Strong and Healthy Bones: A Simple Guide to Maintaining Bone Health

I just had my first DEXA scan; it was a piece of cake and a check-the-box affirmation that my bones were healthy. I get plenty of calcium from things like cottage cheese and Greek yogurt, and I’ve been weight training for 25 years.

Go in, lie down, zip, zap, zoom, take a few pictures, and be done. Easy peasy, lemon squeezy!

Until—I got the results and read the word osteopenia.

Rather than panic, I turned to my friend and colleague, Dr. Stef, to learn everything there is to know about bone health, especially for those of us who are peri to post-menopause.

In this article, Stef explains in simple terms why bone density is essential, the risk factors, when and how to test, and the role estrogen plays in bone health. You’ll learn how to use nutrition, strength training, vitamins, minerals, and healthy life choices to support optimal bone health.

Take it away, Dr. Stef…

Today, we’re diving into the essential topic of bone health. It also happens to be one of my favorite topics! Let’s explore why maintaining bone density is crucial, what affects it, and actionable steps you can take to keep your bones strong and healthy.

Why Bone Density is Important

As we age, our bone density naturally decreases, increasing the risk of conditions like osteopenia and osteoporosis.

Osteopenia and Osteoporosis

These conditions exist on a continuum relative to healthy bone. Osteopenia represents about a 10% reduction in bone mineral density compared to a young, healthy adult. Osteoporosis is a more severe reduction, around 25%.

Factors Determining Who May Be at Higher Risk of Poor Bone Health

• Family history
• Genetics, which accounts for up to 50% of bone health
• Having either parent with a history of a hip fracture
• High exposure to drugs that affect bone metabolism, most commonly corticosteroids (including inhaled ones)

When Should You Have A Bone Mineral Density Scan (DEXA)?

According to the American Association of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Preventive Medicine, the International Society of Clinical Densitometry, and the National Osteoporosis Foundation, the standard recommendations are as follows:

• High-Risk Individuals: Starting at age 50. The WHO recommends screening females at age 40 if they are considered high-risk.
• Women: Typically recommended at age 65.
• Men: Typically recommended at age 70.

Risk Analysis: What Impacts Our Bone Density?

When assessing bone health, personal risk factors and DEXA scan results should be considered in the context of other factors known to influence bone density. This deeper level of assessment can provide a comprehensive overview of one’s risk profile.

• Smoking History: Smoking can directly impact the density of bones. It’s an independent risk factor for low bone density, especially in youth. Early smokers have the worst bone density compared to late and never smokers.
• Biological Sex: Females are at higher risk due to lower peak bone mass and menopausal hormonal changes. While females maintain a reasonable plateau, bone density tends to fall quite steeply in midlife due to the rapid loss of estrogen during menopause. This effect can be buffered with the timely use of hormone therapy.
• Age: Bone density peaks around age 30. After this, it slowly decreases. For females, bone loss accelerates around the onset of menopause before stabilizing about 10 years post-menopause.
• Menopause: As mentioned, females experience a significant drop in bone density due to menopausal hormonal changes. Bone health should be a consideration for females as they decide whether
• makes sense for them.
• Lifestyle Factors: Physical activity level (including weight-bearing activities), nutrition, and habits like smoking can impact bone health. Smoking is an independent risk factor for low bone mineral density (BMD).

At What Age Does Bone Density Start Declining?

Bone density peaks around age 30. After this, it slowly decreases, especially in the absence of proper nutrition, adequate energy balance, and lots of physical activity—specifically physical activity that builds muscular strength. For females, this decline accelerates after natural or surgical menopause without hormone therapy.

How Menopause Impacts Bone Density and The Role of Estrogen

Menopause is associated with a natural shift in hormones, most notably estrogen. Estrogen, a hormone that helps maintain bone density, is responsible for the rapid bone loss experienced in the first 10 years after the onset of menopause. In fact, bone loss can be 3 to 7% annually for 7 to 10 years from the onset of menopause. By age 65, the rate of bone loss slows, so it might be half a percent to 2% per year.

Estrogen plays a crucial role in bone remodeling. It helps regulate the signaling process that tells your bones to deposit more tissue in response to stress. After menopause, the drop in estrogen reduces this signal. You can still support your bone health with strength training—and you should; however, your efforts have more leverage with estrogen on board.

The Opportunity of Perimenopause

There’s a critical period before menopause when increasing bone mass can be highly beneficial. Strength training during perimenopause, when estrogen is still present, helps build stronger bones to better withstand post-menopausal decline.

The Science Behind Strength Training

When you lift weights or do weight-bearing exercises, your muscles, and tendons exert stress on your bones. This stress stimulates bone cells to produce more bone tissue, strengthening your bones. Even without estrogen, exercise is the single most crucial tool for building and preserving bone density.

Supporting Bone Health: What Can We Do?

Nutrition

When we consider the micronutrient side, the big dial movers are calcium, the vitamin D3/K2 combination, and magnesium. Other things matter: protein, total calories, and overall nutritional quality.

Guidelines:

• Calcium: About 1000 to 1200 milligrams daily (adjusted according to diet)
• Vitamin D3: 800 to 1000 IU daily (adjusted according to lab testing)
• Magnesium: 300 to 500 milligrams daily (type and amount according to needs)

It’s pretty tough to get 500 mg of well-absorbed magnesium in the diet every single day. Some folks may require closer to 1 gram per day. Calcium is a bit easier to obtain if you consume dairy, but many people following plant-based diets won’t eat dairy, so it’s essential to look for other sources.

These can be supplemented if you are struggling to hit these targets through food or sunlight, in the case of vitamin D3.

Strength Training

Weight-bearing and muscle-strengthening exercises are crucial. Activities like climbing stairs, walking uphill, walking with a weighted backpack, and lifting weights help stimulate bone formation. These activities apply more strain, which is why they are more effective. Try this 15-minute RESTORE Metabolic Strength Workout.

Movement

On the flip side, low-impact activities like walking, swimming, and cycling don’t significantly improve BMD. But when you make those things a little bit harder, like walking with a rucksack (weighted backpack) or walking uphill, you’ll have a larger effect on bones. You need to apply force if you want to influence your BMD!

Energy Balance and Weight Loss

When people lose significant amounts of weight through caloric reductions, they’re usually losing lean tissue as well. It’s one of the trade-offs, and for some people, it’s reasonable, especially since being overweight increases our risk of metabolic disease. If weight loss is a goal, paying attention to protein intake while prioritizing strength training can help preserve lean muscle mass while losing fat. Folks who reduce caloric intake in combination with significant exercise actually tend to slightly increase their bone mineral density.

Actionable Tips for Strong Bones

• Eat a Nutrient-Dense Diet: Ensure adequate intake of calcium, vitamin D, and other bone-healthy nutrients. Sufficient caloric and protein intake also matter.
• Stay Active by Leveraging the Right Activities: Incorporate weight-bearing and muscle-strengthening exercises into your routine, and sprinkle in other activities that you enjoy.
• Avoid or Stop Smoking: Smoking can decrease bone density.
• Monitor Bone Health: Discuss with your doctor when to start bone density screenings.
• Consider Supplements: If your diet lacks essential nutrients, talk to your healthcare provider about supplements and the correct dose for your needs.

Summary

The most important thing is to be adequately nourished and very active, particularly in activities that load bones—strength training! Taking care of your bones is an investment in your overall health and well-being. Start today with these simple, actionable steps to ensure your bones remain strong and healthy for years to come!