5 Things You Can Do Now to Prevent Osteoporosis in the Future

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These days, getting fit is all about gaining muscle. But what about the intricate structures holding that muscle (and the rest of you) in place? Yes, we're talking about your bones. They give your body its shape, carry you through daily life, and protect your other organs. It's easy to write off osteoporosis—a disease that develops when bones weaken and become more likely to break—as a future-you problem. In reality, how you care for your bones earlier in life can help prevent osteoporosis and control the gap between frailty and mobility when you're older.
Somewhere between the ages of 25 and 35, your body reaches its peak bone mass. 'That's as much bone as you'll ever have in your life,' Kimberly Templeton, MD, professor of orthopedic surgery and sports medicine at the University of Kansas Medical Center and past president of the American Medical Women's Association, tells SELF. 'If you don't make the optimal amount of bone, then it doesn't take as long to start losing bone. So then you may develop osteoporosis in your 50s rather than your 70s or 80s.'
Osteoporosis is a 'silent' disease because most folks don't have symptoms until they're sidelined by a fracture. That's why preventive measures are crucial: Women under 65 should be screened for osteoporosis if they have one or more risk factors for the disease, and the red flags are more common than you'd think. Here's why your bones should be top of mind when you're younger, what causes them to wear out, and how to keep them stronger for longer.
Your bones are 'dynamic, living organs,' Vonda Wright, MD, an orthopedic surgeon and author of Unbreakable: A Woman's Guide to Aging with Power, tells SELF. Meaning, your body continuously breaks down old bone and replaces it with new bone. Most of your skeleton replaces itself every 10 years or so.
Your bones are a storehouse for vital minerals, including 99% of the calcium in your body. Bones form blood cells and immune cells. Dr. Wright also calls bones 'master communicators' because they secrete chemical messengers; this includes osteocalcin, which helps regulate your brain function and metabolism. Our bones do miraculous things for our bodies, but we don't fully reap the benefits if we don't pay attention to them, Dr. Wright says, 'and that starts in our youth.'
Full-blown osteoporosis is less common in women under 50. Osteopenia is more likely: The condition is marked by lower-than-average bone mineral density, a measure of the minerals that make up the structure of your bones. In osteopenia, your bones are weaker than they should be, which is a 'significant predictor' of osteoporosis cropping up later on, Dr. Templeton says. While robust data is lacking, a smaller 2019 study found that 26% of women between the ages of 35 and 50 had signs of osteopenia.
That number jumps to 54% postmenopause. As your estrogen levels dip, so does your body's ability to build and maintain your bones, Dr. Wright says. Some women lose up to 25% of their bone mass in the first 10 years after menopause; by age 80, a whopping 70% of women have osteoporosis. That's why your 20s and 30s are a 'critical time,' she tells SELF. Your body is still pumping out the estrogen it needs for optimal bone health (save for folks with health conditions that can mess with this process).
'Most young women don't think about their bones—but they will,' Dr. Wright says. 'The fact is, until they break, nobody talks about it.' She points to one of her recent patients, a 22-year-old whose lab tests revealed poor bone density. 'She had always been really active and had body image issues because women are taught that we need to be teeny-tiny,' she explains. When you don't get the fuel your body needs, you don't 'lay down enough bone,' she adds. You may skimp on essential nutrients or fall into disordered eating, spiking your risk of long-lasting damage.
The general screening guideline is to get a specialized, low-dose X-ray called a DEXA scan—the gold standard for measuring bone mineral density—at 65, so long as you have no osteoporosis risk factors. 'It focuses on areas that can develop osteoporosis earlier, like your spine, and areas at risk of breaking, like your hips and wrists,' Dr. Templeton says.
But Dr. Wright believes 65 is far too late. 'Most women don't even know what their risk factors are,' she stresses. The list runs the gamut—everything from your genetics to your diet to your Rx refills can weaken your bones.
If one or more of the following apply to you, it's worth talking to your doctor about whether you should be screened to watch for signs of osteopenia or early-onset osteoporosis:
Family history: 'Is your mother shrinking? Did your Aunt Mary fall and break her hip?' Dr. Wright posits. If a close relative has osteoporosis or is showing signs of bone loss, your chances of developing it are higher too.
Low bodyweight: For women in competitive sports, wracking up enough calories to balance out rigorous training can be tough, Dr. Templeton says. Exercise is great for your bones, but without proper nutrition and recovery, this performance level can sometimes be harmful and increase the risk of fractures. Grappling with an eating disorder triggers similar concerns.
Previous fractures: This is a biggie, Dr. Templeton says. If you've broken a bone, think about how it happened. Did you snap your ankle in a skiing mishap? A bummer, but not exactly surprising. But if you were just walking, stepped off a curb, and twisted your ankle to the point of fracturing a bone, that's more of a reason to get checked out.
Nutrient deficiencies: Not getting enough calcium and vitamin D, in particular, can be detrimental to your bones (more on this in a bit).
Certain health conditions: Endocrine disorders like thyroid dysfunction, GI conditions that limit your ability to absorb nutrients, autoimmune diseases like rheumatoid arthritis, and various cancers can also do a number on your bones.
Certain medications: Sometimes the drugs you need to treat the conditions above can also have negative effects on your bone health, Dr. Templeton says. This includes long-term use of steroids for inflammatory conditions, proton pump inhibitors for chronic reflux, and SSRIs for your mood, among others.
Substance misuse: Long-term, heavy drinking or smoking can also contribute to bone loss and a higher fracture risk.
Of course, some of these aren't within your control—you can't change your genes or whether your immune system is attacking your tissues. But knowing that you have risk factors that can set the stage for fractures should prompt you to make a game plan with your doctor, Dr. Templeton says. For example, if you need to take oral steroids to keep arthritis flare-ups in check, then discuss the bone-boosting habits that are within your control, like the foods you should eat more of and exercises that are safe to do on the regular.
Your bones are made of calcium and also act as a reservoir for the calcium you absorb. Your body can't make this mineral on its own, so when you don't get enough in your diet, it'll take what it needs for your cells, nerves, and muscles from your bones. Meanwhile, vitamin D helps your body absorb calcium, aids in replenishing your bones, and supports your muscles to reduce your risk of falls.
Dr. Wright says most women need at least 1,200 milligrams of calcium per day (or a little more if you're pregnant or breastfeeding). You can usually hit this mark with calcium-rich foods like yogurt, cow's milk, cheeses, salmon, sardines, tofu, and leafy greens. Fortified juices and milks are great options too. As for vitamin D? Most experts recommend aiming for at least 800 to 1,000 international units per day. Vitamin D is trickier to get enough of through food alone, though you can find it in fatty fish like salmon and trout, mushrooms, fortified milks, and eggs. While it's known as the 'sunshine vitamin,' various factors can affect how much vitamin D your skin produces from UV exposure. So if you're unsure about your levels, ask your doctor for a blood test. If your vitamin D is low, they can recommend a reputable supplement to help fill in the gaps, Dr. Templeton says.
Dr. Templeton says protein is 'extremely important' because the collagen and amino acids it provides help make up about half of your bones' volume. 'You need protein to maintain the structural part of the bone, the stuff that serves as the framework for calcium to stick to the bone,' she says.
Unless you're purposeful about your protein intake, it's easy to come up short, Dr. Wright says. So, how much do you need? As SELF previously reported, it depends on your age, exercise regimen, and gender assigned at birth. Aiming for 0.8 grams of protein per kilogram of bodyweight (or 0.36 grams per pound) is a solid goal for your bone health, she says. But shooting a little higher than the standard recommendation likely won't hurt.
This handy calculator can give you a better idea of a protein target that will meet your individual needs. An active 35-year-old woman weighing 145 pounds should do well with at least 54 grams a day, for example.
Dr. Wright candidly refers to cigarettes and alcohol as 'bone poison.' Nicotine can tank your health in myriad ways, but one of them is preventing osteoblasts, or your bone-building cells, from doing their job. 'We know from a large body of literature that smoking prevents bone healing, and many surgeons, including me, will not operate on people who smoke,' Dr. Wright says.
Evidence also suggests that heavy, long-term drinking can raise your likelihood of developing osteoporosis by stunting your calcium and vitamin D absorption, impairing your bones' ability to build and repair their structure, and disrupting estrogen production. Not to mention, drinking ups your risk of falls and, therefore, fractures, Dr. Wright says.
Intimidated by the idea of going cold turkey for either? Check out SELF's guides on how to quit smoking and how to quit drinking (or, at the very least, cut back on booze).
Sometimes it feels like you're being 'too hard' on your bones with certain movements, but for most people, the opposite is true: We're simply not moving enough. 'How would your body even know whether you're alive or dead unless it sensed activity?' Dr. Wright says. She explains that exercise is a stimulus for your osteoblasts; when you increase the load on your body, these cells receive messages to build more bone.
Here are three types of movement to focus on for max impact:
Weight-bearing exercises: Cycling and swimming are great for your cardiovascular health, but you need to incorporate physical activity that's rooted in resisting gravity for optimal bone health, Dr. Templeton says. Think: walking, jogging, playing tennis, or climbing stairs. You can also throw in a jumping practice, Dr. Wright says: 20 jumping jacks a day or 10 minutes of jumping rope three times per week.
Resistance training: Bodyweight exercises can be a great entry point for beginners, but you should ideally work your way toward progressively heavier lifting, either via free weights or your gym's machines. 'We need to be lifting heavier and challenging ourselves,' Dr. Wright says. Aim for at least twice a week.
Balance and agility work: This helps reduce your risk of falls, Dr. Templeton says. Squeezing in a weekly yoga or Pilates class is great for this, but Dr. Wright says you can also start with a simple exercise at home: Stand on one leg, in 'tree pose,' while brushing your teeth, alternating the standing leg between your morning and night routines.
If you're worried about your bone health because you watched your mom deal with the aftermath of a devastating fall, or you have a health condition that's thrown your diet out of whack, don't hesitate to ask your doctor about getting screened for early-onset osteoporosis.
The good news is that you've probably got time. Dr. Templeton says osteopenia can be slowed to some degree. The weakened bone probably never returns to its baseline once you're past the age of peak mass, but halting the progression can reduce your chances of sustaining a life-altering injury.
The bottom line: Brittle bones aren't an inevitable part of getting older, especially if you start showing them more love right now. 'The same things that you're doing to maintain your overall health are not all that different from what you should be doing to maintain your bone health,' Dr. Templeton says. So if you're exercising, eating balanced meals, and booking your annual physical, your future self is already thanking you.
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Originally Appeared on Self