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All too often the first symptom of osteoporosis is a painful, debilitating, preventable fracture. Don't treat osteoporosis. Prevent it! Here are 10 early warning signs of brittle bones.

Osteoporosis is a silent disease until it is announced by broken bones. These fractures happen much more easily than might be expected. Often someone with osteoporosis won’t even remember the event that caused the bone to break. Osteoporosis is painless and symptom-less until it is too late for prevention.

Brittle bones can occur even in children, teenagers, and young adults. Some young people are at elevated risk of osteoporosis. Anyone who is extremely athletic but diets to meet weight requirements of a sport is at risk for bone demineralization. The bodies of young women who exercise so much that they miss their periods don’t produce enough estrogen to stimulate bone formation. Treatment with steroids such as prednisone can predispose a young person to the disease, as can celiac disease, Crohn’s disease, inflammatory bowel disease, thyroid problems, and eating disorders, as can frequent use of inhalers to treat asthma.

Osteoporosis sometimes strikes women in their thirties and forties. Any woman who has a hysterectomy or oophorectomy (surgical removal of the ovaries) can have an estrogen deficiency that leads to osteoporosis. Dozens of prescription medications taken by men and women in midlife can lead to bone demineralization.

Any woman over 50 and any man over 65 needs periodic medical examinations for the disease. Early intervention can prevent permanent disability. But even if you don’t fit into these groups of high-risk people, there are 10 early warning signs of osteoporosis you just can’t afford to ignore.

1. A history of broken bones

Once you have had one fracture, you are at risk for more — especially if the bone break occurred after minor stress on the bone.

Not all locations in the body are equally indicative of brittle bones. Fractures of the fingers, toes, face, and skull are often caused by trauma. They are not especially likely to be due to osteoporosis. Fractures of the wrist, hip, and spine are much more likely to be due to osteoporosis. A fracture of a vertebra indicates a 2- to 3-times greater risk of having another fracture of a vertebra, and 5-times greater risk of fracture in some other part of the body. Fracture of a vertebra at any age, even if does not cause pain or disability, and any fracture of any bone after the age of 50 should be followed up with tests for osteoporosis.

2. Back pain

Osteoporosis often strikes the bones of the lumbar (lower) spine. Lower back pain most often is caused by a muscle injury, but sometimes the problem really is a fractured vertebra (or more than one vertebra). Usually this kind of back pain can’t be traced to a single event, or maybe it occurs after an event that wouldn’t ordinarily be expected to cause a fracture, such as a sneeze, a hiccup, or getting out of a chair. This kind of back pain is usually worse when you move and relieved by rest. A minor fracture may heal in a few weeks, but some fractures of the spine result in permanent disability.

3. Loss of height

Another sign of osteoporosis is shrinking over time. People who have osteoporosis may be one inch, two inches (2 to 5 cm) shorter or even more by age 50. Slouching also causes reduction in height, but osteoporosis thins the vertebrae of the spine and causes tiny fractures that cause the spine to collapse. If you learn you are getting shorter, you should see a doctor about the possibility of osteoporosis.

4. Brittle nails

Anyone who washes dishes several times a day, or who does manual labor without gloves, or whose hands are exposed to chemicals may develop brittle nails. But if your fingernails and toenails start breaking without explanation, you should see a physician to find out whether you need a DEXA scan for bone demineralization.

5. Decreased grip strength

A good grip is essential for avoiding falls. In one study of postmenopausal women, loss of grip strength was the single best predictor of osteoporosis. Pay attention to this early warning signal of bone demineralization.

6. Receding gums

An often-overlooked early warning signal for osteoporosis is receding gums. The gums recede when the jaw bone loses bone mass. Dental x-rays are one more tool for diagnosing osteoporosis. Your dentist will refer you to a doctor for osteoporosis assessment when receding gums are found.

7. Muscle pain

Muscle pain is often a symptom of vitamin D and/or magnesium deficiency. Not getting enough of these nutrients is detrimental to creation of new bone. If you have muscle pain, be on the lookout for bone pain that can be caused by these nutritional deficiencies.

8. Bone pain

Anytime you experience bone pain, you may have had a fracture.

9. Muscle cramps

Muscle cramps are another sign of magnesium deficiency. When your body does not get enough magnesium, it can’t use vitamin D or release parathyroid hormone that powers your bones to receive calcium. Eat your greens and take magnesium supplements when you have muscle cramps.

10. Generally being out of shape

Strong muscles are necessary to maintain balance to avoid falls, and resistance exercise stimulates bone growth. Maintaining muscle strength throughout life indirectly prevents brittle bones.

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