Bone health: Tips to keep your bones healthy

Protecting your bone health is easier than you think. Understand how diet, physical activity and other lifestyle factors can affect your bone mass.

By Mayo Clinic staff

Bones play many roles in the body — providing structure, protecting organs, anchoring muscles and storing calcium. While it’s particularly important to take steps to build strong and healthy bones during childhood and adolescence, you can take steps during adulthood to protect bone health, too.

Why is bone health important?

Your bones are continuously changing — new bone is made and old bone is broken down. When you’re young, your body makes new bone faster than it breaks down old bone and your bone mass increases. Most people reach their peak bone mass around age 30. After that, bone remodeling continues, but you lose slightly more than you gain. How likely you are to develop osteoporosis — a condition that causes bones to become weak and brittle — depends on how much bone mass you attain by the time you reach age 30 and how rapidly you lose it later. The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age.

What affects bone health?

A number of factors can affect bone health — some modifiable and some not. For example:

• The amount of calcium in your diet. A diet low in calcium contributes to diminished bone density, early bone loss and an increased risk of fractures.
• Physical activity level. People who are physically inactive have a higher risk of osteoporosis than do their more-active counterparts.
• Tobacco use and excessive alcohol consumption. Research suggests that tobacco use contributes to weak bones. Similarly, regularly having more than two alcoholic drinks a day increases the risk of osteoporosis, possibly because alcohol can interfere with the body’s ability to absorb calcium.
• Being a woman. Women have less bone tissue than do men.
• Getting older. Your bones become thinner and weaker as you age.
• Race, frame size and family history. You’re at greatest risk of osteoporosis if you’re white or of Asian descent. You’re also at greater risk if you’re extremely thin (with a body mass index of 19 or less) or have a small body frame because you may have less bone mass to draw from as you age. In addition, having a parent or sibling who has osteoporosis puts you at greater risk — especially if you also have a family history of fractures.
• Hormone levels. Too much thyroid hormone can cause bone loss. In women, bone loss increases dramatically at menopause due to dropping estrogen levels. Prolonged periods of amenorrhea, the absence of menstruation, before menopause also increases the risk of osteoporosis. In men, low testosterone levels can cause a loss of bone mass.
• Eating disorders and other conditions and procedures that affect bone health. People who have anorexia or bulimia are at risk of bone loss. In addition, stomach surgery (gastrectomy), weight-loss surgery and conditions such as Crohn’s disease, celiac disease and Cushing’s disease can affect your body’s ability to absorb calcium.
• Use of certain medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. Other drugs associated with an increased risk of osteoporosis include long-term use of aromatase inhibitors to treat breast cancer, the antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), the cancer treatment drug methotrexate, some anti-seizure medications, the acid-blocking drugs called proton pump inhibitors and aluminum-containing antacids.

What can I do to keep my bones healthy?

You can take steps to prevent or slow bone loss. For example:

• Include plenty of calcium in your diet. For adults ages 19 to 50 and men ages 51 to 70, the Institute of Medicine recommends 1,000 milligrams (mg) of calcium a day. The recommendation increases to 1,200 mg a day for women age 51 and older and men age 71 and older. Dietary sources of calcium include diary products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products, such as tofu. If you find it difficult to get enough calcium from your diet, ask your doctor about calcium supplements.
• Pay attention to vitamin D. For adults ages 19 to 70, the Institute of Medicine recommends 600 international units (IUs) of vitamin D a day. The recommendation increases to 800 IUs a day for adults age 71 and older. Although many people get adequate amounts of vitamin D from sunlight, this may not be a good source for everyone. Other sources of vitamin D include oily fish, such as tuna and sardines, egg yolks, fortified milk, and vitamin D supplements.
• Include physical activity in your daily routine. Weight-bearing exercises, such as walking, jogging, tennis and climbing stairs, can help you build strong bones and slow bone loss.
• Avoid substance abuse. Avoid smoking and don’t drink more than two alcoholic drinks a day.
• Consider bone-boosting medications. A number of medications are available to help slow bone loss and maintain bone mass, including bisphosphonates (Fosamax, Actonel, Boniva) and raloxifene (Evista). If you’re taking a medication that affects your bone health, talk to your doctor. He or she will monitor your bone density and may recommend other drugs to help prevent bone loss.
• For women, consider hormone therapy. Estrogen, especially when started soon after menopause, can help maintain bone density. However, the use of hormone therapy can increase the risk of blood clots, endometrial cancer and, possibly, breast cancer. Ask your doctor whether hormone therapy is right for you.

If you’re concerned about your bone health or your risk factors for osteoporosis, consult your doctor. He or she may recommend a bone density test. The results will help your doctor gauge your bone density and determine your rate of bone loss.