Features June 2018 Issue

Safeguard Your Bone Health

Protect your bones throughout life with simple lifestyle measures.

Millions of Americans, both women and men, have low bone density, putting them at risk for bone fractures. According to the National Osteoporosis Foundation (NOF), about one-half of women and one-quarter of men over age 50 have a fracture during their lifetime.

For several years, it appeared that progress was being made in reducing the number of fractures. Rates of hip fractures among women age 65 and older declined between 2002 and 2012, according to a study published in Osteoporosis International (December 2017). However, beginning in 2014, those rates started going up again.

Bone Health

Drinking milk

© AtnoYdur| Getty Images

One cup of milk has 300 mg of calcium, which is one-third to one-fourth the daily requirement.

Just like you might take steps to reduce your risk for heart disease or cancer, you should also do what you can to keep your bones strong and healthy. “The most important time to do this is while you are young, up until the time of peak bone mass, which is about age 25 for women and age 30 for men,” says Chad Deal, MD, Head of the Center for Osteoporosis and Metabolic Bone Disease at Cleveland Clinic, and associate editor of Arthritis Advisor. But paying attention to bone health remains important throughout life.

Bone is a living, growing tissue that constantly changes. Through a process of remodeling, cells called osteoclasts break down and resorb old bone and cells called osteoblasts form new bone.

When we’re growing, more bone is formed than is broken down. This uneven pattern continues and bones get denser until we reach peak bone mass. This is the strongest your bones will get. About 70 percent of peak bone mass is genetic. “The rest can be modified by lifestyle factors, such as calcium intake, vitamin D and exercise,” says Dr. Deal.

From the time of peak bone mass on, you can slowly start to lose more bone than you form. For many people bones stay strong enough. A significant imbalance, though, can lead to low bone mass and osteoporosis.

Hormonal Influence

Estrogen influences bone remodeling. The loss of this hormone at menopause speeds up bone loss in women. “Some women can lose 5 percent a year for six years as estrogen levels drop,” says Dr. Deal.

Even though men don’t experience an abrupt decline in testosterone, a more gradual decline in hormone levels results in bone loss and low bone density and possibly osteoporosis. “It tends to occur about five to 10 years later in men than in women,” says Dr. Deal.


Calcium and vitamin D are the key players in bone health. Calcium is a mineral that our bodies need for a variety of essential functions, including building bone. Our bodies can’t make calcium, so we must get it from food. About 95 percent of the calcium we consume gets stored in our bones and teeth.

“That’s your bone bank,” says Dr. Deal. If your calcium intake declines your body will take calcium from bone. If this happens too frequently, it can lead to low bone density.

Because calcium is so essential for bone health, experts have long recommended supplements. This has become controversial over the past several years because some studies suggested that taking calcium supplements may increase risk for heart disease. However, more recent research, including a meta-analysis in 2015 and a large study in 2018, failed to find that calcium supplements are harmful for the heart. Studies also show that dietary calcium is not linked to increased heart disease risk.

The value of taking calcium and vitamin D supplements has also been questioned because of studies showing that they don’t prevent fractures. But studying this connection is complicated. It depends on the population being studied, the amount of the supplements taken, whether participants reliably took the supplements, and other factors. For now, the findings are not conclusive.

The bottom line is that your body definitely needs calcium. “If you don’t want to take supplements, you have to get it in your diet,” says Dr. Deal. If you have concerns about calcium and whether a supplement is necessary, talk with your doctor. Adequate calcium is essential, but there’s no advantage to getting more than the recommended amount.

Dairy products (milk, yogurt, cheese) are the most plentiful sources. You can also get calcium from fortified orange juice, almond milk, soy milk, and green leafy vegetables (such as collard greens, bok choy and spinach).

Vitamin D

Vitamin D is necessary for absorption of calcium and also bone mineralization. Bone is composed of proteins and the mineral hydroxyapatite. “People with low vitamin D levels have undermineralized bone, which is not strong,” says Dr. Deal.

Bone health

© newannyart | Getty Images

Exposure to the sun is the primary source of vitamin D. Ultraviolet B rays in sunlight turn a substance in the skin into a usable form of vitamin D. Vitamin D is much harder to get from food. The only way to know if you need a vitamin D supplement and how much you should take is to get a blood test.

According to the Institute of Medicine, a normal vitamin D level is 20 ng/mL or higher. “Most experts believe it should be 30 or higher,” says Dr. Deal.


The other important lifestyle factor is exercise. Repeated stress on bones from weight-bearing activity stimulates bone to increase the storage of calcium. Inactivity can lead to bone loss.

To have the necessary impact on bone strength, physical activities must involve striking your heel on the floor. Walking, hiking, running, dancing and tennis are good weight-bearing exercises.

Bone Density Testing

The only way to know your bone density is with a dual-energy X-ray absorptiometry (DXA) test. This test is recommended for all women age 65 and older and men age 70 and older. For women with risk factors, Dr. Deal advises getting a bone density test at the time of menopause (around age 50).

A bone density test will give you a T-score. A score of -2.5 or below means you have osteoporosis. It’s recommended that people with osteoporosis take medications, but also continue getting adequate calcium, vitamin D and exercise. If your T-score is between -1 and -2.5 (called osteopenia), your doctor will consider other risk factors (using a web-based tool called FRAX®) to decide whether medication is appropriate.

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