Thin bone can still do the job without
fracturing, as long as it’s strong and healthy — it’s only when
bone is both thin and of poor quality that a person is at increased risk of a low-impact
fracture. Asian-American women illustrate this point: as a group they have significantly
lower bone density than other ethnic groups, yet they fracture less, even less than
African American women.
This is not to say that low bone density is not of concern; it is one of many important
fracture risk factors, but by itself it has marginal predictive value. The good
news is, having bones that are thinner, even considerably thinner, than the standard
is not, in and of itself, good reason to start on drug therapies — no matter
what the bone drug advertisements would have us believe.
Statistic #3: Osteoporosis causes 1.5 million fractures every year in the US
Osteoporosis is commonly said to be a condition of having thin bone, and while thin
bone might be more prone to fracture, as explained above, bone does not
fracture by virtue of being thin alone. It fractures for one of two reasons: 1)
the bone quality is so compromised that the usual activities of day-to-day living
are too much for the bone to withstand; or 2) the bone is strong enough for daily
activity but not strong enough to withstand a fall or other acute force upon the
bone. The second situation is by far more common than the first.
Most people with low bone density who break bones do so because of a fall or some
other minor trauma to the bone. The vast majority of osteoporosis-related fractures
are not life-threatening or even seriously debilitating, much less fatal. Many such
fractures, as I mentioned, are spinal fractures that have gone unnoticed by the
women experiencing them. So while the number of fractures sounds large, as though
it’s very easy to become one in a million and a half, it has been shown that
even in people with very low bone density, the risk of fracture can be greatly reduced
by taking simple steps to prevent falls. Some of these measures include:
- exercise training to restore balance and build muscle strength
- removing or firmly securing area rugs
- improving lighting
- adding grab bars in bathrooms
Studies have shown that such simple measures can greatly reduce falls — and
thereby lower the risk of even minor fractures. Ultimately, if you have osteoporosis,
you’re more likely to be able to avoid fracturing a bone if you make choices
that can help you avoid falling — choices that are actually pretty easy to
What to make of these frightening statistics?
Many of my patients at the Center for Better Bones are relieved when they hear that
they should take these statistics with a big grain of salt. But some of
them also want to know why these frightening statistics are still bandied about,
when they don’t truly reflect most people’s risk. The answer is that
there are people, organizations, and companies that have a vested interest in promoting
osteoporosis as a serious, debilitating disease because spreading fear is an easy
way to get people to pay attention. Sometimes this is done with the best of intentions
— a physician, for instance, may cite these statistics to get the attention
of a patient who really is at risk of osteoporosis in an effort to help this patient
make changes toward better health. Or groups like the National Osteoporosis Foundation
may use the statistic to make the point that osteoporosis is a public health concern
of great significance so that more research and public awareness may be generated.
Unfortunately, all too often the rationale for these statistics isn’t so benign
— osteoporosis drugs are a big business, and it’s a lot easier to market
a drug like Fosamax or Boniva to people who are frightened about their risk of fracture.
It’s in the drug companies’ best interests to make osteoporosis seem
as big and frightening as possible, and statistics like “1 in 2” help
them to do just that.
But whatever the intentions behind the fear-based messaging, what’s missing
is the personal perspective — a way to figure out just where you
stand with respect to these statistics. When you gain perspective on your own bone
health, you learn that you can do a lot to put yourself into the low-risk fracture
category — without taking a prescription drug.
Your bone health is 100% yours!
When someone quotes statistics at you, it can make you think that the problem it
warns you of is inevitable — yet nothing is farther from the truth. At the
Center for Better Bones, our primary goal is to help our clients get a realistic
sense of what their risk factors are, and then help them to reduce their risk. We’ve
been doing that without drugs for over 25 years. We take the position that statistics
aren’t very useful when it comes to the health of an individual person —
everyone is unique, and the risk factors that will (or won’t!) affect their
bone health have to be taken into consideration case by case.
What’s more, worrying or stressing out about how your bones stack up against
the numbers isn’t going to do them any good — quite the opposite! So
here’s a statistic that better represents the state of your bone health right
now: 100% of women age 50 and older have the ability to make decisions about the
food they eat, the exercise they get, and the bone-building nutrients they take.
You have the tools to build stronger bones on your own, and you can start today!
To learn more about the risk factors that you can change, and how to get started,
take our Bone Health Profile. It’s an easy first step, and it’s free.
1 National Institutes of Health. 2007. Fact sheet. Osteoporosis. URL
(PDF): http://www.nih.gov/about/researchresultsforthepublic/Osteoporosis.pdf (accessed
2 Cummings,S., & Melton, L. 2002. Epidemiology and outcomes of osteoporotic
fractures. Lancet, 359 (9319), 1761–1767. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/12049882
3 International Osteoporosis Foundation. [No date of publication listed.]
Facts and statistics about osteoporosis and its impact. URL: http://www.iofbonehealth.org/facts-and-statistics.html
(accessed 10. 12.2009).
Kanis, J., et al. 2000. Long-term risk of osteoporotic fracture in Malmö.
Osteoporos. Int., 11 (8), 669–674. URL (abstract): (accessed 10.13.2009). Melton,
L., et al. 1998. Bone density and fracture risk in men. J. Bone Miner. Res., 13
(12), 1915–1923. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/9844110 (accessed
Melton, L., et al. 1992. Perspective. How many women have osteoporosis?
J. Bone Miner. Res., 7 (9), 1005–1010. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/1414493
4 Roche, R., et al. 2005. Effect of comorbidities and postoperative complications
on mortality after hip fracture in elderly people: prospective observational cohort
study. BMJ, 331 (7529), 1374–1379. URL: http://www.bmj.com/cgi/content/full/331/7529/1374
5 Hoyert, D., et al. 2006. Deaths: Preliminary Data for 2003. CDC. Division
of Vital Statistics. National Vital Statistics Reports, 53 (15). URL (PDF):
http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_15.pdf (accessed 10.13.2009).
6 Tanaka, K., & Kuwabara, A. 2009. [Fat-soluble vitamins for maintaining
bone health.] Clin. Calcium, 19 (9), 1354–1360. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/19721209
Sato, Y., et al. 2005. Menatetrenone and vitamin D2 with calcium supplements
prevent nonvertebral fracture in elderly women with Alzheimer’s disease. Bone, 36
(1), 61–68. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/15664003 (accessed
7 Sato, Y., et al. 2005. Amelioration of osteoporosis and hypovitaminosis
D by sunlight exposure in hospitalized, elderly women with Alzheimer’s disease:
A randomized controlled trial. J. Bone Miner. Res., 29 (8), 1327–1333.
URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/16007329 (accessed 10.13.2009).
8 Barrett–Connor, E., et al. 2005. Osteoporosis and fracture risk in
women of different ethnic groups. J. Bone Miner. Res., 20 (2), 185–194.
URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/15647811 (accessed 10.13.2009).
References on vertebral and spinal fractures
a Gehlbach, S., et al. 2000. Recognition of vertebral fracture in a clinical
setting. Osteoporos. Int., 11 (7), 577-582. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/11069191
Prince, R., et al. 2007. The clinical utility of measured kyphosis
as a predictor of the presence of vertebral deformities. Osteoporos. Int., 18
(5), 621–627. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/17143655 (accessed
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