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If you ask people what health concerns they have, bone health often isn’t at the top of the list, or on the list at all. But every 20 seconds, someone in the U.S. breaks a bone as a result of osteoporosis, according to the National Osteoporosis Foundation (NOF).

“Unfortunately, because we don’t see it, many people tend to take it for granted, but bone health is an integral part of overall well-being,” explains Susan Randall, senior director of science and education for the NOF. “It’s important to keep the skeleton strong to stand, move and bend — critical components of staying mobile and independent throughout life. “

Osteoporosis is a bone disease that occurs when the body loses too much bone or fails to make enough bone. As a result, bones become weak and break easily. It is an issue that impacts many, as one in two women will break a bone during her lifetime, with osteoporosis responsible for 2 million broken bones and $19 billion in costs annually, according to the NOF.

The best way to reduce your risk of fractures is to take steps now to build and maintain strong, healthy bones far into the future.

Improving Bone Health

 A combination of diet and exercise is necessary for good bone health at every age. Calcium is deposited and withdrawn daily from your bones, and if you don’t take in a sufficient amount of calcium, you could be withdrawing more than you’re depositing.

Calcium supplements are widely available, but taking a pill may not be the optimal way to get it. “When calcium supplementation was studied, researchers questioned whether taking too much contributes to increased risk of cardiovascular issues, so it’s important to talk with your doctor and weigh the benefits and risks to determine what’s best for you,” says Dr. Aarti Malik of NorthShore University HealthSystem.

Turns out your parents were right to encourage you to drink your milk though, as, according to Malik, “So far no one has suggested ill effects with dietary calcium intake.”

Milk and dairy products are excellent sources of calcium, but they are not the sole sources. “For people who are following non-dairy diets, many of the soy and almond milks are fortified with calcium,” says Malik. Broccoli and leafy green are also good sources of calcium in the diet.

The body also requires sufficient levels of vitamin D to ensure calcium absorption.

“Living in Chicago, vitamin D deficiency is a fairly common problem and supplementation can help with that,” says Malik, noting that 1,000-2,000 units a day is sufficient for most individuals. She adds that, unlike calcium, one’s level of vitamin D can be monitored with a simple blood test.

Maintaining a healthy weight is also important for bone health, as being underweight increases the chances of fractures and bone loss.

The Surgeon General’s Report on Bone Health and Osteoporosis emphasizes that weight-bearing and muscle-strengthening exercise is another important part of keeping bones strong and healthy.

Growing Strong Bones

Parents who want to help kids grow strong bones need to pay attention to their children’s diets, as most kids do not get enough calcium to help ensure optimal peak bone mass, according to the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. This is particularly concerning given the large amount of bone growth that takes place during childhood.

“Kids have a window of opportunity between ages 9 and 14. During that time they will build more bone than they ever lose in their entire lifetime,” says Kathleen Cody, executive director of American Bone Health and the Foundation for Osteoporosis Research. Eighty percent of a person’s skeleton is built by age 20.

In addition, the American Academy of Pediatrics recommends that all kids be supplemented with vitamin D.

Exercise also plays a crucial role in forming strong bones during childhood and the NOF recommends that children and teens be active every day and get at least 60 minutes of moderate exercise. Fun activities like jumping rope, playing hopscotch and running around the park provide great weight-bearing exercise that helps children build bone density that will benefit them far into the future.

Bones continues to grow and strengthen during the teen years and into the twenties, which is why Malik says it is important to pay attention to calcium and exercise during those life stages.

Bone Loss

Unfortunately, a certain amount of bone loss over time is inevitable. After about the age of 30, the body stops making new bone. Bone density declines with age, and accelerates for women after menopause with the decline of estrogen, which is important to bone building.

“Loss of bone density is a normal consequence of aging and while we do have some treatments and ways to manage it, it’s not a rare or unusual thing,” explains Malik.

She says getting older is not a signal to just give up though, and emphasizes that staying active is beneficial not only for bones and joints, but for all other aspects of health.

“Following menopause, women need to be super vigilant about what they are doing to maintain bone health. They will lose bone density but can minimize the impact by doing other things right,” says Cody.

Older Individuals

Many bone breaks are the result of falls, so Cody urges people to take steps to make their home safe. Simple tasks like moving extension cords that could trip someone, removing throw rugs and ensuring that there’s proper lighting can be helpful. “If we can keep people on their feet, we can prevent them from breaking a bone,” says Cody.

Women should have a baseline bone density test by 65, sooner if they have a family history of bone breaks. Men should have a bone density test by age 70.

Men Need to Pay Attention to Bone Health, Too

Bone health is not just a women’s health issue. It’s true that men are less likely to break a bone, but that doesn’t mean broken bones are a rare occurrence for men. One in four men break a bone at some point in life, and as they get older, the consequences can be more dire for men than for women. Men are more likely than women to die within a year of breaking a hip.

Controversy Over Medication

While all medications have side effects, the ones that accompany drugs to treat osteoporosis have come under fire recently, including in The New York Times. Malik says that patients are less likely to get and fill prescriptions for osteoporosis medications than they were several years ago.

“There are a number of medications available now that have a long track record of effectiveness and safety, but because of fears about very rare side effects, many patients do not take any of these drugs to reduce their risk of fractures,” says Randall.

“We need to stop saying ‘risk for osteoporosis’ and start saying ‘risk for fractures.’ An analogy is with cholesterol and heart attack. We don’t say ‘risk for high cholesterol.’ We say ‘risk for heart attack’ and measure that with a cholesterol blood test. Osteoporosis is determined by the test, the DXA scan, and if you have it, you are at risk for fractures,” says Randall.

“Nobody thinks twice about drugs for heart attacks, but they do when it comes to medication for osteoporosis. People are willing to take a chance with hip fractures, but they really do need to weigh risks and benefits,” says Cody, noting that people underestimate the risks associated with fractures and fail to consider that 25 percent of those who enter the hospital with a hip fracture die within the year.

That balancing act is different for each patient, and Malik says that, as a result, addressing bone health has become more nuanced and individualized. “People are encouraged to get the facts, talk with their physician or other trusted healthcare professional, and make a rational decision, not an emotional one,” says Randall.

Make a Difference

In addition to taking care of your bones and helping loved ones do the same, there are other ways you can get involved in the fight for good bone health and against osteoporosis.

American Bone Health welcomes volunteers and offers training four times a year. You can find more information here.

You can donate to the National Osteoporosis Foundation here. The NOF also works to ensure that patients have access to testing and you can find ways to support those efforts, as well as upcoming events on their website here.


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