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Bone health is something every American should be mindful of, both young and old. When we’re young, we build our bone strength for the rest of our lives. When we’re older, we need to hold on to our bone density to avoid debilitating bone fractures.
Our bones end up reflecting how we’ve lived our lives—everything from diet, activity, and our lifestyle choices end up playing a role in how strong they are.
What happens when you lose bone density?
When we neglect to take care of our bones, we increase our risk of developing osteoporosis, a condition where our bones become weak and fragile because of significantly low bone mineral density.
It’s the most common bone disease in the United States. 1 in 3 women and 1 in 5 men will suffer an osteoporosis-related fracture in their lifetimes. The consequence of these fractures can be debilitating, leading to hospitalization, disability, or death (Sözen, 2017).
Even before you reach such a point where you can be diagnosed with osteoporosis, you may already be at an increased risk for fractures.
More than 2 in 5 people over the age of 50 have low bone mass, or osteopenia, a precursor to osteoporosis. Low bone mass is associated with an increased risk of bone fracture. Let’s learn about the steps we can take to make sure we keep our bone density up (Wright, 2014).
Ways to improve bone density
There are a number of steps you can take to maintain your bone density. It’s important to take care of your bones early in life. Think of it as a retirement account, where you’re storing your bone density credits while you’re young. As you age, you’ll draw upon this account.
Unlike a 401K, however, you only get until a couple of decades to save up. Both men and women reach their peak bone mass during their 20s. This bone mass slowly declines over the course of your lifetime. Let’s go over how you can build and maintain your bone density (Weaver, 2016).
A healthy diet will go a long way to maintaining bone density. One key component in your diet is calcium. It’s important both when you’re building new bone, and when you’re trying to hold onto what you’ve got. Studies have shown that in both children and adults, increased dietary calcium was associated with increased bone mineral density (Tai, 2015).
The National Osteoporosis Foundation recommends a certain amount of calcium per day based on your age and gender. For women over 50 and men over 70, they recommend 1,200 mg daily. For men and women younger than those cutoffs, they recommend 1,000 mg daily.
Foods that are rich in calcium include dairy products, soybeans, broccoli, and fresh leafy greens, including collards greens, kale, and spinach.
If you’re still finding it difficult to get enough calcium in your diet, calcium supplements can help. The formulation of calcium is important to look out for when picking a supplement. Calcium citrate has better absorption when compared to calcium carbonate (Van Der Velde, 2014).
Vitamin D is another key component of a bone-healthy diet. It’s often discussed in conjunction with calcium because the body needs vitamin D in order to absorb calcium. Unlike other vitamins, your body is able to make vitamin D. The process happens in the skin and relies on sun exposure to do so. However, many people aren’t able to make enough vitamin D. It’s estimated that around 42% of people in the United States are deficient in vitamin D (Parva, 2018).
The National Academy of Medicine has put out guidelines as to how much vitamin D people should get. For men and women under 50, 400–800 international units (IU) daily is recommended. And if you’re older than that, you’ve got to get 800–1,000 IU a day.
Unlike calcium, there aren’t very many foods that contain vitamin D. You might find vitamin D in fatty fish and fortified cereals, dairy products, orange juice, and plant-based milk alternatives. Some mushrooms are known to contain vitamin D as well.
Experts also agree that protein is a key component of a bone-healthy diet as well. It’s recommended that adults get 0.8 g of protein per kilogram of weight daily. For the Americans among us, that’s 0.36 g of protein for every pound of weight. A 160-pound person, for instance, needs 58 g of protein per day. Protein is widely available in lots of different foods, including meat, beans, nuts, eggs, and dairy (Burd, 2019).
Exercise is extremely important in building strong bones and maintaining their strength. In children, adolescents, and young adults, physical activity has been repeatedly shown to be good for bone health. In particular, high-impact exercises like jumping may be especially beneficial (Bielemann, 2013).
Weight-bearing exercise programs have also been shown to be helpful in maintaining bone density later on in life, both in men and in women. The most important thing is to make it a consistent, routine part of your life—the benefits of exercise on your bones go away when you stop.
Smoking is well known to decrease bone density and increase the chance of bone fractures. The good news is that quitting smoking can stop the bone loss that smoking causes.
Cut down on drinking
Drinking excessive amounts of alcohol has been shown to be a risk factor for fractures. The U.S. Department of Health and Human Services recommends only drinking up to one drink per day for women and two drinks per day for men (HHS, 2015).
Medications to support bone density
In people with osteoporosis or high fracture risk, bisphosphonate medications may be helpful in improving bone density. Common bisphosphonates include:
- Etidronate (brand name Didronel)
- Alendronate (brand name Fosamax)
- Ibandronate (brand name Boniva)
- Zoledronic acid (brand name Reclast)
- Risedronate (brand name Actonel)
Bisphosphonates work by reducing the breakdown of bone. They’re usually the first medications healthcare providers will try to treat osteoporosis. More recent research has shown that they are also helpful in preventing fractures in osteopenia (low bone density) (Reid, 2018).
There are other medications available that increase bone density. In most patients, healthcare providers will usually try bisphosphonates first because they are effective and have few side effects.
However, other medications may be used, especially in severe cases of osteoporosis or in cases where using bisphosphonates would be unsafe. These other medications include raloxifene, denosumab, teriparatide, and abaloparatide.
Remember, maintaining your bone density is a marathon, not a sprint. Eating a good diet and keeping a regular exercise schedule might not seem like it will make a big difference immediately, but the impacts are huge in the long run. And as always, your healthcare provider is your best resource for navigating your health.
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Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.