You’ve probably heard that osteoporosis affects an older population and this disease could lead to bone fractures as you age. But if you wait until, say, retirement to start worrying about preventing osteoporosis, then you’re missing crucial years — or even decades — to establish habits that can protect your bones and reduce the risk of developing osteoporosis.
Osteoporosis is a degenerative disease in which bones are weakened and thinned to the point that they tend to break more easily. An osteoporosis fracture could happen from a fall or even, in more severe cases, during a coughing fit. Since we’re living longer, age-related degenerative diseases like osteoporosis are becoming more prevalent.
Understanding what you can do to prevent osteoporosis before you’re at high risk is key.
Your body breaks down old bone and replaces it with new bone tissue, a process that slows with age. In order to prevent osteoporosis, you need to try to keep bone tissue healthy for as long as possible so the outer shell of your bones stays thick and strong while the insides of the bones stay dense instead of porous.
Read on to discover how you can prevent osteoporosis with diet, lifestyle changes, and medication.
Understanding How Bone Is Built and Lost
You build new bone throughout your childhood and early adulthood. Most people reach peak bone mass between the ages of 25 and 30. Bone mass in most individuals starts to decline around age 40.
Your bones are living tissue that are constantly changing and remodeling. Specialized bone cells called osteoclasts break down and absorb old bone tissue; other bone cells called osteoblasts then fill in the gaps with new bone tissue.
“Osteoblasts are cells that lay down bone, the osteoclasts reabsorb bone,” says Alejandro Badia, MD, FACS, a hand and upper extremity orthopedic surgeon at Badia Hand to Shoulder Center in Doral, Florida. “There’s a very fine interaction between them.” In people with osteoporosis, osteoclastic cells are more active than osteoblastic cells.
Certain groups of people are more likely to develop osteoporosis than others, including:
- Caucasian and Asian women
- Those with a family history of osteoporosis
- If you’ve ever broken a bone, and that risk factor increases if it was after age 50
- If you take or have taken steroid medication for arthritis, asthma, or other condition
- If you haven’t gotten adequate vitamin D or calcium intake throughout your life
- If you’re thin and have a small frame
- Women who have been through menopause
- Men over age 70
Can You Prevent Osteoporosis?
“Osteoporosis is not completely preventable, but there many things you can do to modulate the severity and how profoundly you develop it,” says Dr. Badia.
Much of osteoporosis prevention has to do with maintaining certain regular healthy habits, including weight-bearing exercise, a healthy diet, and vitamin and mineral supplementation.
A bone density scan can let you know how dense your bones are and determine your chances of breaking a bone. You should have a dual energy X-ray absorptiometry (DEXA) scan by age 65 if you’re a woman and age 70 if you’re a man. If you have risk factors for osteoporosis, you may benefit from starting bone density scans at a younger age. You should talk to your doctor about the right age and frequency for you.
Check out this osteoporosis risk calculator from the nonprofit American Bone Health.
Exercise to Help Prevent Osteoporosis
Doing weight-bearing exercise — in which your body has to work against gravity — can help lower your risk for developing osteoporosis. Bone is living tissue that responds to exercise by becoming stronger, according to the NIH Osteoporosis and Related Bone Diseases National Resource Center.
“When you bear weight, there is a phenomenon in bone that tries to minimize reabsorption,” says Dr. Badia. You need some impact in order for exercise to be weight-bearing exercise. Although walking counts as a wearing-bearing exercise, Dr. Badia recommends doing it for 25 to 30 minutes at a time for better impact on your bones.
Exercises that are weight-bearing include:
- Weight training
Exercises that aren’t weight-bearing include:
- Elliptical machine
- Recumbent bike
- Gentle yoga practices
However, it’s important to aim for a well-rounded exercise routine that includes a mix of weight-bearing cardio, strength and resistance training, and flexibility exercises. Even non-weight-bearing exercise is beneficial for your bone health because it can help with muscle strength, coordination, and balance, which can help prevent falls and related fractures.
Read more here about osteoporosis-friendly exercises to help strengthen your bones.
Foods That Help Prevent Osteoporosis
Eating the right foods is an important part of maintaining strong, healthy bones and preventing osteoporosis. The mineral calcium, which helps make bones hard, and vitamin D, which helps your body absorb calcium and has other bone health functions, get a lot of attention when it comes to bone health, but they’re not the only players. In fact, overly focusing on calcium and vitamin D at the expense of a well-rounded diet with other bone-healthy nutrients isn’t doing your skeleton any favors.
A report from Harvard researchers published in the journal Current Osteoporosis Reports concluded that “dietary approaches can be an important strategy for the prevention of osteoporosis” and “emerging evidence indicates that diet at the level of vitamins, minerals, food groups, and dietary patterns play an important role in skeletal health.”
Calcium and dairy foods
Dairy foods contain a diverse source of bone-boosting nutrients — notably calcium — though some foods appear better at building bone density and possibly preventing fractures than others, research shows. The Harvard paper pointed to research showing that higher intakes of milk and yogurt had positive impacts on bone health, while cream and cheese were not linked to better bone density. One study in the Journal of Bone Mineral Research found that people who drank the most milk (more than seven servings a week) had a 40 percent decreased risk of hip fractures compared to those who drank the least milk (less than one serving a week).
The Institute of Medicine recommends that adults get about 1,000 milligrams of calcium per day; women over age 50 and men over age 70 should get 1,200 mg daily.
Good calcium sources include: dairy products like milk and yogurt, fortified juice, tofu, and dark leafy greens.
Vitamin D is important in bone health, according to the National Osteoporosis Foundation, “both by helping your body absorb calcium and by supporting muscles needed to avoid falls.”
How much vitamin D you need for optimal bone health, however, is still up for debate. According to the NOF, most adults under age 50 need 400 to 800 IU (international units) and adults 50 and older need 800 to 1,000 IU daily. But some people may need more.
Your body makes vitamin D when exposed to sunlight and you can also get it from a small number of foods, including fish, egg yollks, and fortified products such as milk and juice.
More fish consumption may protect against bone loss, according to a study in the American Journal of Clinical Nutrition. More research is needed to understand why, but it may be due to anti-inflammatory effects of the polyunsaturated fatty acids (specifically, omega-3 fatty acids) as well as vitamin D and overall protein content.
There’s mixed research on whether protein is good or bad for your bone health. Some research has suggested high-protein diets could have a negative impact on bone health because they cause your body to leach calcium, but other research on large groups of people has found a beneficial connection between protein and bone. According to more recent research, it may be the case that protein is beneficial for bone health, but that calcium intake matters. In other words, if you eat a lot of protein, it’s good for your bones as long as you also eat a lot of calcium.
Potassium and magnesium
Higher intake of these minerals, found in many fruits and vegetables, was associated with greater bone mineral density in some studies. Potassium may affect bone metabolism by promoting calcium retention at the kidney and magnesium is needed for calcium metabolism, according to the Harvard paper.
Overall fruit and vegetable intake
The Harvard paper noted that studies have found that people with higher fruit and vegetable intakes generally have higher bone mineral density and less bone mineral density loss over time. One study found that middle-aged men and women who ate less than the recommended five servings of fruits and vegetables a day had a greater risk of hip fracture, for example. It may be that combinations of different vitamins and plant compounds (phytochemicals), including potassium, magnesium, vitamin C and carotenoids, work together to enhance bone health and reduce bone density loss.
It’s also important to cut back on certain foods and nutrients that can have a negative effect on your bones, including:
- Excess salt/sodium
- Excess alcohol
- Excess caffeine
Vitamins and Supplements to Prevent Osteoporosis
If you’re eating a healthy, well-rounded diet that’s rich in calcium, vitamin D, and other bone-building foods, is supplementation necessary?
The general thinking is that it’s usually better to get bone-boosting nutrients from food rather than from supplements. Many common foods contain multiple bone-boosting nutrients (milk has calcium, vitamin D, phosphorus, and protein, for example), which have a stronger impact than if you consumed all those nutrients in isolation.
Supplements may still be helpful, but recent research calls into question whether they can actually help prevent the consequences of osteoporosis like fractures.
A study published last year in the Journal of the American Medical Association found that calcium and vitamin D supplements don’t prevent broken bones or hip fractures in a senior population. The problem could be that most Americans aren’t getting enough calcium and vitamin D regularly through their diet or exposure to sunlight, which is why advising an aging populating to take supplements seemed like a good solution.
If you’re hitting recommended amounts, you might not need calcium or vitamin D supplements. Check with your doctor to see what she or he recommends for your diet and supplementation based on your personal risk factors and history.
Osteopenia: Understanding Early-Stage Osteoporosis
If you’ve had a bone density scan and your physician tells you that you have low bone density, but that it’s not low enough to be considered osteoporosis, you probably have osteopenia, which is a precursor to osteoporosis.
If you’re told you have osteopenia, consider it an opportunity to slow bone loss now and prevent it from progressing into full-blown osteoporosis.
Your doctor may advise you to do the following if you have osteopenia:
- Add more calcium and vitamin D-rich foods to your diet
- Take a calcium and/or vitamin D supplement
- Ramp up weight-bearing exercises
- Stop smoking if you haven’t already
- Cut back on caffeine
- Drink less alcohol
Medications That Help Prevent and Treat Osteoporosis
If you’ve already taken the above steps and are still at high risk of developing osteoporosis, the next steps might be taking a prescription medication to slow bone less or help rebuild bone.
Some recommended prescriptions that may be recommended for osteopenia, to prevent bone loss from osteoporosis, or to reduce the risk of fractures in people who already have osteoporosis and are at high risk of having a fracture, are:
Bisphosphonates: These oral medications can prevent bones from losing calcium. Reclast is an injectable given once a year. (Brand names: Boniva, Fosomax, Actonel, Reclast, Aredia)
Raloxifene: An oral medication that can reduce vertebral fracture risk, often in postmenopausal women. (Brand name: Evista)
Hormone therapy: Hormone replacement therapy, including oral and other forms of estrogen, are sometimes used in postmenopausal women to help slow the natural loss of bone density that occurs after hormonal changes during menopause.
Teriparatide: An injection that stimulates osteoblastic bone formation so the bone’s quality and mass can be improved. (Brand name: FORTEO)
Abaloparatide: An injection that stimulates osteoblastic bone formation so the bone’s quality and mass can be improved. (Brand name: Tymlos)
Denosumab: An injection that can help prevent bone loss and reduce the risk of fractures. (Brand name: Prolia)
Romosozumab: An injection that blocks the effects of a protein involved in bone breakdown and works mainly by increasing new bone formation. (Brand name: Evenity)
Some of these newer injectable drugs have “black box” warnings, which is the strictest kind of warning the FDA can issue, because they can have serious or life-threatening side effects for some people. In many cases, the benefits of taking the drug will still outweigh the potential risks, but you should talk to your doctor about which bone-protecting medications are right for you.