Strong bones support us and allow us to move. They protect our heart, lungs, and brain from injury. Our bones are also a storehouse for vital minerals we need to live. Weak bones break easily, causing terrible pain. You might lose your ability to stand or walk. And as bones weaken, you might lose height.

Silently and without warning, bones may begin to weaken early in life if you do not have a healthy diet and the right kinds of physical activity. Many people already have weak bones and don’t know it. Others are making choices that will weaken their bones later.

Weak bones cause the spine to collapse.

There are several kinds of bone disease. The most common is osteoporosis. In this disease, bones lose minerals like calcium. They become fragile and break easily. With osteoporosis, your body’s frame becomes like the frame of a house damaged by termites. Termites weaken your house like osteoporosis weakens your bones. If you have severe fractures from osteoporosis, you risk never walking again. Weak bones can break easily. This can be fatal.

Fragile bones are not painful at first. Unfortunately, most people don’t realize they have weakened bones until one breaks. By that time, it is hard to make your bones strong again.

Osteoporosis causes weak bones.

The good news is that you are never too old or too young to improve your bone health. There are many things you can do to keep bones strong and prevent fractures. At all ages, a diet with enough calcium and vitamin D, together with weight-bearing physical activity every day, can prevent problems later. You can work with your doctor to check out warning signs or risk factors. When you are older, you can have your bones tested and take medicine to strengthen them.

Why does bone health matter?

Our bones support us and allow us to move. They protect our brain, heart, and other organs from injury. Our bones also store minerals such as calcium and phosphorous, which help keep our bones strong, and release them into the body when we need them for other uses.

There are many things we can do to keep our bones healthy and strong. Eating foods rich in calcium and vitamin D, getting plenty of exercise, and having good health habits help keep our bones healthy.

But if we don’t eat right and don’t get enough of the right kinds of exercise, our bones can become weak and even break. Broken bones (called fractures) can be painful and sometimes need surgery to heal. They can also cause long-lasting health problems.

But the good news is that it is never too late to take care of your bones.

What is osteoporosis?

There are many kinds of bone diseases. The most common one is osteoporosis (AH-stee-oh-por-OH-sis). With osteoporosis, our bones become weak and are more likely to break. People with osteoporosis most often break bones in the wrist, spine, and hip.

Our bones are alive. Every day, our body breaks down old bone and puts new bone in its place. As we get older, our bones break down more bone than they put back. It is normal to lose some bone as we age. But, if we do not take steps to keep our bones healthy, we can lose too much bone and get osteoporosis.

Many people have weak bones and don’t even know it. That’s because bone loss often happens over a long period of time and doesn’t hurt. For many people, a broken bone is the first sign that they have osteoporosis.

Who gets osteoporosis?

There are many things that can increase your chances of getting osteoporosis. These things are called “risk factors.” Some risk factors are things you can control, and some things are outside of your control.

Risk factors you can control:

• Diet. Getting too little calcium can increase your chances of getting osteoporosis. Not getting enough vitamin D can also increase your risk for the disease. Vitamin D is important because it helps the body use the calcium in your diet.
• Physical activity. Not exercising and not being active for long periods of time can increase your chances of getting osteoporosis. Like muscles, bones become stronger – and stay stronger – with regular exercise.
• Body weight. Being too thin makes you more likely to get osteoporosis.
• Smoking. Smoking cigarettes can keep your body from using the calcium in your diet. Also, women who smoke go through menopause earlier than those who don’t smoke. These things can increase your risk for osteoporosis.
• Alcohol. People who drink a lot are more likely to get osteoporosis.
• Medicines. Certain medicines can cause bone loss. These include a type of medicine called glucocorticoids (gloo-ko-KOR-ti-koids). Glucocortiocoids are given to people who have arthritis, asthma, and many other diseases. Some other medicines that prevent seizures and that treat endometriosis (en-do-me-tree-O-sis), a disease of the uterus, and cancer can cause bone loss, too.

Risk factors you cannot control:

• Age. Your chances of getting osteoporosis increase as you get older.
• Gender. You have a greater chance of getting osteoporosis if you are a woman. Women have smaller bones than men and lose bone faster than men do because of hormone changes that happen after menopause.
• Ethnicity. White women and Asian women are most likely to get osteoporosis. Hispanic women and African American women are also at risk, but less so.
• Family history. Having a close family member who has osteoporosis or has broken a bone may also increase your risk.

Am I really at risk?

Because more women get osteoporosis than men, many men think they are not at risk for the disease. Many Hispanic and African American women are not concerned about their bones either. They believe that osteoporosis is only a problem for white women. However, it is a real risk for older men and women from all backgrounds.

Also, people from certain ethnic backgrounds may be more likely to have other health problems that increase their risk for bone loss. If you have one of the following health problems, talk to your doctor about your bone health:

How do I know if I have osteoporosis?

Since osteoporosis does not have any symptoms until a bone breaks, it is important to talk to your doctor about your bone health. If your doctor feels that you are at risk for osteoporosis, he or she may order a bone density test. A bone density test measures how strong – or dense – your bones are and whether you have osteoporosis. It can also tell you what your chances are of breaking a bone. Bone density tests are quick, safe, and painless.

What can I do to make my bones healthier?

It is never too early or too late to take care of your bones. The following steps can help you improve your bone health:

• Eat a well-balanced diet rich in calcium and vitamin D. Good sources of calcium include low-fat dairy products, and foods and drinks with added calcium. Good sources of vitamin D include egg yolks, saltwater fish, liver, and milk with vitamin D. Some people may need to take nutritional supplements in order to get enough calcium and vitamin D. The charts below show how much calcium and vitamin D you need each day. Fruits and vegetables also contribute other nutrients that are important for bone health.

Recommended calcium and vitamin D intakes

Definitions: mg = milligrams; IU = International Units
Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2010.

• Get plenty of physical activity. Like muscles, bones become stronger with exercise. The best exercises for healthy bones are strength-building and weight-bearing, like walking, climbing stairs, lifting weights, and dancing. Try to get 30 minutes of exercise each day.
• Live a healthy lifestyle. Don’t smoke, and, if you choose to drink alcohol, don’t drink too much.
• Talk to your doctor about your bone health. Go over your risk factors with your doctor and ask if you should get a bone density test. If you need it, your doctor can order medicine to help prevent bone loss and reduce your chances of breaking a bone.
• Prevent falls. Falling down can cause a bone to break, especially in someone with osteoporosis. But most falls can be prevented. Check your home for dangers like loose rugs and poor lighting. Have your vision checked regularly. Increase your balance and strength by walking every day and taking classes like Tai Chi, yoga, or dancing.

Will I need to take medicine for my bones?

There are medicines to help prevent and treat osteoporosis. These include bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMs); calcitonin; parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor. Your doctor may want you to take medicine if your bone density test shows that your bones are weak and that you have a good chance of breaking a bone in the future. Your doctor is more likely to order medicine if you have other health concerns that increase your risk for breaking a bone, such as a tendency to fall or a low body weight.

To understand osteoporosis, it is important to learn about bone. Made mostly of collagen, bone is living, growing tissue. Collagen is a protein that provides a soft framework, and calcium phosphate is a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone strong and flexible enough to withstand stress. More than 99 percent of the body's calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood.

Two types of bone found in the body—cortical and trabecular. Cortical bone is dense and compact. It forms the outer layer of the bone. Trabecular bone makes up the inner layer of the bone and has a spongy, honeycomb-like structure.

The bone bank account

Think of bone as a bank account where you “deposit” and “withdraw” bone tissue. During childhood and the teenage years, new bone is added to the skeleton faster than old bone is removed. As a result, bones become larger, heavier, and denser. For most people, bone formation continues at a faster pace than removal until bone mass peaks during the third decade of life.

After age 20, bone “withdrawals” can begin to exceed “deposits.” For many people, this bone loss can be prevented by continuing to get calcium, vitamin D, and exercise and by avoiding tobacco and excessive alcohol use. Osteoporosis develops when bone removal occurs too quickly, replacement occurs too slowly, or both. You are more likely to develop osteoporosis if you did not reach your maximum peak bone mass during your bone-building years.

Women, men, and osteoporosis

Women are more likely than men to develop osteoporosis. This is because women generally have smaller, thinner bones than men have and because women can lose bone tissue rapidly in the first 4 to 8 years after menopause because of the sharp decline in production of the hormone estrogen. Produced by the ovaries, estrogen has been shown to have a protective effect on bone. Women usually go through menopause between age 45 and 55. After menopause, bone loss in women greatly exceeds that in men. However, by age 65, women and men tend to lose bone tissue at the same rate. Although men do not undergo the equivalent of menopause, production of the male hormone testosterone may decrease, and this can lead to increased bone loss and a greater risk of developing osteoporosis.

Osteoporosis prevention

Osteoporosis is preventable for many people. Prevention is important because although there are treatments for osteoporosis, a cure has not yet been found. A comprehensive program that can help prevent osteoporosis includes:

• A balanced diet rich in calcium and vitamin D.
• Weight-bearing exercise.
• A healthy lifestyle with no smoking or excessive alcohol intake.
• Bone density testing.
• Medication, when appropriate.

When you think of bones, you might imagine a hard, brittle skeleton. In reality, your bones are living organs. They are alive with cells and flowing body fluids. Bones are constantly renewed and grow stronger with a good diet and physical activity.

After your mid-30s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause, but it happens to men too.

The amount of calcium that makes up your bones is the measure of how strong they are. But your muscles and nerves must also have calcium and phosphorus to work. If these are in short supply from foods you eat, your body simply takes them from your bones.

Each day calcium is deposited and withdrawn from your bones. If you don’t get enough calcium, you could be withdrawing more than you’re depositing. Our bodies build up calcium in our bones efficiently until we are about 30 years old. Then our bodies stop adding new bone. But healthy habits can help us keep the bone we have.

Too many of us assume we are not at risk for bone loss or fractures. We believe that if we haven’t had any signs of bone damage, then our bones are strong. Because there are no obvious warning signs, even doctors often miss signs of the problem. Most of us have our blood pressure and cholesterol checked for heart health. Testing bone density is an important way to check for bone health.

The risk of osteoporosis is highest among women. It is also higher for whites and Asians than other groups. However, it’s important to remember that it is a real risk for older men and women of all backgrounds.

Here are some clues that you are at risk:

• Your older relatives have had fractures.
• You have had illnesses or have been on medications that might weaken bones.
• You are underweight.

That’s why it is important to know the risks for poor bone health at all ages. There are many “red flags” that are signs that you are at risk for weak bones. In addition, your calcium and vitamin D intake, level of physical activity, and medications should all be evaluated.

Why being active makes your bones strong

When you jump, run, or lift a weight, it puts stress on your bones. This sends a signal to your body that your bones need to be made stronger. New cells are added to strengthen your bones. If you are right-handed, the bones in your right arm are slightly larger and stronger from the extra use.

There is some natural bone loss as women and men age. As we grow older, bones can break or weaken if we don’t take steps to keep them strong. The most common breaks in weak bones are in the wrist, spine, and hip.

Broken bones in your spine are painful and very slow to heal. People with weak bones in their spine gradually lose height and their posture becomes hunched over. Over time a bent spine can make it hard to walk or even sit up.

Broken hips are a very serious problem as we age. They greatly increase the risk of death, especially during the year after they break.

People who break a hip might not recover for months or even years. Because they often cannot care for themselves, they are more likely to have to live in a nursing home.

You can prevent most falls.
Falls are not just the result of getting older. But as you age, falls become more dangerous. Most falls can be prevented. By changing some of the things listed here, you can lower the chances of falling for you or someone you love.

1. Begin a regular exercise program.
   Exercise is one of the most important ways to reduce your chances of falling. It makes you stronger and helps you feel better. Exercises that improve balance and coordination, like dancing and Tai Chi, are the most helpful. Consider joining an organized program at your local community center or gym.
2. Make your home safer.
   • Remove things you can trip over from stairs and places where you walk.
   • Remove all small rugs.
   • Don’t use step stools. Keep items you need within easy reach.
   • Have grab bars put in next to your toilet and in the bathtub or shower.
   • Use nonslip mats in the bathtub and shower.
   • Use brighter light bulbs in your home.
   • Add handrails and light in all staircases.
   • Wear shoes that give good support and have nonslip soles.
3. Ask a health care professional to review your medicines. Ask your doctor, nurse, pharmacist, or other health care professional to review all the medicines you are taking. Make sure to mention over-the-counter medicine, such as cold medicine. As you get older, the way some medicines work in your body can change. Some medicines, or combinations of medicines, can make you drowsy or light-headed, which can lead to a fall.
4. Have your vision checked.

   Poor vision increases your risk of falling. You could be wearing the wrong glasses or have a condition such as glaucoma or cataracts that limits your vision.

• Calcium is found in foods like milk, leafy green vegetables, and soybeans. Enjoy snacks of yogurt and cheese to increase your calcium. You can also take calcium supplements or eat food specially fortified with calcium.
• Your body needs vitamin D to absorb calcium. Make sure you get enough vitamin D from your diet, sunshine, or supplements.
• Like muscle, bone is living tissue that responds to exercise by becoming stronger. Even simple activities like walking and stair climbing can help strengthen your bones.

The average American eats too little calcium. And nearly half of us do not get enough physical activity to strengthen our bones.

The same healthy lifestyle that strengthens your bones strengthens your whole body. You might not hear as much about bone health as other health concerns. But healthy habits are good for all your organs, including your bones.

• Be physically active every day—at least 60 minutes for children, 30 minutes for adults. Do strength-building and weight-bearing activities to build strong bones.
• Eat a healthy diet. Educate yourself on proper nutrition. Be aware that certain foods are naturally rich in calcium and vitamin D. Get the recommended amounts of calcium and vitamin D daily.
• Reduce your risks of falling. Check your home for loose rugs, poor lighting, etc. Take classes that increase balance and strength—like Tai Chi or yoga. Make stretching a part of your workout.

Even people who know better don’t always do what’s good for their bones. Make yourself an exception. Be aware of your risks and work to reduce them. Get help from your family and friends and your doctor, nurse, pharmacist, or other health care professional. Building healthy bones begins at birth and lasts your whole life.

Many things weaken bones. Some are outside your control. If you have a family member who has bone problems, you could also be at risk. Some medical conditions can also make you prone to bone disease.

There are some things you can control:

• Get enough calcium and vitamin D in your diet at every age.
• Be physically active.
• Reduce hazards in your home that could increase your risk of falling and breaking bones.
• Talk with your doctor about medicines you are taking that could weaken bones, like medicine for thyroid problems or arthritis. Also talk about ways to take medicines that are safe for bones. Discuss ways to protect bones while treating other problems.
• Maintain a healthy weight. Being underweight raises the risk of fracture and bone loss.
• Don’t smoke. Smoking can reduce bone mass and increase your risks for a broken bone.
• Limit alcohol use. Heavy alcohol use reduces bone mass and increases your risk for broken bones.

Fast Fact

Many types of physical activity can contribute to bone health, but most people are not active enough.

Vital at every age for healthy bones, exercise is important for treating and preventing osteoporosis. Not only can exercise improve your bone health, it can also increase muscle strength, coordination, and balance, and lead to better overall health.

Why exercise?

Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. For most people, bone mass peaks during the third decade of life. After that time, we can begin to lose bone. Women and men older than age 20 can help prevent bone loss with regular exercise. Exercising can also help us maintain muscle strength, coordination, and balance, which in turn helps to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.

The best bone building exercises

Weight-bearing and resistance exercises are the best for your bones. Weight-bearing exercises force you to work against gravity. They include walking, hiking, jogging, climbing stairs, playing tennis, and dancing. Resistance exercises – such as lifting weights – can also strengthen bones. Other exercises such as swimming and bicycling can help build and maintain strong muscles and have excellent cardiovascular benefits, but they are not the best way to exercise your bones.

Exercise tips

If you have health conditions – such as heart trouble, high blood pressure, diabetes, or obesity – or if you are age 40 or older, check with your doctor before you begin a regular exercise program.

According to the Surgeon General, the optimal goal is at least 30 minutes of physical activity on most days, preferably daily.

Listen to your body. When starting an exercise routine, you may have some muscle soreness and discomfort at the beginning, but this should not be painful or last more than 48 hours. If it does, you may be working too hard and need to ease up. Stop exercising if you have any chest pain or discomfort, and see your doctor before your next exercise session.

If you have osteoporosis, ask your doctor which activities are safe for you. If you have low bone mass, experts recommend that you protect your spine by avoiding exercises or activities that flex, bend, or twist it. Furthermore, you should avoid high-impact exercise to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of people with osteoporosis.

A complete osteoporosis program

Remember, exercise is only one part of an osteoporosis prevention or treatment program. Like a diet rich in calcium and vitamin D, exercise helps strengthen bones at any age. But proper exercise and diet may not be enough to stop bone loss caused by medical conditions, menopause, or lifestyle choices such as tobacco use and excessive alcohol consumption. It is important to speak with your doctor about your bone health. Discuss whether you might be a candidate for a bone mineral density test. If you are diagnosed with low bone mass, ask what medications might help keep your bones strong.

Calcium

To keep your bones strong, eat foods rich in calcium. Some people have trouble digesting the lactose found in milk and other dairy foods, including cheese and yogurt. Most supermarkets sell lactose-reduced dairy foods. Many nondairy foods are also calcium-rich.

Calcium-Rich Foods

Vitamin D

Vitamin D helps your body absorb calcium. As you grow older, your need for vitamin D goes up. Vitamin D is made by your skin when you are in the sun. For many, especially seniors, getting enough vitamin D from sunlight is not practical. Almost all milk and some other foods are fortified with vitamin D. If you are not getting enough calcium and vitamin D in your diet, supplements can be bone savers.

Your body needs calcium and vitamin D.

The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. We need to get enough of two nutrients in particular, calcium and vitamin D, to help keep our bones strong.

What does calcium do for our bones?

Calcium is a mineral. Our bodies contain many different minerals, such as iron and magnesium, but the most abundant mineral in the body is calcium.

Also, our bones are partly made of calcium salts (mixtures of calcium with other minerals), especially calcium phosphate. Calcium phosphate hardens and strengthens bone.

Our bodies cannot make calcium. We need to get calcium from foods and drinks, and supplements when needed, to build strong bones and teeth and to keep them healthy. Healthy bones are less likely to break if we fall.

What happens to our bones without enough calcium?

Calcium does more than build strong bone. It also helps our muscles, heart, and nerves work properly.

If we do not get enough calcium in our diets, our body takes the calcium we need from our bones. Over time, this process makes bones weaker and raises the risk of osteoporosis. Osteoporosis is a disease that makes bones weak and brittle, and people with osteoporosis have a higher risk of fractures (broken bones).

How much calcium do we need?

The amount of calcium each person needs depends on their age and sex. Table 1 lists how much calcium people need every day to keep their bones strong and healthy.

Table 1

Source: National Institutes of Health Office of Dietary Supplements

What foods have calcium?

The best food sources of calcium are milk and other dairy products, like cheese and yogurt. Other food sources of calcium include:

• Fish (such as salmon and tuna).
• Leafy green vegetables (such as kale and turnip greens).
• Tofu (set with calcium).
• Small fish with bones (including sardines and canned salmon).

Some foods and drinks are fortified with calcium. A food is fortified when the manufacturer adds vitamins or minerals that the food does not naturally have. Examples of foods fortified with calcium are certain brands of juice, soymilk, oatmeal, and breakfast cereal.

Some supplements contain calcium. Talk to your health care provider if you are thinking about taking a calcium supplement.

What does vitamin D do for our bones?

Vitamin D promotes bone health in these ways:

• Helps absorb the calcium we get from food.
• Along with calcium, helps protects older adults from osteoporosis.
• Promotes healthy functioning of our muscles and immune system. We need strong muscles to help us balance and reduce the risk of falling and breaking bones.

What happens to our bones without enough vitamin D?

When children do not get enough vitamin D, they can develop rickets. With rickets, the bones are soft, weak, deformed, and painful.

In adults, too little vitamin D over time can cause:

• Osteomalacia, a painful condition that makes bones and muscles weak and more likely to bend and break.
• Osteoporosis.

How much vitamin D do we need?

Table 2 lists how much vitamin D people need every day to keep their bones healthy.

Table 2

Source: National Institutes of Health Office of Dietary Supplements

In the United States, most people do not consume enough vitamin D to meet recommended intakes. Some vitamin D can be made in the body with sun exposure. Still, many people have low vitamin D status.

What foods have vitamin D?

Not many foods have vitamin D. Some kinds of fish can provide some of the vitamin D we need each day. Examples are:

• Trout.
• Salmon.
• Tuna.
• Mackerel.

Most of the vitamin D that Americans get from food comes from fortified foods. Most milk and some yogurts in the United States are fortified with vitamin D, but most other dairy products do not have added vitamin D.

Other foods that may be fortified (check the label to be sure) include:

• Ready-to-eat breakfast cereals.
• Orange juice.

Some supplements contain vitamin D. Talk to your health care provider if you are thinking about taking a vitamin D supplement.

Talk to your doctor about bone health. Together you can evaluate your risks. Some things to discuss include your current health, your diet and physical activity levels, and your family background.

Your doctor can look at your age, weight, height, and medical history. From that he or she can determine if you need a bone density test. Broken bones are a “red flag” for your doctor. If you break a bone after the age of 50, talk to your doctor about measuring your bone density. Even if you broke a bone in an accident, you might have weak bones. It is worth checking.

Your doctor might recommend a medical test called a bone mineral density test. Bone density tests use x-rays or sound waves to measure how strong your bones are. These tests are quick (5 to 10 minutes), safe, and painless. They will give you and your doctor an idea of how healthy your bones are. All women over age 65 should have a bone density test. Women who are younger than age 65 and at high risk for fractures should also have a bone density test.

Your doctor might also want to do a blood test to check for a vitamin D deficiency or abnormal calcium levels.

If your doctor finds that your bones are becoming weaker, there are things you can do to make them stronger. You can be more physically active, change your diet, and take calcium and vitamin D supplements. If your bones are already weak, there are medicines that stop bone loss. They can even build new bone and make it less likely that you will suffer a broken bone.

Your doctor might suggest medications to help you build stronger bones. To reduce the chance that you might fall, have your vision checked. When you speak to your doctor, be prepared with a list of questions and concerns. The list on the next page should help get you started.

Fast Fact

All women over age 65 should have a bone density test.

Although osteoporosis is the most common disease that harms bones, certain other conditions can also be harmful. Your doctor can help you learn if you are at risk and can help you treat these conditions.

• Rickets and osteomalacia—Too little vitamin D causes these diseases in children and adults. They can lead to bone deformities and fractures.
• Kidney disease—Renal osteodystrophy can cause fractures.
• Paget’s disease of bone—Bones become deformed and weak, which can be caused by genetic and environmental factors.
• Genetic abnormalities—Disorders like osteogenesis imperfecta cause bones to grow abnormally and break easily.
• Endocrine disorders—Overactive glands can cause bone disease.

Fast Fact

Bone disease is often a “silent” disorder until it causes a fracture.

What to discuss with your doctor

Talk with your doctor, nurse, or other health care professional about your bone health. Use this checklist to start your discussion.

_____ Ask to check your risk for bone disease.

_____ Discuss your need for a bone density test.

_____ Talk about any fall, even ones in which you were not hurt. Tell him or her about any broken bones you’ve had.

_____ If you have fallen, ask about the need for a full evaluation. Tests include vision, balance, walking, muscle strength, heart function, and blood pressure.

_____ Go over all the medications you are taking (including over-the-counter ones). Do this at least once a year.This helps avoid dangerous drug interactions and taking higher doses of drugs than you need, which can lead to falls.

_____ Ask if your doctor checks vision. Annual vision checks can help eliminate bone-breaking falls.

_____ Know your calcium and vitamin D intake. Report your totals to your doctor.

_____ If you would like to try a new physical activity, ask about the best choices for you.

Are you at risk for weak bones?

Check any of these that apply to you.

____ I’m older than 65.

____ I’ve broken a bone after age 50.

____ My close relative has osteoporosis or has broken a bone.

____ My health is “fair” or “poor.”

____ I smoke.

____ I am underweight for my height.

____ I started menopause before age 45.

____ I’ve never gotten enough calcium.

____ I have more than two drinks of alcohol several times a week.

____ I have poor vision, even with glasses.

____ I sometimes fall.

____ I’m not active.

____ I have one of these medical conditions:

• ____ Hyperthyroidism
• ____ Chronic lung disease
• ____ Cancer
• ____ Inflammatory bowel disease
• ____ Chronic hepatic or renal disease
• ____ Hyperparathyroidism
• ____ Vitamin D deficiency
• ____ Cushing’s disease
• ____ Multiple sclerosis
• ____ Rheumatoid arthritis

____ I take one of these medicines:

• ____ Oral glucocorticoids (steroids)
• ____ Cancer treatments (radiation, chemotherapy)
• ____ Thyroid medicine
• ____ Antiepileptic medications
• ____ Gonadal hormone suppression
• ____ Immunosuppressive agents

If you have any of these “red flags,” you could be at high risk for weak bones. Talk to your doctor, nurse, pharmacist, or other health care professional.

People of all ages need to know what they can do to have strong bones. You are never too old or too young to improve your bone health.

Babies

Bone growth starts before babies are born. Premature and low-birth-weight infants often need extra calcium, phosphorus, and protein to help them catch up on the nutrients they need for strong bones. Breastfed babies get the calcium and nutrients they need for good bone health from their mothers. That’s why mothers who breastfeed need extra vitamin D. Most baby formula contains calcium and vitamin D.

Children

Good bone health starts early in life with good habits. While children and young adults rarely get bone diseases, kids can develop habits that endanger their health and bones. Parents can help by encouraging kids to eat healthful food and get at least an hour of physical activity every day. Jumping rope, running, and sports are fun activities that are great for building strong bones. Children need the amount of calcium equal to 3 servings of low-fat milk each day. If your child doesn’t drink enough milk, try low-fat cheese, yogurt, or other foods that are high in calcium. If your child is allergic to milk or lactose intolerant, talk to your pediatrician about milk substitutes.

Fast Fact

Children should get at least an hour of physical activity every day. Adults should get at least 30 minutes every day.

Teens

Teens are especially at risk for not developing strong bones because their bones are growing so rapidly. Boys and girls from ages 9 to 18 need 1,300 milligrams of calcium each day, more than any other age group. Parents can help teens by making sure they eat 4 servings of calciumrich and vitamin D-fortified foods a day. At least 1 hour a day of physical activities—like running, skateboarding, sports, and dance—is also critical. But take note: extreme physical exercise, when combined with undereating, can weaken teens’ bones. In young women, this situation can lead to a damaging lack of menstrual periods. Teens who miss adding bone to their skeletons during these critical years never make it up.

Adults

Adulthood is a time when we need to look carefully at our bone health. As adults, we need 1,000 to 1,200 milligrams of calcium, depending on our age, and at least 30 minutes of moderate physical activity every day. Activity that puts some stress on your bones is very important.

Many women over age 50 are at risk for bone disease, but few know it. At menopause, which usually happens in women over age 50, a woman’s hormone production drops sharply. Because hormones help protect bones, menopause can lead to bone loss. Hormone therapy was widely used to prevent this loss, but now it is known to increase other risks. Your doctor can help advise you on protecting bone health around menopause.

Seniors

Seniors can take steps to help prevent bone problems. Physical activity and diet are vital to bone health in older adults. Calcium, together with vitamin D, helps reduce bone loss. Activities that put stress on bones keep them strong. Find time for activities like walking, dancing, and gardening. Strengthening your body helps prevent falls. Protecting yourself against falls is key to avoiding a broken hip or wrist. All women over age 65 should have a bone density test.

Seniors should also know that recent studies conclude that anyone over age 50 should increase his or her vitamin D intake to 600 International Units (IU) per day. After age 70, 800 IU per day are needed.