Silent bone mass loss begins earlier than you think
Bones are one of the most underestimated parts of the human body. Unless our back hurts or we break a wrist in a fall, few of us pay much attention to our skeletal system. And yet, deep within it, a slow, entirely painless process may be taking place — one that doctors call silent bone loss. This phenomenon has no obvious symptoms, sends out no warning signals — and that is precisely what makes it so insidious.
Osteoporosis, or bone thinning, affects more than 200 million people worldwide according to the World Health Organization. In the Czech Republic, approximately one in three women after menopause and one in five men over the age of sixty suffer from this disease. Yet bone density is discussed surprisingly little — particularly in the context of prevention, which could save thousands of people not only their health, but in extreme cases their lives as well.
Try our natural products
What is actually happening inside bones
Bones are not static, unchanging tissue. On the contrary — they are living structures that are constantly being remodelled. Specialised cells called osteoclasts break down old bone tissue, while osteoblasts form new tissue. In youth, this process occurs in balance and bones are strong, dense and resilient. Peak bone mass — the moment when bones are at their strongest — occurs at approximately 25 to 30 years of age. After the age of thirty, this process slowly but surely begins to tip the scales in the other direction: breakdown begins to slightly outpace formation.
This natural loss is very slow in a healthy person and causes no problems for most of one's life. Problems arise when additional factors join the natural ageing process — an unsuitable diet, lack of exercise, hormonal changes or chronic illness. In such cases, bone loss can progress significantly faster, without the person feeling anything at all.
This is precisely why osteoporosis is nicknamed "the silent disease" in medical circles. A person only becomes aware of it at the moment a fracture occurs — most commonly of a vertebra, hip or wrist. And at that point, it becomes clear that the problem had existed long before it manifested itself.
When to start thinking about bone density — sooner than you think
The answer to the question of when to start thinking about bone density will surprise many people: ideally while bones are still healthy. Prevention does not begin at the age of sixty — it begins much earlier. Experts from the National Osteoporosis Foundation have long been warning that habits built in youth and middle age have a direct impact on the condition of bones in old age.
Take as an example a thirty-year-old woman who works in an office, spends most of her day sitting, eats irregularly and does not particularly favour dairy products. At first glance healthy, energetic, without any complaints. And yet she may be among those in whom silent bone loss is progressing faster than is healthy. Insufficient calcium in the diet, minimal vitamin D and almost no weight-bearing physical activity — these are the classic ingredients for later bone problems.
The key age at which it makes sense to start actively monitoring bone health is around forty. That is when natural bone loss gains in intensity, and that is precisely when it makes sense to consider a preventive bone density examination — known as densitometry. This simple and painless examination using low-dose X-ray radiation can measure the mineral density of bone tissue and detect any weakening before the first fracture occurs.
For women, the pivotal moment is menopause. The drop in oestrogen levels during this period dramatically accelerates bone loss — in the first five to ten years after menopause, a woman can lose 20 to 30 percent of her bone density. This is not a figure that can be overlooked. This is precisely why gynaecologists and internists recommend that every woman after menopause undergo a densitometric examination — and if she has risk factors, even earlier.
Risk factors are varied. They include a family history of osteoporosis, low body weight, smoking, excessive alcohol consumption, long-term use of corticosteroids, as well as certain chronic conditions such as rheumatoid arthritis, coeliac disease or eating disorders. Men do suffer from osteoporosis less than women, but they are certainly not immune — and their cases tend to be diagnosed late precisely because male osteoporosis receives less attention.
As leading American endocrinologist Dr. Robert Heaney aptly noted: "Osteoporosis is not an inevitable part of ageing. It is a disease that can largely be avoided — if we start paying attention to it in time."
What genuinely helps bones
Caring for bone density does not rest on a single pillar, but on three interconnected areas: nutrition, exercise and lifestyle. And the good news is that all three are largely within each person's own hands.
Calcium is the fundamental building block of bones. An adult should consume approximately 1,000 mg of calcium per day, while women after menopause and older adults need up to 1,200 mg. The best sources remain dairy products — yoghurts, cheeses, cottage cheese — but calcium is also found in leafy vegetables such as kale or broccoli, almonds, sardines and fortified plant-based drinks. Calcium alone is not enough, however: without sufficient vitamin D, the body cannot absorb it effectively. Vitamin D is produced in the skin through sunlight exposure, but at our latitudes, a deficiency during winter months is almost the norm. Vitamin D supplementation is therefore sensible for a large proportion of the population — and not only for the elderly.
Exercise is just as important for bones as nutrition. In particular, so-called weight-bearing activities — walking, running, strength training, dancing or hiking — stimulate the formation of new bone tissue. Bones respond to mechanical load by becoming stronger, much as muscles respond to training. Conversely, prolonged immobility or a sedentary lifestyle leads to their weakening. Swimming and cycling are excellent for the cardiovascular system, but offer less benefit for bone density than activities in which the body bears its own weight.
Lifestyle also plays a significant role. Smoking damages bone cells and reduces calcium absorption. Excessive alcohol consumption disrupts bone tissue metabolism. Too much caffeine or sodium in the diet can increase calcium excretion through the kidneys. And chronic stress, which raises cortisol levels, has a demonstrably negative effect on bone density — as evidenced by research published in the journal Bone.
In recent years, interest has been growing in natural dietary supplements that can support bone health. Alongside calcium and vitamin D, vitamin K2 is discussed for its role in directing calcium into bones and teeth rather than blood vessels. Magnesium supports the conversion of vitamin D into its active form and contributes to the function of osteoblasts. Zinc, boron and silicon are trace elements whose roles in bone metabolism are the subject of intensive research. These substances can be obtained through a varied, balanced diet rich in wholegrains, nuts, seeds and vegetables — or in the form of quality dietary supplements when diet alone is insufficient.
A separate chapter is the gut microbiome, whose influence on the absorption of nutrients — including calcium — is increasingly well documented. A healthy microbiome supports the efficient utilisation of minerals from food, and therefore fermented foods such as kefir, kimchi or kombucha may have a positive indirect effect on bone health.
It is also important to mention that there are medications that demonstrably reduce bone density. In addition to the already mentioned corticosteroids, these include certain antiepileptic drugs, proton pump inhibitor medications for stomach acid when used long-term, and drugs used in oncology. Anyone taking these medications long-term should actively discuss this with their doctor and consider regular monitoring of bone health.
Bone health is a topic that concerns everyone — regardless of age or sex. The sooner a person realises that bones are not an unchanging fortress but living tissue requiring daily care, the greater their chance of preserving their strength into old age. Silent bone loss need not be an inevitable fate — it is a challenge to which one can respond. And the best time to start is always now.
