What Is Bone Demineralization and What Causes It

8.26.2025 0 comments

Author: Trisha Houghton, CNS, ASIST

As we age, natural repair processes can become less efficient, which raises the risk for conditions such as heart disease, osteoporosis, and certain cancers.

One problem that affects a surprising number of people—as much as 1 in 3 women and 1 in 5 men older than 50—is osteoporosis. This is a condition caused by significant bone mineral loss. Aging bones can become brittle, weak, and easily broken because of this very serious, very common issue.

In this post, we’ll take a closer look at bone demineralization, including what it is, how it affects the body, and what causes it. We’ll also dive into the symptoms to watch out for and examine some basic prevention strategies to help you maintain good bone health as you age.

What is Bone Demineralization?

Bone demineralization, also called osseous demineralization, refers to loss of bone minerals seen on imaging. I can be a feature of conditions like osteoporosis, where bones lose density and become fragile.

The human body has its own intrinsic repair and restoration mechanisms, which plays a role in bone formation and keeps your muscles and other tissues healthy. Those mechanisms sometimes need to extract minerals from your bones to make repairs elsewhere.

You see, your bones contain roughly 85% of your body’s phosphorus stores, and a whopping 99% of your body’s calcium stores. When no dietary phosphorus or calcium is available, your body extracts it from your bones in order to restore or repair any other damaged tissues. Or it may use it for other crucial purposes, such as releasing hormones, moving muscles, relaying messages via your nerves, blood circulation, etc.

Over time, that removal of minerals can cause the bones to weaken, especially if your body isn’t able to replace what was taken. As you’ll see in a section below, there are a number of things that can reduce your body’s ability to replace minerals, all of which can contribute to higher risk of bone demineralization.

How Bone Demineralization Affects the Body

Bone demineralization affects the body by reducing bone density. Loss of bone mass can make your bones weak, brittle, and easily broken.

While bone demineralization is not typically painful, conditions linked to it (such as osteomalacia from vitamin D deficiency) can cause bone pain.

Is Bone Demineralization The Same as Osteoporosis

Osteoporosis is a medical condition in which the bones are weak and prone to fractures. That weakening of the bones is caused by long-term mineral loss, aka bone demineralization.

Bone demineralization can be an early sign of conditions like osteopenia or osteoporosis, but it doesn’t always progress to osteoporosis. It can sometimes be the first step down a path that can lead toward osteoporosis.

7 Common Causes of Bone Demineralization

Below you can find details about the most common bone demineralization causes.

Aging: Natural Bone Density Loss

As your body ages, your internal repair mechanisms grow less efficient. Injuries and damage take longer to repair, and the mechanisms that replenish minerals, amino acids, and other nutrients to your muscles, bones, and other tissues do so more slowly.

Aging is the most common cause of low bone mineral density. It’s fairly common over the age of 50, but once someone hits their mid-sixties (particularly women), doctors recommend getting bone density tests to measure bone mineral content to identify low bone mass.

Hormonal Changes: Impact of Estrogen and Testosterone

Hormones are crucial for healthy bones.

In men, testosterone stimulates bone formation and reduces mineral resorption (breakdown). However, when testosterone levels decline (a common effect of aging), the result can be less effective restoration of bones and accelerated demineralization.

In women, estrogen is the hormone that predominantly maintains bone density. Menopause and other hormonal changes can lead to estrogen deficiency, which in turn accelerates bone breakdown and leads to greater weakness.

Other hormones like calcitonin and parathyroid hormone directly affect bone density, while others such as prolactin can influence bone health indirectly through their effect on sex hormones. Significant fluctuations in the levels of these hormones may also contribute to bone demineralization and bone fragility.

Women tend to be at significantly higher risk for bone demineralization and osteoporosis than men—at a ratio of 1 in 3, rather than 1 in 5.

Nutritional Deficiencies: Calcium and Vitamin D

Your body needs calcium, along with vitamin D to absorb it, plus other nutrients like phosphorus and magnesium.

Calcium is the mineral that primarily makes up your bone tissue, but it can not be absorbed efficiently into your body without sufficient Vitamin D.

The problem with Vitamin D is that it’s not easily available through dietary sources. Sunlight exposure is the main, natural source of Vitamin D, though diet and supplements are also important, especially in people with limited sun exposure.

Spending time in the sun triggers your body to produce Vitamin D, which in turn helps your level of Vitamin D absorb calcium. However, many need supplementation with sunlight, especially during those cooler months.

In countries with little or no sunlight, or among people who spend most of their time indoors with little sunlight exposure, low Vitamin D levels can lead to low calcium levels. This, in turn, can lead to high risk of bone demineralization and greater probability of osteoporosis.

Sedentary Lifestyle: The Role of Physical Activity

A sedentary lifestyle greatly increases risks for poor health-not just bone health, but joint muscle, metabolic, and overall health.

The human body is an adaptable machine. It builds or stores what it most needs, whether that’s fat (to protect against famine), muscle (to lift heavy objects), bone (to increase resilience), blood sugar (for energy), and so on.

If you’re living an active life, that activity “teaches” your body that it needs to prioritize the parts most commonly utilized and damaged—for example, the muscles, joints, and bones you damage during heavy workouts or high-intensity exercise.

In fact, high-impact exercise causes microscopic damage to your bones, which triggers your body’s internal repair mechanisms. Your body not only restores your bones back to their original condition, but makes them stronger and more resilient to ensure they’re not damaged in the future. That’s why high-impact exercise is crucial for healthy bones.

But a sedentary lifestyle teaches your body that those parts aren’t as important. That means when repairs need to be made, your body can draw nutrients away from your bones, muscles, and other joints, and there’s no real hurry to replace them because they won’t be utilized anytime soon.

Over time, this can lead to significant weakening of your bones, stiffness in your joints, atrophy and weakness in your muscles, reduced energy expenditure (slow metabolism), and many, many other issues.

A sedentary lifestyle all but guarantees poor health—not just bone health, but joint health, muscle health, metabolic health, weight gain, higher disease risk, and the list goes on.

Chronic Diseases: Conditions That Affect Bone Health

There are a number of chronic diseases and medical conditions that can affect your bone health, including:

• Osteomalacia involves bone softening in adults, usually from vitamin D deficiency; in children, a similar condition is called rickets.
• Hyperparathyroidism is an excessive production of parathyroid hormones, which can lead to weakened bones and increased bone resorption over time.
• Rheumatoid arthritis and lupus are among the autoimmune disorders that can damage your bones and joints, causing bone density loss over the long-term.
• Gastrointestinal disorders that inhibit your body’s ability to absorb sufficient calcium, phosphorus, and other minerals needed by your bones can lead to bone weakening.
• Anorexia nervosa can deprive your body of calcium and other minerals needed for healthy bones.
• HIV or AIDS can directly affect the bones, can trigger hormonal changes that cause bone loss, or the medications used to treat the infections can impact your bone health.
• Certain cancers, including bone and bone marrow cancer, like multiple myeloma, can damage bone tissue and lead to weakening.

Any one of these chronic diseases or medical conditions may be a risk factor for bone density loss. If you suffer from any of them, it’s worth getting tested to measure your bone mass and determine if you need to take active measures to restore full bone health.

Medications: Side Effects That Lead to Demineralization

A number of medications can have negative impact on your bone health and cause demineralization over time:

• Proton pump inhibitors used to treat acid reflux and GERD reduce the amount of acid present in the stomach, which can decrease the amount of calcium absorbed from the food you eat. Over time, use of these drugs has been associated with higher risk of fractures, osteoporosis, and weakened bones.
• Selective serotonin reuptake inhibitors (SSRIs) may influence osteoblast and osteoclast activity, which can impact bone resorption and formation. Long-term SSRI use has been linked to bone demineralization and fracture risk.
• Glucocorticoid steroids can reduce the activity of bone-forming cells, but also increase the activity of your body’s cells responsible for breaking down bone mass for minerals. This accelerated deterioration and reduced reformation can lead to significant bone density loss over time.
• Certain cancer medications, including those used to treat breast and prostate cancer as well as chemotherapy drugs, can lower hormone levels and prevent the body from repairing bone damage.
• Antiepileptic medications may reduce your body’s ability to not only absorb calcium, but also Vitamin D. As you saw above, both micronutrients are needed for healthy bones, which is why this medication can elevate your risk of bone density loss.
• Some Diuretics such as loop diuretics, can increase calcium loss in urine and may weaken bones, while others, like thiazides, may actually help protect bone.

While all of these medications are intended to help address medical issues, it’s important to be aware that they have these potential side effects. That way, you can take extra precautions to protect your bone health while using these medications.

Lifestyle Factors: Smoking and Alcohol Consumption

Smoking can disrupt your body’s bone repair and restoration mechanism, slowing down recovery following injuries or intense exercise and leading to reduced bone density. It can also lower levels of the crucial hormones needed to maintain healthy bone repair rates and even decrease the amount of calcium absorbed via your diet.

But did you know that smoking can directly affect your bone cells? That’s right: your osteoblasts and osteoclasts will be negatively impacted, which will have both immediate and long-term consequences for your bone health.

The more you smoke, the greater your risk that your bones will degenerate and the more widespread the damage is likely to be.

Drinking in excess can also have serious repercussions on your bone health. Onestudy examining data on alcohol’s effects on bone done way back in 1998 explained its findings: “Alcohol consumption can disrupt the ongoing balance between the erosion and the remodeling of bone tissue, contributing to alcoholic bone disease. This imbalance results in part from alcohol-induced inhibition of osteoblasts, specialized cells that deposit new bone.”

Alcohol can impair the production of bone-regulating hormones, prevent the body from absorbing calcium and Vitamin D, slow bone remodeling, and inhibit the action of bone-forming cells.

Anything more than 3 drinks per day (regular heavy drinking), over the long-term, is linked with weaker bones and higher risk of osteoporosis.

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Recognizing Symptoms of Bone Demineralization

The problem with bone loss is that usually it comes with no symptoms until a fracture occurs.

Bone demineralization typically only manifests itself when it’s grown very serious, to the point of osteoporosis, or you experience an injury and your body is slow to repair itself.

When to Consult a Healthcare Provider

The fact that bone demineralization is asymptomatic in its early stages makes it all the more imperative that you’re proactive against it.

Ideally, you’d want to consult your healthcare provider if you are:

• A man or woman over the age of 65—as this is when bone loss becomes most prevalent.
• A post-menopausal woman between the ages of 50 and 64, who has suffered previous fragility fractures, or who smokes, drinks a lot, has rheumatoid arthritis, experiences low body weight, has lost more than 10% of your body weight after the age of 25, or uses any of the medications listed above that may contribute to bone demineralization.
• A man under the age of 50 with rheumatoid arthritis, Cushing’s disease, uncontrolled hyperthyroidism, primary hyperparathyroidism, hypogonadism, chronic inflammatory conditions, or uses medications that may elevate bone fracture risk.

Typically, you will be able to get a good sense of your bone mass using a dual energy x-ray absorptiometry test, or DXA test.

Bone samples (also called “bone biopsies”) are only taken when the possibility of bone cancer is being evaluated or doctors are attempting to diagnose degenerative bone diseases.

Prevention Strategies to Maintain Bone Health

Some of the factors that contribute to bone demineralization are beyond your control—for example, the existence of an autoimmune disease or the natural hormonal changes caused by aging. However, there are many factors you can control that will either elevate or decrease your risk of bone density loss.

Here are five simple preventative measures you can take today that will maximize your bone health for years to come:

• Feed your bones. Your bones need plenty of calcium, vitamin D, and other nutrients to remain strong, so it’s imperative that you include plenty of foods rich in these (and other minerals) in your diet. Leafy greens, prunes, nuts, seeds, whole grains, and tofu are all excellent plant-based sources of these crucial micronutrients.
• Get adequate Vitamin D. Spend 30 minutes a day (time varies by skin, location, age, etc) outside and in direct sunlight when possible. If you can’t get outside (in winter, for example) or you live somewhere with very little sunlight, make sure to eat foods fortified with Vitamin D or take vitamin D supplements.
• Avoid smoking and reduce alcohol use. These two habits are major risk factors for bone loss and fractures. If you’re a smoker, reduce and work towards quitting. It will give your body a chance to restore the damage years of smoking has already caused. Limit your alcohol intake to no more than 1-2 drinks per day (less is better!) to maintain good bone health.
• Exercise. Weight-bearing exercise (such as bodyweight training and weightlifting) and high-impact exercise as is safe (such as running, sports, plyo training, and HIIT) will increase your bones’ resilience and make your body’s restoration mechanisms more efficient. You’ll also build greater muscle that supports and protects your bones.
• Maintain a healthy weight. Excess body weight can place a strain on your bones and increase your risk of injury. Being underweight can also have a negative impact, as your body will take from your bones crucial minerals needed to maintain other internal functions.

The combination of these small steps implemented starting now can significantly lower your risk of bone loss and help protect your bones as you age.

Taking steps like eating well, exercising, and getting enough Vitamin D are essential for protecting your bones and slowing age-related decline—but sometimes, the body’s repair systems need extra support. Because aging affects not just bones but also metabolism, joints, and even cellular repair, finding ways to keep those internal processes strong can make a real difference for long-term health.

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Frequently Asked Questions

Does bone demineralization cause pain?

No, bone demineralization does not cause pain. Bone demineralization is asymptomatic, and will only become noticeable once it progresses to the point that the resulting weakness leads to injuries or more serious conditions (like osteoporosis).

Is demineralization reversible?

Bone demineralization can be slowed or partially reversed, especially in early stages, depending on the cause. While it may be difficult to reverse if it’s caused by more serious factors—for example, autoimmune conditions, long-term smoking, or use of medications—it is possible to remineralize and rebuild bone density.

What is the fastest way to increase bone density?

To support bone density, focus on adequate calcium and vitamin D, along with regular weight-bearing and resistance exercise. In some cases, supplements may be recommended by your healthcare provider. Please ask your primary care physician if you have concerns.

Sources

Is bone demineralization the same as osteoporosis?

Bone demineralization, a factor of increasing significance in the management of primary hyperparathyroidism

Bone Demineralization

Bone Demineralization, Pathologic

Comparison of different protocols for demineralization of cortical bone

Bone Demineralization and Vertebral Fractures in Endogenous Cortisol Excess

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