Interview with Dr. Ji-Eon Kim, Director of Healthy Will Hospital
Most peak bone mass is achieved by the mid-30s. After that, bone mass gradually declines, and in women, the rate of bone loss can accelerate significantly around menopause.
When menopause occurs, levels of estrogen, a key female hormone, decrease sharply. Estrogen plays an important role in preventing excessive bone breakdown. As estrogen levels fall, bone loss accelerates, increasing the risk of osteoporosis. Research shows that bone loss is most rapid during the first three to five years after menopause.
Menopause is not the only cause of osteoporosis. Calcium absorption disorders and vitamin D deficiency are also important contributing factors. Individuals who have undergone gastrointestinal surgery or who suffer from chronic inflammatory bowel diseases may have difficulty absorbing calcium, which can increase their risk of osteoporosis.
Vitamin D helps the intestines absorb calcium, reduces calcium loss through the kidneys, and helps prevent bone deterioration. Maintaining adequate vitamin D levels is therefore essential for osteoporosis prevention.
Family history is another significant risk factor. Women whose mothers or sisters have osteoporosis are at greater risk of developing the condition themselves. In addition, lack of physical activity, smoking, and excessive alcohol consumption can impair bone formation and calcium metabolism, further increasing the risk of osteoporosis.
Osteoporosis often develops silently, with few or no symptoms in its early stages. For this reason, it is frequently referred to as a “silent disease.” As the condition progresses, weakening of the spine can result in loss of height or a stooped posture.
The risk of fractures also increases. In severe cases, even minor falls, coughing, or bending movements can cause a fracture. Among women aged 50 to 70, wrist fractures are often the first sign of osteoporosis. After age 70, fractures of the spine and hip become more common.
Bone density testing is recommended around the time of menopause. In general, screening begins around age 50 and is repeated every two to three years thereafter. Individuals with risk factors such as family history, smoking, low body weight, or excessive alcohol consumption may benefit from earlier testing.
A hysterectomy does not necessarily increase the risk of osteoporosis. The ovaries, rather than the uterus, are responsible for producing female hormones. Therefore, women who have undergone hysterectomy but retained their ovaries typically experience little change in hormone levels and bone density. However, if the ovaries are removed along with the uterus, the resulting decline in estrogen can increase osteoporosis risk.
Osteoporosis treatment is not always lifelong. Commonly prescribed bisphosphonate medications are usually taken orally for about five years, while intravenous zoledronic acid therapy is often administered for approximately three years before reassessment. If bone density stabilizes and fracture risk decreases, a temporary drug holiday may be considered.
During a drug holiday, regular bone density monitoring remains important. Treatment can be resumed if bone density declines again or if a new fracture occurs.
Weight-bearing exercise is among the most effective ways to prevent osteoporosis. Activities such as brisk walking, jogging, and stair climbing place healthy stress on the bones, helping maintain bone density.
Exercise should ideally be performed at least three times per week for 30 minutes or more per session. Stationary cycling can also help strengthen the thigh muscles. A moderate intensity level, enough to cause light sweating and slight shortness of breath, is generally recommended.
On the other hand, exercises that involve excessive spinal extension, deep forward bending, high-impact jumping, or twisting motions such as golf swings should be approached with caution, particularly for individuals with osteoporosis.
Lifestyle management is equally important. Smoking cessation and limiting alcohol consumption are essential. Regular aerobic exercise and strength training can help preserve bone mass and overall health.
Dietary habits also play a critical role. Adequate calcium intake is necessary for maintaining strong bones. Excess sodium consumption increases calcium loss through urine, making a low-sodium diet beneficial. Excessive caffeine intake can also increase calcium excretion and should therefore be moderated.
Women who are underweight have a higher risk of osteoporosis than those with a healthy body weight, making weight management another important preventive measure.
Osteoporosis is often called the “silent thief of bones” because it can progress unnoticed until a fracture occurs. Individuals with risk factors should undergo regular bone density screening to ensure early detection.
The foundation of osteoporosis prevention and treatment is adequate calcium intake combined with regular physical activity. Monitoring vitamin D levels and taking supplements when necessary can also be beneficial. Most importantly, osteoporosis should be diagnosed and managed early, before fractures occur.
This has been an interview with Dr. Ji-Eon Kim, Director of Healthy Will Hospital.
