Strong Bones for Life: Fight Off Osteoporosis
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Strong Bones for Life: Fight Off Osteoporosis

Fight osteoporosis! Our simple plan gives you the power to fend off this scary disease, starting right now.

Lisa Dombrowski, 41, doesn't want to be crippled -- and she knows that's a real risk for her. Both her mother and grandmother had osteoporosis, the bone-thinning disease that currently afflicts 10 million Americans. So five years ago, when she was pregnant with her first child, she got serious: She upped her calcium intake by eating more yogurt and cottage cheese and by taking high-calcium prenatal supplements. After the baby was born, she started attending a doctor-approved fitness class nearly every day to make sure she got the weight-bearing exercise that builds bone. "My doctor says she's pleased with my progress," says Dombrowski, who owns a design communications firm in a Chicago suburb.

But you shouldn't wait to get pregnant to start protecting your bones and it's not too late to start if you're well past that stage. The more doctors learn about how women get osteoporosis -- and osteopenia, the low bone mass condition that precedes it -- the more convinced they are that diet and exercise geared to preserving bone are the best insurance against it. "It's never too late to maintain a healthy skeleton," says Ethel Siris, MD, director of the Toni Stabile Osteoporosis Center of the Columbia University Medical Center at New York-Presbyterian Hospital.

The reason? Your body constantly builds up and breaks down bone tissue, a cycle designed to supply bones with strong, young cells. After you reach peak lifetime bone mass, around age 30, your body begins to break down bone cells faster than it can make new ones -- a process that accelerates in your 40s, when supplies of the bone-building hormone estrogen start to dwindle. Indeed, menopause is a key reason women are four times more likely than men to develop osteoporosis. Also, men's bigger size helps: Guys have about 25 percent more bone mass on average. And they tend to eat more, including more foods that contain calcium.

Follow our strong-bones plan and you'll give yourself the best possible chance to stay out of the osteoporosis danger zone.

Choose an Exercise Program with Your Bones in Mind

You need two types of exercise -- weight-bearing and muscle-strengthening.

Weight-bearing exercise means that muscles and bones work against gravity. A walking program is an excellent choice -- if it's intense. "Leisurely walking doesn't challenge the skeleton enough to maintain bone mass," says Scott Going, PhD, an exercise physiologist at the University of Arizona. To ramp up walks, do bursts of fast walking up hills, go up and down stairs, or wear a weighted vest. Dancing, hiking, running, tennis, and jumping rope are also good, and rowing is excellent for increasing bone mass in the spine. Get 30 or more minutes on most days.

Resistance and strengthening exercises build power and prevent falls by working the core muscles, which help you maintain balance. Weight lifting with free weights or machines, push-ups or pull-ups, and resistance bands all qualify. Do two or three days a week for at least 20 minutes. In one study, postmenopausal women raised their bone density by one to two percent with 20 to 25 minutes of resistance training -- plus 7 to 10 minutes of weight-bearing exercise -- three times a week.

Eat for Your Bones, Starting with Calcium

Calcium is the mineral that makes bones strong. Women under 50 need 1,000 milligrams of calcium a day (about three 8-ounce glasses of skim milk, one cup of calcium-fortified cereal, or three 8-ounce servings of low-fat yogurt). To absorb and use that calcium, you also need 400 to 800 international units of vitamin D2 or D3 (fortified milk, egg yolks, and saltwater fish are excellent sources). After age 50 -- or after menopause, if that comes earlier -- you need to raise your intake to 1,200mg of calcium and 800 to 1,000 international units of D, according to the National Osteoporosis Foundation.

Try to get as much calcium as possible from food. Dairy products are the best source; broccoli, kale, tofu, and canned salmon with bones are also good sources, as are fortified foods like juices, cereal, and bottled water. For a list of calcium-rich foods from the National Institutes of Health, see

But eating more calcium is not the be-all and end-all. Research suggests that women whose diet is rich in fruits and vegetables (at least nine servings a day, seven days a week) have higher bone mineral density than those who eat less produce, possibly because the nutrients slow how fast bone is dissolved. Also, some foods can reduce your ability to absorb calcium. Don't take calcium supplements for two hours or more before or after eating cereal or bread with 100 percent wheat bran. Get extra calcium if you drink lots of caffeinated drinks -- adding milk to coffee will do the trick. Soft drinks containing phosphoric acid may leach calcium from bones. And sodium causes excess calcium excretion when you sweat or urinate, another reason to cut back on salt.

Take Supplements Strategically

Many people find it difficult to get all the calcium and vitamin D they need from food. Recent research is also pointing to the importance of B vitamins for bones.

Calcium carbonate is the cheapest, most widely used supplement, but you need to take it with food, not on an empty stomach. Calcium citrate is easier to tolerate -- it doesn't cause stomach upsets -- and you can take it any time. However, it's more expensive and less concentrated, so you may need to swallow more pills. Calcium citrate and another option, calcium phosphate, are less likely to cause constipation, sometimes a problem with calcium carbonate. (Don't pop calcium at the same time as iron supplements; it blocks the ability to absorb iron.)

Vitamin D -- either D2 or D3 -- helps the body take in calcium and deposit it in your bones; it may also help muscles stay strong.

Vitamins B6 and B12. The Framingham Osteoporosis Study in Massachusetts found that elderly people deficient in these vitamins had a greater risk of broken bones. The ability to absorb these nutrients declines over time. From 50 on, make sure your multivitamin contains both of these B vitamins and ask if you need additional B6 and B12.

When You Reach Menopause, Insist on a Bone Scan

Government guidelines recommend that healthy women wait until they're 65 before getting a bone scan (60 if you're at high risk of osteoporosis). But women start losing the largest percentage of bone more than a decade earlier, when their estrogen level drops and menstruation ends. That's why most doctors advise getting your first baseline scan at menopause. "It's hard to know how high your osteoporosis risk is without measuring bone density at the beginning of menopause," says Steven T. Harris, MD, an endocrinologist at the University of California, San Francisco.

Insurance coverage is generally good for these baseline scans, which can cost around $150. If your doctor can show you're at increased risk (see "Assess Your Risk"), you can probably get your health plan to pay for it, says Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation, in Washington, D.C., and author of What Your Doctor May Not Tell You About Osteoporosis. If you're not covered, baseline testing may still be a good investment and you can pay for it with a healthcare flexible spending account, if you have one.

Be sure that your scan is measured by the new FRAX (Fracture Risk Algorithm) scoring system, which is significantly more accurate at predicting the risk of hip fracture than a bone-density test alone. FRAX weighs both your bone-density score and nearly a dozen other risk factors -- including age, height, weight, and whether you smoke -- to estimate your likelihood of breaking a bone within a 10-year period. "Bone density alone only accounts for about 20 percent of your fracture risk," says Joseph Lane, MD, a professor at Weill-Cornell College of Medicine and chief of the Metabolic Bone Disease Service at the Hospital for Special Surgery, in New York City. "FRAX throws all the other factors into the mix to get a much more accurate picture." Use the results to sit down with your doctor and discuss whether there is more you should be doing to protect your bones.

Assess Your Risk

Anyone can benefit from our four-part program, but you should pay special attention to maintaining your bone mass if you're at higher-than-normal risk of osteoporosis, says Abby Abelson, MD, a rheumatologist at Ohio's Cleveland Clinic. Talk to your doctor to see whether you need to consider these factors:

Family history
If either of your parents or a sibling had osteoporosis, you're more likely to develop the disease and may want to have earlier screening.

Frame size
Being exceptionally small or thin means you have less bone mass to start with, and so increases your odds of getting osteoporosis.

Whites and those of Southeast Asian descent are more at risk than are African-Americans and Latinas.

Smoking and heavy drinking can raise your risk. If you've ever had an eating disorder you're also more vulnerable.

Irregular menstrual cycles
Studies indicate that young women who stop menstruating -- a condition called amenorrhea that may be triggered by intense athletic training -- can have 20 to 30 percent lower bone density in their spine than athletes whose periods were never affected. And there's a flip side: the longer your body is exposed to estrogen (meaning you got your period early or entered menopause late, or both), the lower your risk of osteoporosis.

Taking oral steroids for conditions such as asthma or chronic pain can thin your bones. In addition, certain diseases make us more prone to osteoporosis. These include poorly controlled diabetes, an overactive thyroid, rheumatoid arthritis, and breast cancer. In addition, digestive problems -- a food allergy, colitis, or Crohn's disease, for example -- make it harder for the body to absorb bone-fortifying calcium.

For reasons doctors are still figuring out, this disease can give you brittle bones at a relatively young age. If you've taken the SSRI class of antidepressants, you may also have low bone density.

Broken bones
What doctors call a "fragility fracture" is another tip-off that your bones are thinning. "If someone breaks a bone in a car accident, that's not a fragility fracture," says Dr. Abelson. "But if you slip on the ice and break your wrist or fracture your spine lifting a heavy suitcase from the overhead rack on a plane, you have reason to worry about bone mass."

Age-by-Age Planner

In Your 20s
Watch your diet and make sure you're getting the calcium you need to keep bones strong -- 1,000mgs daily -- plus 400 to 800 international units of vitamin D2 or D3, to help your body absorb and use it. Avoid smoking and other unhealthy habits that can erode bone density. If you're using injectable contraceptives, check with your doctor about their effect on your bones -- Depo-Provera has been associated with reduced bone mass. And maximize bone growth by doing high-intensity weight-bearing exercises for at least 30 minutes a day six times a week.

In Your 30s
In this decade you start losing bone more rapidly than you replace it. Don't slack off on calcium and continue regular exercise.

In Your 40s
Estrogen levels fluctuate in the years leading up to menopause, which can speed up bone loss. But if you add 45 minutes of strength training twice a week to your regular workouts, you can substantially decrease this loss, studies show.

In Your 50s and Beyond
Bump up calcium intake to 1,200mgs per day and increase vitamin D3 intake to at least 800 to 1,000 international units. Get a baseline bone scan after menopause and ask your doctor about bone-preserving medications when you hit 60. Continue your program of weight-bearing and strength-training exercises.

Kids Need It, Too

Building bones in childhood can give your kids lifetime protection against osteoporosis. By age 18 girls have up to 90 percent of their peak bone mass (it's age 20 for boys). Unfortunately, kids prefer sodas or caffeinated beverages that not only interfere with calcium absorption but crowd out calcium-rich beverages like milk. To better meet their daily calcium quota -- 500mg for 2- to 3-year-olds; 800mg for kids 4 to 8; 1,300mg for ages 9 through 18 -- cut out soft drinks and substitute low-fat milk at every meal. Also, add a 6-ounce glass of calcium-fortified juice for breakfast and put other calcium-rich foods -- yogurt, almonds, tofu -- on your menu (it's good for the whole family).

The right high-impact exercise can also make a huge difference. Two 2008 studies at Oregon State University found that jumping -- kids ages 6 to 9 jumped 100 times off a two-foot elevation three times a week -- increased bone mass by up to 4.5 percent. Doing this regularly could reduce lifetime fracture risk by up to 25 percent.


Originally published in Ladies' Home Journal, June 2009.