Understanding Bone Health and Why It Matters
Bones are living tissues that constantly break down and rebuild throughout your life. This process is called bone remodeling. When you are young, new bone is created faster than old bone is removed, which increases bone mass. Most people reach their peak bone mass around age 30. After that, bone remodeling continues, but you lose slightly more bone mass than you gain.
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Your skeleton serves several critical functions beyond just holding you up. Bones protect your organs, store minerals like calcium and phosphorus, and contain marrow that produces blood cells. About 99 percent of your body's calcium is stored in your bones and teeth. When your body needs calcium for other functions, it pulls calcium from your bones, which can weaken them over time if you do not replace that calcium through diet.
Bone density refers to how tightly packed the material in your bones is. Higher bone density means stronger bones and lower risk of fractures. Osteoporosis develops when bone density decreases significantly, making bones brittle and more likely to break from a minor fall or even a cough or bump. The disease often develops without symptoms—many people do not know they have it until they break a bone.
Understanding how your bones work helps you make decisions about protecting them. Bone health is not just about preventing fractures in older age. The habits you develop now, at any age, affect your bone strength throughout your life. A woman's risk of breaking a hip due to osteoporosis is equal to her combined risk of breast, uterine, and ovarian cancer. For men, osteoporosis is less common but still serious.
Practical takeaway: Bone health is a lifelong process. Start thinking about your bones now, regardless of your age, because the choices you make today influence your risk of fractures and bone disease later.
Who Is at Risk for Osteoporosis
Certain people have higher chances of developing osteoporosis. Women after menopause face the greatest risk because their bodies produce less estrogen, a hormone that helps maintain bone density. In the first five to ten years after menopause, women can lose bone density much faster than men or younger women. About one in three women over age 50 will experience a fracture related to osteoporosis in their lifetime.
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Men also develop osteoporosis, though often later in life than women. Men over 70 have similar fracture risk to women over 70. Men experience bone loss more gradually because they do not go through a sudden hormonal change like menopause. However, conditions affecting testosterone levels can speed up bone loss in men at any age.
Several factors increase your risk of low bone density:
- Age—bone loss increases as you get older for both men and women
- Family history—genetics influence bone density
- Small body frame—people with less muscle and bone mass have higher risk
- Medical conditions—such as rheumatoid arthritis, kidney or liver disease, cancer, and diabetes
- Certain medications—including corticosteroids used for conditions like asthma and lupus
- Low calcium and vitamin D intake—your body needs these nutrients to maintain bone
- Sedentary lifestyle—bones weaken without physical activity
- Smoking and heavy alcohol use—both reduce bone density
- Hyperthyroidism and other thyroid disorders—excessive thyroid hormone increases bone loss
Some risks you cannot change, like your age or family history. However, many risk factors are within your control. Even if you have multiple risk factors, taking steps to strengthen your bones can reduce your fracture risk significantly.
Practical takeaway: Review the risk factors listed above and identify which ones apply to you. If you have several risk factors, focus first on the ones you can change—diet, exercise, and lifestyle habits.
Calcium and Vitamin D: The Foundation of Bone Strength
Calcium is the primary mineral that makes up bone tissue. Your body cannot produce calcium, so you must get it from food or supplements. An adult needs 1,000 to 1,200 milligrams of calcium daily, depending on age and sex. Women over 50 and men over 70 should aim for 1,200 milligrams per day. Getting enough calcium is especially important during childhood and early adulthood when bones are still building.
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Good food sources of calcium include dairy products like milk, yogurt, and cheese, which are among the most reliable sources. One cup of milk contains about 300 milligrams of calcium. Other options include leafy green vegetables such as kale, collard greens, and bok choy; canned fish with bones like salmon and sardines; fortified plant-based milks and orange juice; beans and legumes; nuts and seeds like almonds and tahini; and tofu prepared with calcium sulfate.
Vitamin D works alongside calcium to maintain bone health. Vitamin D helps your intestines absorb calcium from food. Without enough vitamin D, your body cannot use dietary calcium effectively, even if you eat plenty of calcium-rich foods. Vitamin D also helps regulate calcium levels in your blood. Adults need 600 to 800 international units (IU) of vitamin D daily, though some experts recommend higher amounts for people over 50.
Your skin produces vitamin D when exposed to sunlight, but many people do not get enough sun exposure to produce adequate amounts, especially in winter months or if they live in northern climates. You can get vitamin D from fatty fish like salmon, mackerel, and herring; egg yolks; mushrooms; and fortified dairy and plant-based milks. Most people benefit from both dietary sources and limited sun exposure.
If you cannot meet your calcium and vitamin D needs through food, you may consider a supplement. Talk with your doctor about whether supplements are appropriate for your situation. Taking more than recommended amounts does not provide extra bone protection and may cause other health problems.
Practical takeaway: Track your calcium and vitamin D intake for three days. Use a nutrition app or write down what you eat. Compare it to the recommended amounts. If you are falling short, add one or two calcium-rich or vitamin D-rich foods to your daily meals.
Exercise and Physical Activity for Strong Bones
Physical activity is one of the most powerful tools for building and maintaining bone strength. Bones respond to stress by becoming denser and stronger. When you exercise, your muscles pull on your bones, which stimulates bone-building cells. Exercise also improves balance and coordination, reducing your risk of falls that could cause fractures.
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Weight-bearing exercises are particularly effective for bone health. These are activities where your feet and legs carry your body weight against gravity. Walking, jogging, hiking, dancing, and playing sports are all weight-bearing exercises. Even gentle weight-bearing activity like leisurely walking provides some benefit. A study found that women who walked four hours per week had higher bone density than women who walked less than one hour per week.
Muscle-strengthening exercises also protect your bones. Resistance training, whether using weights, resistance bands, or your own body weight, creates the pulling forces that build bone. Exercises like squats, lunges, push-ups, and lifting weights are beneficial. Yoga and Pilates can build strength and improve balance, though they may not build bone as effectively as higher-impact activities.
The current physical activity guidelines recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity each week for adults. This can be spread throughout the week. Adding muscle-strengthening activities on two or more days per week is also recommended. However, something is better than nothing. Even people who have not been active can start with small amounts of activity and gradually increase.
If you have osteoporosis or low bone density, certain exercises may not be safe. High-impact activities and exercises involving twisting or bending at the waist could increase fracture risk. Talk with your doctor or a physical therapist about which exercises are appropriate for your situation.
Practical takeaway: Choose one weight-bearing activity and one muscle-strengthening activity you enjoy. Start with just 10 to 15 minutes, two or three times per week. As these activities become routine, gradually increase the time and frequency.