Why Bone Health Matters
1 in 2 women over 50 will break a bone due to osteoporosis.✓✓✓ Well-Established
That's more than breast cancer, ovarian cancer, and uterine cancer combined. But osteoporosis is largely preventable when you start taking action in your 30s and 40s.
What You Need to Know
- Your bones reach peak strength around age 30, then slowly start losing density—about 0.5-1% per year. ✓✓✓
- After menopause, bone loss speeds up dramatically—1-3% per year for 5-10 years due to dropping estrogen levels. ✓✓✓
- Hip fractures are especially serious: 15-20% of women die within a year (often from complications), and only 40% fully recover. ✓✓✓
- Osteoporosis has no symptoms until you break a bone. That's why it's called the "silent disease."
- Prevention works. The right nutrition, exercise, and medications (when needed) can dramatically reduce your fracture risk.
Are You at Risk?
Factors You Can't Change
Check if any of these apply to you:
- ☐ You're a woman (women have 4x higher risk than men)
- ☐ You're white or Asian (highest risk groups)
- ☐ Your mother or grandmother had osteoporosis or hip fracture
- ☐ You have a small frame or weigh less than 127 lbs
- ☐ You went through menopause early (before 45) or had your ovaries removed
- ☐ You've broken a bone after age 50
- ☐ You missed periods for 6+ months (other than pregnancy) due to low weight, excessive exercise, or hormonal issues
Factors You CAN Change
- Not getting enough calcium (less than 1,000-1,200 mg/day)
- Low vitamin D levels (very common—40% of adults are deficient)
- Not exercising, especially no strength training or weight-bearing activity
- Smoking (increases fracture risk by 30-50%)
- Drinking heavily (more than 2-3 drinks daily)
- Taking certain medications long-term: steroids like prednisone, some seizure meds, acid-blocking drugs (PPIs), or too much thyroid hormone
Speak Up: If you have multiple risk factors or take bone-affecting medications, ask your doctor: "Should I get a bone density test before the standard age of 65?" Many women benefit from earlier screening.
What You Can Do: The Foundation
1. Get Enough Calcium ✓✓✓
How much you need:
- Ages 30-50: 1,000 mg/day
- Ages 51+: 1,200 mg/day
Best food sources:
| Food |
Serving |
Calcium |
| Plain yogurt |
1 cup |
~400 mg |
| Milk or fortified plant milk |
1 cup |
~300 mg |
| Cheese |
1.5 oz |
~300 mg |
| Sardines with bones |
3 oz |
~325 mg |
| Tofu (calcium-set) |
½ cup |
~250-400 mg |
| Collard greens (cooked) |
1 cup |
~270 mg |
Example day: 1 cup yogurt (400 mg) + 1 cup milk (300 mg) + 1.5 oz cheese (300 mg) + 1 cup cooked greens (270 mg) = 1,270 mg ✓
If you need a supplement:
- Calcium citrate absorbs better and doesn't need to be taken with food (good if you take acid blockers)
- Calcium carbonate is cheaper but must be taken with food
- Take no more than 500 mg at once (your body can't absorb more efficiently)
- Don't exceed 2,000 mg total per day (from food + supplements)
2. Get Enough Vitamin D ✓✓✓
Vitamin D helps your body absorb calcium. Without enough, even high calcium intake won't protect your bones.
How much you need: 1,000-2,000 IU/day (higher end is better for bone health)
The problem: Most people don't get enough from sun or food alone. 40% of adults are deficient.
Ask your doctor to test your vitamin D level. The blood test is called 25-hydroxyvitamin D. Your level should be at least 30 ng/mL, ideally 40-50 ng/mL for bone health.
Food sources are limited: Fatty fish (salmon, mackerel), fortified milk and plant milks, egg yolks. Most people need a supplement (vitamin D3 is best).
3. Eat Enough Protein ✓✓
Protein is essential for bone structure and muscle strength (which protects bones and prevents falls).
How much you need:
- Ages 30-50: At least 1.0-1.2 g per kg of body weight daily
- Ages 50+: 1.2-1.6 g per kg daily (higher needs as you age)
Example: A 140 lb (64 kg) woman over 50 needs about 75-100 g protein daily.
Spread it out: Aim for 25-30g per meal. Good sources include chicken, fish, eggs, Greek yogurt, cottage cheese, legumes, tofu, and nuts.
4. Exercise—The Most Powerful Tool ✓✓✓
Exercise is the ONLY way to actively build bone (not just prevent loss). It also strengthens muscles, improves balance, and reduces fall risk.
Your Bone-Building Exercise Plan:
- ✓ Weight-Bearing Aerobic (4-7 days/week):
Activities where your feet and legs support your weight: brisk walking, jogging, dancing, tennis, hiking, stair climbing. (Swimming and cycling don't count—they're great for your heart but don't stress bones enough.)
- ✓ Strength Training (2-3 days/week):
Lift weights, use resistance bands, or do bodyweight exercises (squats, lunges, push-ups). Focus on major muscle groups. Gradually increase weight over time—that's what builds bone.
- ✓ Balance Exercises (2-3 days/week):
Tai chi, yoga, single-leg stands. These reduce fall risk by 20-30%.
If you already have osteoporosis: Avoid exercises that involve bending forward at the waist (sit-ups, toe touches) or twisting your spine—these can cause vertebral fractures. Work with a physical therapist to create a safe program.
5. Quit Smoking & Limit Alcohol
- Smoking directly damages bone cells and increases fracture risk by 30-50%. Quitting at any age helps.
- Heavy alcohol (more than 2-3 drinks daily) impairs bone formation and increases fall risk. Keep to 1 drink/day or less.
When to Get a Bone Density Test (DEXA Scan)
A DEXA scan is a quick, painless X-ray that measures your bone density. It tells you if you have osteoporosis or are at risk.
Standard screening age: 65✓✓✓
But you should get tested EARLIER if you have risk factors.
Get tested before 65 if you have:
- A parent who had a hip fracture or osteoporosis
- Low body weight (BMI <20 or weight <127 lbs)
- A fracture after age 50 from a simple fall
- Early menopause (before 45) or ovaries removed
- Long-term steroid use (prednisone ≥5 mg daily for 3+ months)
- Other bone-affecting conditions or medications
Understanding Your Results
Your DEXA results include a T-score, which compares your bone density to a healthy 30-year-old.
| T-Score |
What It Means |
| -1.0 or higher |
Normal – Your bones are healthy |
| -1.0 to -2.5 |
Osteopenia (low bone mass) – Your bones are weaker than normal but not yet osteoporosis. You may or may not need medication depending on your overall fracture risk. |
| -2.5 or lower |
Osteoporosis – Your bones are significantly weakened. Medication is usually recommended. |
If you have osteopenia: Ask your doctor to calculate your fracture risk using the FRAX tool (finds it at frax.shef.ac.uk). This helps determine if you need medication or just lifestyle changes plus monitoring.
Treatment Options If You Need Them
If you have osteoporosis or high fracture risk, medications can reduce your fracture risk by 30-70%. ✓✓✓
First-Line Treatment: Bisphosphonates
These medications slow bone breakdown. Most common options:
| Medication |
How You Take It |
Key Points |
| Alendronate (Fosamax) |
1 pill weekly |
Take on empty stomach with full glass water; stay upright 30 min. Most prescribed; generic available. |
| Risedronate (Actonel) |
1 pill weekly or monthly |
Similar to alendronate |
| Zoledronic acid (Reclast) |
IV infusion once yearly |
Most convenient; avoids stomach upset; very effective |
Common side effects: Heartburn or stomach upset (oral forms), flu-like symptoms for 1-3 days after first IV dose. Most people tolerate these medications well.
How long to take them: Usually 5 years (oral) or 3 years (IV), then reassess. Your doctor may recommend a "drug holiday" (temporary break) if your bones have stabilized.
Other Options
- Denosumab (Prolia): Injection every 6 months. Good if you can't tolerate bisphosphonates or have kidney disease. Important: Don't stop suddenly—bone loss rebounds quickly.
- Raloxifene (Evista): Daily pill; less effective than bisphosphonates but also reduces breast cancer risk. Good for younger postmenopausal women with mild osteoporosis.
- Bone-building medications (Forteo, Tymlos, Evenity): Reserved for severe osteoporosis or multiple fractures. These actually build new bone (not just slow loss). Expensive; require injections.
What About Hormone Therapy?
Estrogen therapy prevents bone loss and reduces fractures by 30-40%. ✓✓✓ However, it's not recommended as first-line treatment for osteoporosis due to other health risks with long-term use.
Consider hormone therapy if:
- You're having severe hot flashes AND have osteopenia or osteoporosis
- You went through early menopause (before 45) and need to take estrogen until age 50 anyway
Important: Bone protection only lasts while taking hormones. If you stop, you'll need to start a bisphosphonate to prevent rebound bone loss.
Advocate for Yourself
Questions to Ask Your Doctor
- ☐ "Given my risk factors, should I get a DEXA scan before age 65?"
- ☐ "Can you test my vitamin D level?"
- ☐ "Am I taking any medications that affect my bones?"
- ☐ "What's my T-score? Do I need medication, or can we focus on lifestyle and recheck later?"
- ☐ "If I have osteopenia, can we calculate my FRAX score to assess my fracture risk?"
- ☐ "What exercises are safe for me? Are there any I should avoid?"
Red Flags—When to Push Back or Get a Second Opinion
- You have multiple risk factors but your doctor refuses DEXA screening before 65
- You're told "everyone your age has some bone loss; don't worry about it"
- Your DEXA shows osteoporosis but your doctor doesn't discuss treatment options
- You're told to "just take calcium" without addressing vitamin D, exercise, or medication
- You've taken bisphosphonates for 5+ years without reassessing whether you still need them
- You have a fracture from a simple fall but your doctor doesn't investigate why
Remember: Osteoporosis is preventable and treatable. You deserve proactive screening based on YOUR risk factors and comprehensive discussion of all your options—not a one-size-fits-all approach.
Key Takeaways
- Start protecting your bones in your 30s and 40s—by the time you have symptoms, significant damage is done.
- Bone loss speeds up dramatically after menopause (1-3% per year for 5-10 years). This is when fracture risk really climbs.
- Get enough calcium (1,000-1,200 mg/day), vitamin D (1,000-2,000 IU/day), and protein. Most people need supplements to reach these goals.
- Exercise is the most powerful tool—combine weight-bearing activity with strength training 4-7 days/week.
- Get screened at 65, or earlier if you have risk factors. A DEXA scan is quick, painless, and tells you if you need treatment.
- If you need medication, bisphosphonates reduce fracture risk by 30-70%. They're safe and effective for most people.
- Hip fractures are life-threatening—15-20% die within a year, 50% never walk independently again. Prevention is critical.