Don’t Let Your Bones and Muscles Quietly Disappear: What the Experts Now Say
Based on guidelines from the American Academy of Family Physicians (AAFP) and the American Association of Clinical Endocrinology (AACE)
Two Silent Problems That Sneak Up on You
Most people don’t notice their bones getting thinner or their muscles getting weaker — until something goes wrong. A hip fracture from a minor fall. Difficulty getting up from a chair. Losing balance climbing stairs. By that point, years of slow, invisible loss have already taken their toll.
The good news is that both of these problems — osteoporosis (bone loss) and sarcopenia (muscle wasting) — are now well understood, increasingly preventable, and in many cases treatable. What’s especially important is that they’re closely linked: people who lose muscle are more likely to fall, and falling with weak bones is what leads to devastating fractures.
This article breaks down the latest guidance from two leading medical organizations — the American Academy of Family Physicians (AAFP) and the American Association of Clinical Endocrinology (AACE) — on how to detect, prevent, and treat both conditions.
PART ONE: OSTEOPOROSIS
What It Is
Osteoporosis means your bones have become less dense and more fragile — like the difference between solid wood and Swiss cheese. A bone that was once tough enough to withstand a fall becomes brittle enough to break from something as minor as a sneeze, a minor bump, or stepping off a curb.
Osteoporosis currently affects about 10% of adults over 50 in the United States, and that number is projected to rise to nearly 14% by 2030 as the population ages. An estimated 2 to 3 million osteoporotic fractures happen every year in the U.S. Hip fractures are the most serious — and carry a shocking one-year mortality rate of 21 to 24%. Yet despite all of this, only about one in four women over 60 receive osteoporosis treatment even after a fracture.
More than two-thirds of osteoporotic fractures occur in women, and one in two postmenopausal women will experience an osteoporotic fracture at some point in her life.
Who Should Get Screened — and When
Bone density is measured by a painless imaging test called a DEXA scan (dual energy x-ray absorptiometry). Think of it like an x-ray that specifically measures how dense your bones are. The AAFP, AACE, and U.S. Preventive Services Task Force all agree on who should get one:
Women:
- All women 65 and older — regardless of risk factors
- Postmenopausal women younger than 65 who have risk factors (see below)
Men:
- The evidence for routine screening in men is less clear. The AACE and the Bone Health and Osteoporosis Foundation recommend screening men 70 and older, and men between 50 and 69 with significant risk factors. The USPSTF has not found sufficient evidence to recommend routine screening in men.
Anyone at any age who has experienced a fracture from a minor injury, or who takes medications known to weaken bones, should discuss testing with their doctor.
The AAFP recommends not repeating DEXA more often than once every two years in most cases — there’s no benefit to testing more frequently.
What the Test Results Mean
Your DEXA scan produces a number called a T-score. Here’s how to read it:
| T-score | What it means |
| -1.0 or higher | Normal bone density |
| Between -1.0 and -2.5 | Osteopenia (low bone density — early warning) |
| -2.5 or lower | Osteoporosis |
Think of the T-score as how far your bones have “fallen behind” compared to a healthy young adult. A score of -2.5 means your bone density is 2.5 standard deviations below average — which significantly increases fracture risk.
Osteoporosis can also be diagnosed if you’ve had a fragility fracture — a break that happened from something that wouldn’t normally break a bone, like bending over, a minor fall from standing height, or a hug. You don’t need a T-score in the low range to be diagnosed if you’ve had one of these.
Your Risk Factors: What Puts You at Higher Risk
Some risk factors you can’t control, and some you can. Knowing yours helps you and your doctor decide when to start screening and treatment.
Risk factors you can’t change:
- Being a woman (especially postmenopausal)
- Age over 50
- Family history of osteoporosis or fragility fractures
- Early menopause (before age 45)
- Low body weight (under about 127 pounds)
- Being White or Asian (though all races are affected)
Risk factors you can change or manage:
- Smoking
- Excessive alcohol intake
- Low calcium or vitamin D intake
- Sedentary lifestyle (not doing weight-bearing exercise)
- Vitamin D deficiency
Medical conditions that increase risk:
- Rheumatoid arthritis
- Type 1 or type 2 diabetes
- Thyroid disease
- Kidney disease
- Digestive disorders like celiac disease or Crohn’s disease (which reduce nutrient absorption)
- Chronic use of steroid medications (prednisone and similar drugs are a major cause of bone loss)
Medications that thin bones:
- Long-term steroids (prednisone, cortisone)
- Some antidepressants (SSRIs)
- Proton pump inhibitors (like omeprazole/Prilosec)
- Certain seizure medications
- Some hormonal treatments
If you’re on any of these medications long-term, talk to your doctor about bone health monitoring.
What You Can Do Without a Prescription
The AAFP and AACE both emphasize that lifestyle measures form the foundation of osteoporosis prevention and treatment — for everyone, regardless of whether medication is also used.
Calcium Calcium is the main mineral in bone. If you don’t get enough from food, your body borrows it from your skeleton — weakening it over time. The target for most adults:
- Ages 19–50: 1,000 mg/day
- Women 51+: 1,200 mg/day
- Men 51–70: 1,000 mg/day
- Adults 71+: 1,200 mg/day
Food sources are preferred over supplements: dairy products (milk, yogurt, cheese), leafy greens like kale and bok choy, canned salmon and sardines with bones, fortified foods like orange juice and plant milks. Supplements can help fill gaps but should be taken in doses of 500 mg or less at a time for best absorption.
Vitamin D Without enough vitamin D, your body can’t absorb calcium properly — even if you’re eating plenty of it. Most adults need 1,000–2,000 IU of vitamin D daily (some guidelines suggest even more for people who are deficient). Your doctor can check your vitamin D level with a simple blood test. Sunlight, fatty fish, egg yolks, and fortified foods all provide vitamin D, but many people need a supplement.
Weight-bearing exercise Bones respond to stress by getting stronger — it’s the same principle as lifting weights. Any activity where you’re on your feet and working against gravity counts: walking, jogging, dancing, hiking, stair climbing, tennis, even gardening. At least 30 minutes most days is recommended. Swimming and cycling, while great for cardiovascular health, don’t count as weight-bearing and don’t build bone.
Balance and fall prevention Since the goal is to avoid fractures, fall prevention is just as important as bone strengthening. Yoga, tai chi, and balance training have all shown benefits in reducing fall risk. Home safety matters too: remove loose rugs, improve lighting, install grab bars in the bathroom, and keep floors clutter-free.
Quit smoking and limit alcohol Smoking directly damages bone-forming cells and reduces estrogen levels. Alcohol, in excess, impairs calcium absorption and increases fall risk. Both are significant and modifiable contributors to osteoporosis.
When Medication Is Needed
Not everyone with low bone density needs medication. The decision depends on your T-score, fracture history, and overall risk of breaking a bone. The AAFP and AACE both recommend medication for:
- Anyone with a T-score of -2.5 or lower (osteoporosis)
- Anyone who has had a hip or vertebral (spine) fracture
- Anyone with a T-score between -1.0 and -2.5 and a calculated 10-year risk of at least 20% for a major fracture or 3% for a hip fracture
Here’s a plain-language breakdown of the main treatment options:
Bisphosphonates (first-line treatment) These are the most commonly prescribed medications for osteoporosis — they work by slowing the breakdown of bone. Examples include alendronate (Fosamax), risedronate (Actonel), and zoledronate (Reclast, given as an IV infusion once a year). Guidelines recommend using oral bisphosphonates for up to five years, and then reassessing. After that, a “drug holiday” may be considered for lower-risk patients, since some benefit persists after stopping. IV bisphosphonates are typically used for up to three years.
Denosumab (Prolia) An injection given every 6 months that improves bone density faster than bisphosphonates. The catch: if you stop this medication, bone density can drop quickly — so it typically needs to be followed by a bisphosphonate.
Anabolic agents (bone builders) These newer medications actually build new bone rather than just slowing its breakdown — making them especially powerful for people at very high fracture risk or with previous vertebral fractures:
- Teriparatide (Forteo) and abaloparatide (Tymlos): These are synthetic versions of parathyroid hormone, given as daily injections for up to two years. They dramatically improve bone density but must be followed by a bisphosphonate to maintain the gains.
- Romosozumab (Evenity): A newer injectable given monthly for one year that both builds bone and slows breakdown simultaneously. Studies show one year of romosozumab followed by one year of alendronate reduces fracture risk more than two years of alendronate alone.
An important equity note: Despite having a higher mortality rate from hip fractures, Black women are significantly less likely than White women to receive osteoporosis treatment after diagnosis. This gap exists even after accounting for insurance and income differences — and it’s a problem the medical community is actively working to address.