6 Things to Do Now to Keep Your Bones Strong in the Future

By Nicole Pajer
Reviewed by Daniel Lew, M.D.
May 13, 2024

As we age, our body is constantly absorbing and replacing bone tissue. If the rate of bone being broken down is higher than bone being formed, it can lead to bone loss.

Bone loss is more likely to occur in older women and especially during menopause, likely due to a decrease in estrogen levels. Bone loss can lead to the weakening of bones, also known as osteoporosis, which can lead to an increased risk of hip fractures if a fall occurs. Around age 51, the average age of menopause in North America, bone loss—a decrease in total bone mass—can speed up.

Bone Loss in the U.S. by the Numbers

According to the National Osteoporosis Foundation, of the estimated 10 million Americans with osteoporosis, about 8 million, or 80 percent, are women. Then, after 10 years of menopause, bone loss tends to slow down. “It continues, but not to the degree of the early menopausal years,” says Stephen Honig, M.D., the director of the NYU Langone Osteoporosis Center.

While people tend to drop bone mass at different rates, once menopause starts, it’s common to lose an average of 0.5 percent to 1 percent bone mass per year, according to Honig. “We like to say that 10 percent of women can be rapid bone losers, 10 percent don't seem to lose very much bone, and 80 percent generally follow the pattern of bone loss during the first 10 years of menopause, which then slows down after that,” he explains.

How Women Can Potentially Slow Down Bone Loss in Midlife

While there isn’t much you can do to rebuild bone mass after midlife, there are a few steps to prioritize bone health that can help to slow down the rate at which you may lose it. Here are six things you can do in your 40s and 50s to give your bones a little TLC, according to experts.

1. Don’t Overdo or Underdo the Calcium

Over the years, there has been conflicting data about calcium supplements and whether you should take them. The recommended daily calcium intake for the average adult woman is between 1,000 and 1,200 milligrams per day. Low calcium intake contributes to bone density loss over time. Stuart Weinerman, M.D., a board-certified endocrinologist and assistant professor of medicine with the Division of Endocrinology at the Zucker School of Medicine at Hofstra/Northwell, in Hempstead, New York, says the majority of that should come from food.

Dairy products are known to be great sources of calcium. For example, 1 cup of milk provides 300 milligrams of calcium. Weinerman says there are also plenty of plant-based options. A 4-ounce portion of tofu contains 120-390 milligrams, fortified cereal can contain anywhere from 250 milligrams to 1,000 milligrams, and 1 cup of cooked broccoli contains 180 milligrams.

Weinerman doesn’t recommend that most people take more than 500-1,000 milligrams of supplemental calcium a day, and the calcium supplements should be divided throughout the day and taken with food. “There is some evidence that more [calcium] probably doesn't help, and more may have increased risk,” he explains. These risks can include kidney stones, bloating, constipation, and possibly heart disease, like irregular heartbeats, which Weinerman says is controversial and is being further studied.

A person who has a digestive or dietary issue, like inflammatory bowel disease (IBD), celiac disease, a history of stomach or small intestine surgery, or the need of a restricted diet, may need to take more than the typical 500 milligrams, but ask your doctor first.

2. Be Careful with Medications—and Even Some Supplements

Certain medications, like corticosteroids, may be harmful to your bones. “If people are taking prednisone or [a similar steroid medication], they should be aware it can have an impact on bone [mass] and discuss that with their doctor,” says Honig. Steroids decrease the body’s ability to absorb calcium and also increase the rate that bone is broken down.

Certain post-breast cancer medications, as well as proton pump inhibitor drugs, may also have a modest negative effect on bone mass. “So, people who have reflux and heartburn and use proton pump inhibitors on a regular basis should have that discussion with their doctor,” Honig says.

Always be cautious about taking supplements. Just because something says it’s meant to treat osteoporosis doesn’t necessarily mean it’s good for your bones. “An over-the-counter supplement known as strontium should not be used, as it has been shown to increase risk of heart disease,” Weinerman explains. It’s best to run all your medications and dietary supplements by your physician to make sure they’re safe for you to take.

3. Do Regular Weight-Bearing Exercises

Regular exercise that includes resistance training can help keep your bones strong. Honig recommends weight-bearing exercises, which means “standing on your own two feet and bearing your own weight.” These exercises could include yoga or brisk walking.

There is evidence, he says, that higher-impact activity (like running) may be more beneficial in terms of bone density improvement than routine weight-bearing exercises. And while research has suggested that high-impact training, even in menopausal women, might improve bone density, Honig says to ideally look at weight-bearing exercises as a way to “moderate bone loss” rather than increase bone formation.

“You should not expect to see significant gains with a routine of weight-bearing exercise,” Honig says. “You’re hoping to stabilize the situation.”

It is recommended to exercise at least 30 minutes three times per week, regardless of what type of exercise you do. Although certain types of exercise may be more beneficial, the data is not entirely conclusive, so the most important thing is to do any type of exercise that you enjoy and can do on a regular basis.

4. Cut Back on Sugar, Alcohol, and Smoking

“The National Osteoporosis Foundation recommends that women limit their alcohol intake [according to the National Institutes of Health, that number is a limit of one drink per day], and that's probably too much according to some sources,” Weinerman says. “There are other indirect effects of alcohol on nutritional balance, but there appears to be direct effects on bone health, increasing the risk of bone loss and osteoporosis.”

Go easy on the soda, as well. A recent follow-up of an older study concluded that higher consumption of soft drinks leads to an increased risk of bone fracture.

And if you’re a smoker, now is the time to quit, as people who smoke have an increased risk of osteoporosis and fractures. “Smokers have less estrogen, and that seems to be one major potential cause or mechanism by which smokers have the worst bone health,” suggests Weinerman. Smoking also decreases the efficacy of estrogen therapy, likely due to increased estrogen breakdown.

5. Follow a Balanced Diet

In addition to getting enough dietary calcium, it’s important to eat a balanced diet filled with vegetables, fruits, whole grains, and protein. A higher intake of fruits and vegetables has been associated with higher bone mass density and lower bone mass loss over time. “We generally recommend a high-protein diet [including fruits and vegetables] as the best diet for bone health,” Honig says.

You’ll also want to prioritize foods rich in other bone-essential nutrients, like vitamin D. Also, go for salmon and dark leafy greens, which are good sources of vitamin K. Magnesium is also important and can be found in spinach and sweet potatoes. Additionally, seek out foods rich in vitamin C, like bell peppers, oranges, and broccoli.

And stay away from extreme diets that may be too restrictive and will therefore place you at risk of nutritional deficiencies. “Some of these very bizarre diets are unbalanced and unhealthy,” Honig says. “With fad diets, you have to be very careful.”

6. Consider Hormone Therapy for Early Menopause

The North American Menopause Society recently updated its position on the use of hormone therapy and notes that “it has been shown to prevent bone loss and fracture.”

“If somebody has an early menopause, say at age 47 or 48, hormone therapy, at least until the [common] age of menopause, is often recommended,” says Honig, adding that the treatment could help reduce or prevent menopausal bone loss. “Even if somebody has a normal bone density, if they have an early menopause, they might want to go on hormone replacement.” So, if you’re experiencing early menopausal symptoms, Honig says to run this idea by your gynecologist.

You should also get a bone scan to evaluate the strength of your bones. Depending on the results of your scan, and if you have a history of bone fractures, hormone therapy may also be a good option for you.

The fact is that we can’t stop the aging process. But we can keep ourselves a little healthier and make it all a little easier by following our doctor’s advice, making some lifestyle changes, and keeping our bones—and our health—at the front of our minds.

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