How to keep your bones strong

How to keep your bones strong

It's never too early — or too late — to protect your bones from osteoporosis. What follows is an action plan to develop and maintain strong bones for a lifetime. These steps will help reduce your risk of osteoporosis.

Even if you've been told that you have osteoporosis or an increased risk of fracture, these same steps can help keep your bones as healthy as possible.

Follow a bone-healthy diet

If your mother told you to drink milk to keep your bones strong, that was sound advice. Good bone health starts with good nutrition. Your body needs protein, minerals and vitamins to make and regenerate bone. Even though as an adult you might not still be drinking milk, there are plenty of other ways to get the nutrients needed for bone health.

To keep your bones healthy, nutrition is essential! You need a balanced diet that includes enough calcium, vitamin D and other nutrients.


Because calcium is a major component of bone, you need adequate amounts of this mineral throughout life to achieve and maintain peak bone mass. A diet that is low in calcium contributes to diminished bone density, early bone loss and an increased risk of fractures.

Women between the ages of 19 and 50 need 1,000 milligrams (mg) of calcium a day to maintain strong bones, and for women over age 50, the recommended daily amount is 1,200 mg. Men ages 19 to 70 need 1,000 mg of calcium a day to maintain strong bones, and for men over age 70, the recommended daily amount is 1,200 mg.

Dietary sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products, such as tofu. An 8-ounce (240 milliliter) glass of milk provides 300 mg of calcium. Many calcium-fortified foods are also available, including cereals, juices, breakfast bars and pastas. Because the typical diet provides much less calcium than recommended, a calcium supplement can help make up the difference. Calcium supplementation has been shown to improve bone mineral density by 1 to 2 percent. Taking calcium without vitamin D may not prevent fractures.

Vitamin D

Although most people know that calcium is critical for bone health, vitamin D is just as important. Your body needs vitamin D to absorb calcium. A lack of vitamin D can weaken bones and increase the risk of fracture.

The dietary sources of vitamin D are fatty fish, such as tuna and sardines, as well as egg yolks and fortified milk or other products. The primary source of vitamin D is sunlight; however, many people, especially those who live in northern latitudes and older people, don't get enough sun exposure to provide adequate vitamin D. Therefore, a dietary supplement may be recommended.

The supplemental amount of vitamin D recommended by the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) is 600 to 800 international units (IU) daily. However, some experts recommend a higher daily amount, especially for individuals who have a vitamin D deficiency. A health care professional can order a simple blood test to determine a possible deficiency.


Magnesium is another mineral that can contribute to bone mineral density. Magnesium helps keep calcium in the bones and out of the blood vessels and other soft tissues. Food sources of magnesium include green vegetables, almonds, black beans, kidney beans, nut butters and whole-wheat bread. Magnesium supplements may also be helpful if a blood test shows that magnesium is low.

Vitamin K

Vitamin K is needed for normal bone metabolism and helps prevent excess bone loss.

Vitamin K is found in leafy green vegetables such as spinach, kale and broccoli, as well as peas and green beans. If blood levels of vitamin K are low, the vitamin can be taken as a dietary supplement, either alone or in combination with other bone support nutrients.

Some nutrients can influence your bone health both positively and negatively:


This nutrient is important for normal development and maintenance of bones and tissues. However, phosphorus consumption has risen in recent decades with increased use of food additives and the consumption of carbonated beverages. Excessive phosphorus might have an adverse effect on your skeleton, possibly increasing the risk of low bone density. Stick with fresh, whole-food options and non-carbonated beverages when possible to minimize these effects.


Sodium chloride, the main component in table salt, increases calcium excretion through the urine. A diet that's high in sodium might adversely affect the calcium balance in your bloodstream, so aim to take in no more than 2,300 mg a day.

Move your body

Being physically active is another key component in preventing osteoporosis. Studies show that regular exercise early in life helps young people achieve a higher peak bone mass. During the adult years, exercise can help slow bone loss, maintain posture and strengthen cardiovascular health. Exercise also improves balance, coordination and muscle strength — all of which reduce the risk of falling and breaking a bone.

You don't have to run a 5K or go to the gym every day. Moving around throughout the day is good for you. Every bit of activity helps. Any weight-bearing exercise, such as walking and climbing stairs, can help slow bone loss, improve muscle tone and reduce the risk of falls. Your bones also benefit from resistance exercises, which can involve the use of weights.

Tai chi, a gentle series of slow, flowing movements and stretching, can be helpful. Research suggests that tai chi is a safe alternative to conventional exercise for postmenopausal women to maintain bone mineral density. Tai chi can also improve balance to help reduce the risk of falls.

Avoid smoking and excessive alcohol use

Along with eating a balanced diet and staying physically active, other lifestyle factors can affect bone health, including not smoking and limiting alcohol consumption.

Research indicates that smoking can increase the rate of bone loss. Women who smoke have lower estrogen levels than women who don't smoke. Smokers also tend to undergo menopause earlier than nonsmokers, and cigarette smokers tend to be thinner. All of these factors can increase the risk of osteoporosis and fractures.

Studies indicate that consuming more than a moderate amount of alcohol can hasten bone loss and reduce your body's ability to absorb calcium. Alcohol can also adversely affect the hormones that regulate calcium levels and reduce the formation of new bone. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

Conventional medications for osteoporosis prevention

Medications are often prescribed for people at high risk of developing osteoporosis. Most prescription medications for osteoporosis are called bone anti-resorptive agents. The term refers to the action of slowing or stopping the breakdown of bone tissue (resorption). By putting the brakes on bone removal, anti-resorptive agents can help bone formation keep pace. This often allows bone density to increase over time.

Common drugs used for this purpose include bisphosphonates, such as alendronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel); denosumab (Prolia, Xgeva); raloxifene (Evista); and calcitonin (Calcitonin-Salmon, Fortical, Miacalcin).