How to Strengthen Your Bones and Reduce Osteoporosis Risk – The New York Times

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Despite growing up with the message that “milk does a body good,” I’ve never been a fan of drinking my calcium. So when I recently stumbled across research findings suggesting that hip fractures are on the rise, I got a little panicky.
Earlier this month, researchers in Hong Kong reported, based on data from people 50 and older who had fractured their hips between 2005 and 2018, that hip fractures will nearly double worldwide by 2050. This is likely because the population is increasing and getting older.
A key cause of hip fractures is poor bone health: One study estimated that half of breaks are the result of osteoporosis, a disease characterized by a loss of bone mass. Osteoporosis afflicts some 10 million Americans, many of whom are not properly diagnosed and treated.
The study’s findings are not welcome news, given that hip fractures are extremely debilitating. “Twenty-five to 30 percent of people die within one year of a hip fracture,” said Nicole Wright, an epidemiologist at the University of Alabama at Birmingham School of Public Health.
Based on these dire predictions, I wondered what we should collectively be doing to strengthen our bones and minimize our osteoporosis risks at every age. I interviewed three researchers to find out.
Calcium is a crucial nutrient for bone health throughout our lives. Kids, teens and young adults need calcium to help build strong bones, Dr. Wright explained. The strength of our bones during youth directly affects their strength as we get older, too. We reach our peak bone density around the age of 25 or 30. Then after the age of 60 (as well as during menopause), bone density starts to drop.
You want your peak bone density in early adulthood to be as high as possible so you don’t drop too low later on, said Dr. Mara Horwitz, an endocrinologist at the University of Pittsburgh. But you need calcium beyond the age of 30, too. The body uses calcium in a number of ways, and if we don’t get enough of the mineral from our diet, our body starts taking it out of our bones, leaving them weaker, Dr. Wright said.
The best sources of calcium are dairy products — milk, yogurt, cheese — but you can also get calcium from nondairy options like almonds, fortified cereal, fortified almond or soy milk, Dr. Horwitz said, and even fortified orange or apple juice. Ultimately, you’ll want to get three to four servings of calcium-rich foods per day, she said. When I tracked my calcium intake this week, I discovered that I get only about half of my recommended intake. (This government website explains how much you should be getting based on your age and sex.)
If you don’t get enough calcium from your diet, you can take supplements, Dr. Horwitz said. Calcium carbonate is the most cost-effective option, but it can cause nausea and constipation, and it needs to be taken with food to be properly absorbed, she said. Calcium citrate is better tolerated, but more expensive.
Don’t over-supplement, though: Some research suggests that getting too much calcium increases the risk for heart disease in people over 45, and it can increase the risk for kidney stones, too. Jeri Nieves, a clinical epidemiologist and nutrition researcher at Columbia University Mailman School of Public Health, recommended not consuming more than 2,000 milligrams of calcium a day, either through diet or supplements.
Vitamin D is another key nutrient for bones, in part because it helps the body absorb calcium. According to the National Academy of Medicine, an independent nonprofit organization that provides guidelines on a number of issues, individuals between the ages of 1 and 70 should consume at least 600 international units (IU) per day, while those over 70 should get 800 IU. Foods rich in vitamin D include salmon, sardines, dairy products and fortified juices.
It can be hard to meet our vitamin D needs through dietary sources, so Dr. Horwitz often recommends vitamin D supplements — typically between 800 and 2,000 IU a day — but check with your doctor first. You can get adequate vitamin D from spending about 30 minutes a day in the sun four to five times a week, too, she said, but doing so may be harder if you wear sunscreen.
If you’re not sure whether you’re getting enough vitamin D, ask your doctor for a vitamin D blood test, she recommended. Beware that levels often drop in the winter and spring because we spend less time outdoors — so you may want to supplement in the winter months no matter what.
To maintain strong bones, experts recommended engaging in regular weight-bearing activity such as walking or running. “Walking is a weight-bearing exercise that builds and maintains strong bones and it also increases your muscle strength, coordination and balance, which can help prevent falls and fractures,” Dr. Nieves said.
Many people misinterpret the phrase “weight-bearing exercise” to mean that they should do heavy weight lifting, but that’s not the case, Dr. Horwitz said. To keep your leg, foot and hip bones healthy, all you need is to bear your own body weight as you move around, she explained. That said, to keep the bones in your upper body healthy, strengthening exercises can be helpful, but light weights will suffice, she added.
As for how much activity to aim for, Dr. Nieves cited the Physical Activity Guidelines for Americans, which recommend that adults get 150 minutes of moderate-intensity physical activity and engage in muscle-strengthening exercises at least two days per week.
In addition to getting enough calcium, vitamin D and physical activity, consider avoiding lifestyle choices that are known to weaken bones. These include drinking more than two servings of alcohol or caffeine a day, Dr. Horwitz said. Cigarette smoking reduces bone density, too, Dr. Nieves added.
Other common-sense choices can reduce your risk of fractures as well, Dr. Horwitz said. For instance, it’s rarely a good idea to walk around in socks — it’s better to go barefoot or wear rubber-soled shoes or slippers to prevent falling. Dr. Horwitz also recommended using night lights in the dark so you don’t trip. She added that assistive devices such as canes and walkers are very helpful for preventing falls and fractures when recommended by a doctor.
Also, keep in mind that although osteoporosis is most common among older women — the drop in estrogen after menopause reduces bone density — the disease also affects men, who are often underdiagnosed, as are women of color, Dr. Wright said.
Bone density scans, which are X-ray tests that measure calcium and other minerals in your bones, are recommended for women who are at least 65 and men who are at least 70. But individuals who are at higher risk for osteoporosis may be eligible for them sooner, Dr. Nieves said.
If you’ve fractured a bone in the past that wasn’t the result of a serious trauma such as a car crash or a fall from a ladder, or a parent had a hip fracture or osteoporosis, you may be at increased risk. One symptom of low bone density is a loss of height of at least two inches over the course of a year, Dr. Wright said — that’s a sign that your spine is, essentially, collapsing.
People at high risk for osteoporosis also include those with diabetes (Type 1 and Type 2) as well as people with conditions that affect nutrient absorption, such as Celiac disease or inflammatory bowel disease. People who take steroids long-term, such as for arthritis or other immune-related conditions, are also higher risk, as are people with a low body mass index, or BMI. If you fit into one of these categories, talk to your primary care physician or gynecologist about getting an early bone density scan.
Depending on the result of your scan, you may be eligible for one of a number of drugs that can be used to improve bone density and treat osteoporosis, Dr. Horwitz said.
I’m not yet eligible for a bone density scan, but I am going to starting being more proactive about my bone health. I don’t like milk, but I do like yogurt — so now I’m eating yogurt for breakfast. I’m taking a vitamin D supplement and going on daily walks. But I won’t just think about myself: I’ll encourage my husband and kids to be kinder to their bones, too. “Everyone has a skeleton,” Dr. Wright said. “Therefore, everyone should be thinking about their bone health.”
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