Everybody needs to be concerned about preventing osteoporosis—a medical condition in which bones weaken and become easier to break. About 10 million Americans suffer from it, while another 44 million have low bone density, which is a precursor to the disease.
One in two women, and up to one in four men, will break a bone as a consequence of osteoporosis. And while it mostly affects women over 50—almost 20% of those living in the U.S., according to the Centers for Disease Control and Prevention—everyone loses bone density as they age. (As we said, every body should be concerned with bone health.)
Even more concerning, many people don’t realize they have osteoporosis until they’ve already broken a bone. “This condition is painless and can only be detected by screening bone density to measure the weight of the bone, or when we develop a fracture, which is the ultimate complication of osteoporosis,” says Ejigayehu Abate, M.D., an endocrinologist who treats osteoporosis and other conditions at the Mayo Clinic in Jacksonville, Florida. “There are no symptoms to alert us; therefore, it is important to understand how to best protect your bones and when you should be screened.”
White and Asian women with a thin build are at highest risk of osteoporosis, says Elise Brett, M.D., an endocrinologist and associate clinical professor in the division of endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mount Sinai, in New York City. Other risk factors include low calcium intake, nulliparity (the medical term for never having given birth to a child), rheumatoid arthritis, past or current treatment with corticosteroids (especially if it involves more than five milligrams of prednisone for over three months), family history of osteoporosis (especially hip fractures), smoking, excess alcohol intake and early menopause. Certain medical conditions are also known to cause osteoporosis, including, says Dr. Brett, “chronic malnutrition, type 1 diabetes, hyperthyroidism, hyperparathyroidism and osteogenesis imperfecta, which is a genetic bone disorder—just to name a few.”
Dr. Abate adds a sedentary lifestyle and organ transplantation to the list, and notes that weight-loss surgery and certain prescription medications, such as proton pump inhibitors and acid-reflux medications, can block the absorption of calcium and vitamin D, which also increases risk.
Your Bones Over a Lifetime
“Bone is an active organ throughout life,” Dr. Abate points out. Specific cells called osteoclasts break down old and weak bone tissue, and signal other cells, called osteoblasts, to lay down new bone where the old bone has been eliminated. “The balance between osteoclast and osteoblast activity changes with age and is affected by our lifestyle and genetics,” she notes.
From puberty up until about age 30, we build more bone than we break down, a process kicked off by estrogen in girls and testosterone in boys. This growth depends a great deal on lifestyle and activity level. Or as Elyse Sosin, RD, a dietitian who works with Dr. Brett, puts it, “you need to be thinking about preventing osteoporosis early on, because by the time you get to your 30s, the peak time for laying down bone density has finished.”
From the age of about 30 until menopause for women, and about age 50 for men, “there is a balance between the amount of bone we break down to get rid of old bone and the amount of bone being replaced,” says Dr. Abate. However, that equilibrium can be thrown off by lifestyle factors, such as smoking, drinking too much alcohol, and not getting enough exercise or calcium.
Around age 50, because of the reduction of estrogen in women and, to a lesser extent, testosterone in men, bone breakdown overtakes bone building. This is a natural part of the aging process, so you can’t reverse it. But through savvy nutrition and lifestyle choices, “we can certainly slow down and reduce our chances of breaking bones,” says Dr. Abate.
So if you’re at risk of osteoporosis, see your doctor and ask for a bone scan. (Note: This may not be covered by insurance if you’re premenopausal or under the insurance company’s age cutoff, so you might have to pay out of pocket.) If you’re found to have osteoporosis or osteopenia — low bone density that has not developed into full-fledged osteoporosis — your doctor may refer you to a specialist, who may prescribe medication that can range from estrogen replacement to specific osteoporosis medication to prevent further bone loss.
And whatever your situation or age, there are lifestyle choices that can prevent bone loss and reduce your present or future risk of osteoporosis, detailed below.
Consume Calcium
This is “the major mineral in bone,” says Sosin. And since our body can’t produce it, it’s imperative that we get calcium from food, or failing that, from supplements. The recommended amount to consume is 1,000 milligrams a day prior to menopause or age 50, and 1,200 a day after. This should come, says Dr. Abate, “preferably from food rich in calcium, such as dairy or dairy alternatives like almond milk, yogurt, soy, green vegetables.”
That being said, it can be challenging to reach your calcium quota through diet alone, especially if you’re lactose intolerant or vegan. That’s where supplements come in. A cup of cow’s milk, says Sosin, usually contains about 250 to 300 milligrams of calcium — so a single serving of dairy isn’t going to fulfill your requirements. (If you or your family members drink almond, soy, or oat milk instead, Sosin recommends checking the label to make sure it’s calcium-fortified.)
Another tip from Sosin: Most people can’t absorb more than 500 to 600 milligrams of calcium at a time, so if you’re taking 1,200 milligrams a day via supplements, do so in two pills of 600 milligrams each, taken at different times. And always check with your doctor before starting any kind of supplement, since they can interfere with certain medications.
Get Enough Vitamin D
“If your vitamin D is low, then you can not absorb the calcium from the gut,” says Dr. Abate. “For a healthy person, keeping the vitamin D level greater than 30 but not exceeding 50 nanograms per milliliter (ng/mL) in the blood” is the goal. But while wild fish contains vitamin D, and sunlight absorbed by the body creates it, which still makes it difficult to get enough. Dr. Brett notes that her patients with osteoporosis often take supplements of 1,000 to 4,000 IU daily. Again, speak with your doctor, and if supplements are recommended, have a blood test to check your levels before starting on them.
Eat Protein
While the links between protein and bone health are still being explored, “protein intake is important throughout life,” says Dr. Abate. “And the amount of protein a person needs is variable, so it's best to consult with your doctor to ensure that you get the right amount and type of protein.” Sosin says that many of her patients get enough protein from their food; if you do use protein powders, check the label to make sure yours doesn’t contain anything you can’t identify or may not want, such as herbs or artificial sweeteners. If you’re a vegetarian who does not consume animal protein, look to eggs; low-fat, high protein dairy sources like cottage cheese, ricotta, and yogurt; beans, lentils and legumes; or soybean proteins like tempeh and tofu. Also, if you’re doing a lot of weight training, you may want to increase your protein intake to help repair any muscle being broken down.
Exercise Wisely
Speaking of working out, physical activity is also key in preventing osteoporosis and promoting bone health. “Regular weight-bearing exercise helps slow bone loss,” says Dr. Brett. Think walking, jogging, dancing, tennis, and the like for about 30 to 40 minutes per session, and at least 150 minutes per week. “Resistance training [such as weight lifting] may also help slow bone loss and decrease fracture risk through improving balance and decreasing the risk of falls,” Dr. Brett adds. And Sosin points out that even walking is considered weight-bearing exercise, because you’re carrying your body weight. (Whereas swimming, say, is not, because there the water does the work of bearing your weight.)
Maintain a Healthy Weight
Building muscle mass and exercising regularly can help you maintain a healthy body weight. “Women who are underweight and premenopausal often have low estrogen, which can contribute to osteoporosis risk later in life,” says Dr. Brett. She points out that for women, a body mass index of less than 20 or weighing less than 127 pounds is considered a risk factor for the disease.
Quit Smoking
“Any amount of consumption of tobacco is toxic to all cells, including bone cells, and is associated with early osteoporosis and fracture,” says Dr. Abate. So for bone health, it’s wise to never start smoking, or stop if you have started.
Be a Teetotaler
Alcohol impacts bone cells, and consuming it can directly result in bone loss. Therefore, if you feel that you can’t abstain from drinking, both Drs. Abate and Brett suggest keeping alcohol intake low. Dr. Abate states that “no more than three drinks per week is the safe amount.”
Avoid Salt
One final no-no: Dr. Brett advises patients to “avoid processed foods and excess dietary salt, which pulls calcium from the bones and leads to bone loss.”
In sum: While our genetic makeup is beyond our control, simple lifestyle changes like these can help us prevent bone loss, whatever our bone density.