Your Guide to Healthy Bones at Every Age How to Maintain Peak Bone Mass and Skeletal Health

Did you know your bones change throughout your 20s, 30s, 40s and beyond? Our experts explain how and suggest tips for each decade to help you maintain healthy bones and avoid osteoporosis… We think of bone as hard, sturdy and unyielding – the internal scaffolding that holds us together and helps us stand tall. That’s true. But bone is also living tissue that adjusts and evolves throughout our lives. Maintaining healthy bones doesn’t just happen; it takes work. Eat the right foods, do the right exercises, dodge the bad habits – and you’ll likely be rewarded with strong bones that resist breakage. Indulge in unhealthy activities, like partying and fad diets, and you could be stuck with a frame that’s porous, weak and easily fractured. For women, paying attention to skeletal health is critical. “Women begin life with a lower bone mass than men do,” says John Aloia, M.D., director of bone-mineral research at Winthrop University Hospital in Mineola, N.Y. “This is one reason women are more likely to develop osteoporosis [loss of bone density].” About 80% of bone mass is based on the amount you accumulate in childhood and early adulthood, Aloia says. Exactly how strong your bones become is determined largely by genetics, but also by lifestyle. “Bone mass can be increased by exercise,” he says. “Drinking milk in childhood is also associated with a higher peak bone mass.” But even though you stop growing, your bones don’t. In fact, your habits play a big role in bone strength well into old age. Read on to learn how they develop each decade, and what you can do to keep them healthy. In Your 20s: You can eat almost anything without consequence and have boundless energy to boot – but you still haven’t hit peak bone mass, when your bones are at their strongest. “The 20s are a critical period,” says rheumatologist Nathan Wei, M.D., director of the Arthritis Treatment Center in Frederick, Md. “If you engage in behavior that hurts your bones, you’ll never reach peak bone mass.” Some key strategies: Eat bone-building foods. To make sure your bones become as strong as possible, Wei recommends getting 1,000-1,200 mg of calcium every day from dairy foods such as yogurt, low-fat cheese or skim milk (about four servings a day). Make sure you’re also getting 400-800 IU of vitamin D every day, which will help you absorb that calcium, he says. (See Top Foods for Vitamin D.) Load up on other nutrients, too – including magnesium, phosphorous and vitamin K, says Marcelle Pick, ob-gyn N.P., co-founder of a women’s holistic medical clinic in Yarmouth, Maine. You’ll get magnesium in leafy greens, legumes and whole grains, and phosphorous in low-fat dairy foods, eggs and lean red meat. Vitamin K is found in leafy greens and broccoli. Avoid excessive dieting and exercising. Eating too little and following extreme exercise regimens can stop your menstrual period, Wei says, which prevents the ovaries from producing estrogen your body needs to build bone. Limit alcohol. “Alcohol slows down the activity of the osteoblasts – the cells that make bone,” says Kimberly Templeton, M.D., professor of orthopedic surgery, health policy and management at the University of Kansas Medical Center in Kansas City, Mo., and president of the U.S. Bone and Joint Decade Initiative. It happens if you drink more than two alcoholic beverages a day, she says. Imbibing more can also interfere with liver function and reduce hormones such as estrogen, she adds. Nix the cigarettes. Smoking tobacco slows down cells that make bone, interfering with the development of peak bone mass in younger people and increasing bone loss in those over 30, Templeton says. Watch your soft-drink intake. While some phosphorus is good for you, the phosphoric acid in sodas can overload your system and upset its balance with calcium – which is detrimental to bone health, Wei says. In your 30s: During your early 30s, your body’s more womanly, you may be having children for the first time and your bones become fully mature, hitting peak bone mass. “Unless there’s a lifestyle issue or a health issue, bones remain fairly stable during your 30s,” Templeton says. This is a good time to establish healthy bone habits. Here’s how: Make exercise a priority. “For healthy bones, you need to do some type of weight-bearing exercise, like walking, jumping, or running,” Pick says. These force the bones to work against your body weight, which makes them stronger. Protect your skeletal health during pregnancy. Nutrients can be lost during pregnancy and breastfeeding, so replenish them by eating foods rich in calcium and vitamin D, Wei says. You should also take a prenatal vitamin. Pay attention to your thyroid. If you develop hyperthyroidism (meaning your body produces too much thyroid hormone), you run the risk of developing osteopenia, or slightly reduced bone-mineral density – which can lead to osteoporosis, Wei says. Symptoms include frequent insomnia, heart palpitations or unexplained weight loss. And if you develop hypothyroidism (meaning your body makes too little thyroid hormone, causing fatigue, weight gain or depression and foggy thinking), you may need to take a replacement hormone. In that case, work with your doctor to make sure the dosage isn’t too high, because that can also cause bone loss and osteopenia, Wei says. In Your 40s: Forty may be the new 30, but like it or not, this is the decade when most women approach menopause, and the body produces less estrogen, Pick says. It’s also a busy period for many women, who may be juggling children, aging parents and careers. To stay on top of bone health: Consider interval training, which alternates short bursts of intense exercise with less intense recovery periods. When you’re pressed for time, this highly efficient workout technique is the quickest way to burn calories and stay fit, Pick says. Here’s how: Warm up for three minutes, then do 30 seconds of a high-intensity walk or run. Follow it with a 90-second, low-intensity cool-down. Alternate between the high-intensity and cool-down phases, and then wrap up with a three-minute cool-down. Take up weight training. With estrogen levels diminishing, strength training becomes more important, Pick says. The resistance forces bone to rebuild itself and improves both bone and muscle strength. Watch your weight. Gaining too many pounds can worsen conditions like osteoarthritis, which may limit your mobility and make it harder for you to exercise, Wei says. In Your 50s: Congratulations on reaching the half-century mark! But, alas, once you hit menopause, your ovaries stop producing estrogen, and bone loss accelerates. Your risk of osteoporosis also significantly increases. In fact, 55% of all Americans over the age of 50 are at risk for osteoporosis, and 80% of those who have the disease are women, according to the National Osteoporosis Foundation. Here’s how to handle these new challenges: Load up on fruits, vegetables and whole grains. Scottish women in their 50s who ate a lot of fruits and vegetables had higher bone density than those who ate a diet high in processed and snack foods, according to a 2010 study in the European Journal of Clinical Nutrition. And women in their 50s who ate a diet rich in fruits, vegetables and whole grains reduced their risk of fracture, a 2011 study in the American Journal of Clinical Nutrition found. Get more calcium. Winthrop University’s Aloia recommends increasing your calcium intake to 1,200 mg per day, if you haven’t already. If necessary, take a supplement to reach those levels, he says. But don’t go overboard. Too much calcium – more than 2,000 mg per day for women over 50, usually the result of overdoing supplements – has been associated with kidney stones and perhaps vascular disease, Aloia says. Take up balance exercises. Balance training becomes more important at this age, says Sharon Brangman, M.D., director of geriatrics at SUNY Upstate Medical University in Syracuse, N.Y., and president of the American Geriatrics Society. Tai chi, an ancient Chinese discipline that involves slow, fluid movements, is one of the best exercises for this purpose, she says. And it’s relaxing too. “Tai chi focuses on concentration, balance and flexibility, which are all important keys to avoiding falls,” she says. In Your 60s and Beyond: The kids are grown and you can finally enjoy a quiet house or a cruise to the Galapagos Islands. But as you age, bones become more fragile. The risk for fractures rises, making good habits and preventing falls even more important, Brangman says. Besides eating a nutritious, well-balanced diet, here’s what you need to do for healthy bones: Get your vitamin D levels tested. “Vitamin D is the only vitamin that can reduce the risk of falls,” Brangman says. “It’s also important for maintaining healthy muscles – which is critical for healthy bones.” Many people in their 60s have low vitamin D levels because they don’t spend much time in the sun – and even if they do, their skin becomes less efficient at making the vitamin, Brangman says. If you aren’t taking a vitamin D supplement, this is the time to start. Once you’re over 70, you should get 800 IU daily, according to the Institute of Medicine. (Some experts recommend more: Read Are You Deficient in Vitamin D?) Have a bone-mineral density test. The U.S. Preventive Services Task Force recommends the test for all women at age 65, and earlier if you have risk factors (such as a thin frame or a family history of broken bones). The test reveals whether you have or are at risk of osteoporosis. Mind your meds. Certain medications, such as steroids, can cause bone loss, Wei says. Other medicines or combinations of drugs can cause problems with balance and coordination, Brangman says. Sedatives and antidepressants, for instance, can potentially make you drowsy or even change your gait. If your prescriptions are causing problems with balance, talk to your doctor about switching drugs or cutting dosages, Brangman says. Keep exercising. While you may no longer want to do the high-intensity workouts you once did, it’s important to stay active. A daily 30-minute walk can help maintain bone and muscle strength and prevent unwanted weight gain, while also helping keep blood sugars and blood pressure under control, Brangman says. What’s Your Supplement IQ? You know that taking calcium supplements can help build strong bones when you don't eat enough dairy foods, but do you really know all that you should about supplements? Beyond the world of basic nutrition, there's a different solar system of weird, wacky and wonderful facts about vitamins, minerals and herbs.