How do I keep my bones healthy?

Your bones are full of living tissue that’s always working to keep you healthy. Their framework supports your whole body and protects some of your organs. They store important minerals your body needs. And new blood cells grow within the marrow, the soft tissue inside them.

Bones can also renew themselves. As old bone cells break down, new ones replace them. Throughout your childhood and teen years, your body replaces more bone cells than it loses. Your bones also get bigger and denser as you grow.

By your 30th birthday, your body has reached its peak bone mass. As you move into your 40s and beyond, your bone cells begin to break down faster than they’re replaced. And you start losing bone density.

Many people enter their older adult years with much weaker bones. This can raise their chances of having osteoporosis (brittle bones). Falls become more dangerous. You’re more likely to break a bone if you tumble. Each year:²

• 36 million older adults (age 65+) report falls.
• 3 million older adults go to the emergency room because of their falls.
• More than 32,000 older adults die because of falls.

So it’s important to support your bone health. You want to keep your bones strong and healthy throughout your life and especially as you get older.

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You can support your bone health in many ways. Two great ways are eating foods that help make your bones strong and getting plenty of exercise.

What are the best foods to eat to keep my bones strong and healthy?

Eating healthy meals is one of the best ways to help keep your bones strong.³ Some foods you’ll want to eat include:

• Foods rich in the mineral calcium, such as:
  • Almond milk, rice milk, soy milk and other fortified plant-based milks
  • Bok choy
  • Broccoli
  • Canned shrimp
  • Cheese
  • Cow’s milk
  • Dark leafy vegetables (such as collard greens, broccoli rabe and kale)
  • Dried figs
  • Oatmeal (fortified)
  • Orange juice (fortified)
  • Oranges
  • Salmon and sardines (canned, with bones)
  • Soybeans
  • Tofu
  • Yogurt

Every cell in your body uses calcium. The mineral also makes up part of your bone structure and is stored in your bones. If you don’t get enough calcium, your body can take it from your bones, weakening them.

• Foods rich in vitamin D, such as:
  • Beef liver
  • Cod liver oil
  • Egg yolk
  • Fortified cereals
  • Fortified cow’s milk and plant-based milks
  • Fortified orange juice
  • Salmon
  • Sardines
  • Swordfish
  • Tuna

Vitamin D is a key nutrient in keeping your bones healthy. It helps your body take in calcium, which is important for bone health. Your body can also make vitamin D when your skin is exposed to sunlight. But you’ll need to also protect your skin from too much sun, which can increase your risk of developing skin cancer.

• Foods rich in protein, such as:
  • Beans, chickpeas and lentils
  • Beef
  • Chicken
  • Corn
  • Cow’s milk and fortified plant-based milks
  • Eggs
  • Fish
  • Nuts
  • Rice
  • Soy

Eating enough protein helps build strong muscles, which helps support and strengthen your bones. It also helps your body soak up calcium.⁴

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Can I still get enough calcium if I don’t drink milk or eat dairy?

The simple answer is yes. Maybe you’re allergic to cow’s milk or dairy products or you don’t eat them because you’re a vegan. But plenty of plant-based milks have calcium added to them, such as:

• Almond milk
• Cashew milk
• Oat milk
• Rice milk
• Soy milk

Many plant-based milk products, such as vegan yogurt and cheese, have added calcium. Other foods that are a good source of calcium include:

• Almond butter
• Broccoli
• Dark leafy greens such as collard greens and kale
• Dried figs
• Oranges
• Salmon (canned or fresh)
• Sardines
• Tofu and soybeans

It’s worth noting that some leafy greens such as spinach, chard and beet greens do contain some calcium. But they aren’t considered good sources of it. They can also prevent calcium from getting into your body. Still, these foods have a lot of nutrients that are helpful for other reasons.

What about a calcium or vitamin D supplement?

If your doctor has you take calcium or vitamin D, it likely won’t be a lot. Also, a recent study said that taking vitamin D might not keep you from breaking bones.⁵ So talk to your doctor before starting treatment. (Are you falling for these other bone-health myths?) 

Don’t rely only on supplements to get your daily calcium, says Michael Guma, DO. He’s the director of rheumatology at Riverside Medical Group, part of Optum, in North Arlington, New Jersey. “It’s better if it comes from your diet or a combination of diet and supplements.” He recommends taking no more than 500 milligrams of calcium at a time, with food, for the best results.

There’s no reason to go above the suggested daily amounts, he adds. It can put you at risk of problems like kidney stones. (The kidney is an organ that filters the blood.) It also could cause heart problems over time.

Most adults need:

• 1,000 to 1,200 milligrams of calcium per day; 1,500 milligrams daily if you have osteooporosis⁶
• 600 international units (IUs) of vitamin D a day
• 800 IUs of vitamin D a day if you’re over 70

What exercises are best for bone health?

Regular exercise puts “good” stress on your bones and muscles. It helps to make them stronger.³ Weight-bearing exercises force your bones to work against gravity.⁷ Some of the best exercises include:

• Climbing stairs
• Dancing
• Hiking
• Jumping rope
• Playing tennis
• Running
• Walking

“I tell people to walk 30 minutes daily,” says Jill Stanton, MD. She’s a family medicine doctor with American Health Network, part of Optum, in Indianapolis. “It’s good for your whole body: your bones, heart, lungs and muscles. And it’s also good for your mental health.”

Resistance exercises also help your bones. They work by causing your muscles to pull a little on your bones to strengthen them. These include:

• Body-weight exercises such as pull-ups, pushups and squats
• Exercises with dumbbells, barbells and kettlebells
• Medicine ball exercises
• Resistance band exercises
• Weight machines

Almost any exercise can help support strong bones and help protect you against falls. Go for activities like bike riding and swimming. They get your heart rate up and promote energy and stamina. Exercises like yoga and tai chi protect you in other ways. They improve your balance and help keep you stable and prevent falls. (Here's how to boost your workout motivation.)

If you have weak bones, talk to your doctor or a physical therapist before you start a new exercise program. (A physical therapist uses movement and exercise to care for pain and weakness.) They’ll help you find the safest routine for your age, bones and activity level.

Several factors can increase your chances of having weak bones. These include:

• Age. The rate at which you lose bone tissue gets faster as you age. The rate at which you grow new bone also slows.
   
• Body size. If you’re slimmer, with thinner bones, you have less bone tissue to lose as you age. This is true for both men and women.
   

• Drinking alcohol. Heavy drinking can affect the balance of chemicals (hormones) that help keep your bones strong.⁸ It can also keep your body from making vitamin D, which helps your bones soak up calcium.

• Eating habits. You have a higher risk of weak bones if you don’t get enough calcium or vitamin D from the foods you eat. The same is true with extreme weight-loss diets or those that are low in protein.
   
• Family history. If your parent has a bone disease, for example, you may be more likely to get it, too.
   
• Low levels of physical activity. If you sit for most of the day, your bones don’t get the good stresses they need to keep strong. Being in poor shape can also make you weaker and more likely to fall.
   
• Medications. Some medications that help with the following conditions can have side effects that weaken your bones:
  • Arthritis
  • Asthma (lung problem that makes it hard to breathe)
  • Depression
  • Diabetes
  • Seizures
  • Stomach issues
     
• Other health problems. The following conditions can put you at risk of having weaker bones:
  • Gastrointestinal disease
  • Hormone-related disease
  • Rheumatoid arthritis (a form of arthritis that is painful)
  • Some cancers
     
• Race. White and Asian women are more likely to have weak bones than Black and Mexican American women. White men have a higher risk than Black or Mexican American men.
   
• Your sex. Women are about four times more likely to get osteoporosis than men. That said, men tend to have more complications when they have weak bones. Both men and women with osteoporosis tend to suffer wrist, spine and hip breaks. But breaks in the hip are most dangerous for men. More hip breaks tend to be fatal for men than women.⁹
   
• Smoking. “When you smoke, every part of your body gets less oxygen. This includes your bones,” says Dr. Stanton. “Less oxygen means less health.” Also, smokers tend to be at higher risk of bone loss and fractures. It can also make it more difficult for bones to heal after they break.10

Yes. These can include:

• Osteopenia. Your bones weaken and may become fragile. There are no symptoms. “It can lead to osteoporosis,” says Dr. Guma. If you have it, talk to your doctor. Ask how to strengthen your bones. That could be through eating habits, exercise or medication.
   
• Osteoporosis. Your bones are fragile enough to break. These can happen with a fall or with any significant stress on your hip, arm or spine. You may also have back pain or a hunched-over posture caused by changes in the bones of your spine.

What happens if I fall with weak bones?

With weak bones, a minor fall or even bending over or lifting an object could cause a painful bone break. Your bones can also take longer to heal. That can have a major effect on how you’re able to live your life, and it can even be life-threatening.

The most dangerous and life-changing fractures for older adults are hip and spine fractures. They significantly decrease the quality of life for that person, says Dr. Stanton. And many need to move into a nursing home after breaking a hip, she adds.

But you can do plenty to stay away from the dangers of breaking bones. “Prevention is really the key,” says Dr. Stanton. The earlier you start working on keeping your bones strong, the better. That way you’ll have a strong, healthy bone “bank” that you can draw on in your later years.

Your bone density is highest by the time you’re 30. The higher your density is at age 30, the more room you have to lose before you risk bone breaks, says Dr. Guma. “That’s why it’s so important for young people to eat healthy and exercise,” he adds. (In your 20s now? We’ve got health tips just for you.) 

Women are more likely than men to get osteoporosis. One reason is that women tend to have smaller, lighter bones to begin with. But they also lose more bone tissue around menopause. That’s due to a rapid drop in estrogen, which helps protect bones.

Women slowly lose bone mass until they hit menopause, according to Dr. Guma. “Then the decline happens rapidly in the next five to seven years or so,” Dr. Guma adds. After that, the rate at which women lose bone slows down. Starting around age 65, women and men tend to lose bone at the same rate.

It’s important to know that men can have weak bones, too. As many as 10 million people over 50 have osteoporosis. Two million of them are men.¹¹

Men who have health issues such as diabetes or prostate cancer may be at risk of weak bones. The care for both issues can lead to a loss of testosterone in the body. Testosterone helps bones grow and get stronger.

Your doctor can do a bone density scan to see if you have weak bones. Other names for the test are:

• Bone mineral density (BMD) test
• Dual-energy X-ray absorptiometry (DEXA or DXA) scan

This test measures how much calcium and other minerals are in your bones. You get what’s called a T-score from the test. It’s a number that compares your bones to those of a healthy 30-year-old.

If your T-score is zero, you have normal bone density. But if your score is negative, that means you may have some bone loss. The more negative the number, the weaker your bones are. A T-score of minus-2.5 or lower may mean you have osteoporosis.

If you’re a woman, you may have your first bone scan shortly after menopause, according to Dr. Stanton. You might get a bone scan earlier if you have other risk factors or a family history of weak bones.

If you’re a man, talk to your doctor about when it might be good to get a scan. Your chances of having weak bones go up if you:

• Are a heavy alcohol user
• Take steroid medicines (like cortisone or prednisone)
• Have a family history of weak bones

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What kind of medications can I take to strengthen my bones?

If your bone density scan suggests your bones are weak, your doctor may suggest you take medication to help strengthen them.

“The goal of osteoporosis care? It’s to help reduce further bone loss and improve bone density,” says Farheen Rasool, MD. She’s chief of rheumatology and neurology at Southwest Medical, part of Optum, in Las Vegas.

Treatment can also help lower your chances of breaking bones, says Dr. Guma. That can prevent a patient from physical impairment, decrease their pain and improve their quality of life, he adds.

Medication, better eating habits and exercise can all help strengthen your bones, Dr. Rasool notes. Ask your doctor about supplements. You can also expect to have regular DEXA scans and checks of your risk for bone breaks.

As with any medication, it’s important to know that it might have harmful side effects. So talk to your doctor or pharmacist.

“I make sure to discuss with my patients in detail all the possible side effects of a medication. I always tell patients to talk with their pharmacist to make sure how to take a medication,” says Dr. Rasool. “I also tell them to talk to their pharmacist. Go over the meds they’re taking. Look for any interactions that can sometimes be missed by their doctor’s clinic.”

Here are some of the options your doctor may suggest, according to Dr. Rasool:

• Bisphosphonates (Fosamax®, Actonel®, Boniva®, Reclast®). These medications help slow down bone loss and can help lower the risk of bone breaks. You can take them as a pill, a shot or an IV infusion. (An IV puts medicine directly into a vein.) They have side effects, like muscle cramps, pain and difficulty swallowing. Because of this, they’re usually given for no longer than five years. Even after you stop using them, they can help protect your bones.
   
• RANKL inhibitor (Prolia®). This type of medication can help slow bone loss. You may take it if you have osteoporosis and are at high risk for bone breaks. This includes people with brittle bones who also have prostate or breast cancer.
   
• Parathyroid hormone (PTH)/PTHrp analogs (Forteo®, Tymlos®). They help build bone density and strength. You can take them by daily self-injection and only for one or two years at a time.
   
• Sclerostin inhibitor (Evenity®). This medicine helps build bones. If you have severe osteoporosis and have already had a bone break, you can take this as a monthly shot for one year. (It’s only recommended when patients can’t tolerate other medications. It can increase the risk of heart attack and stroke.)
   
• Selective estrogen receptor modulator (SERM) (Evista®). This type of medication can help make bones denser and protect them from breaking. This medication isn't recommended for people with a history of blood clots. 

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If you have weak bones or osteoporosis, it may cover certain parts of your bone-related care.

Medicare covers a bone density scan every 24 months or more often if medically necessary.

Medicare also helps pay for an osteoporosis medication that comes in a shot you give yourself. It also will help pay for visits by a home health nurse to inject the medication if:

• You’re a woman
• You’re eligible for Part B and meet the criteria for home health services
• Your doctor certifies that you have a bone break due to postmenopausal osteoporosis
• Your doctor certifies that you can’t learn to give yourself the shot and your family members or caregivers are unable and unwilling to give it to you

Bottom line: Good bone health is a lifelong effort. It starts by having good eating habits and exercising. Also, quitting smoking and cutting back on alcohol can help. And with the right care team in place, you can follow a plan that works for you.

1. American Academy of Orthopaedic Surgeons. Healthy bones at every age. Last reviewed August 2021. Accessed August 5, 2022.
2. Centers for Disease Control and Prevention. Keep on your feet—preventing older adult falls. Last reviewed December 16, 2020. Accessed August 5, 2022.
3. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. The Surgeon General’s report on bone health and osteoporosis: What it means to you. Last reviewed December 2019. Accessed August 5, 2022.
4. Current Opinion in Clinical Nutrition and Metabolic Care. Dietary protein is beneficial to bone health under conditions of adequate calcium intake: an update on clinical research. Published January 2014. Accessed August 5, 2022.
5. The New England Journal of Medicine. Supplemental vitamin D and incident fractures in midlife and older adults. Published July 28, 2022. Accessed August 5, 2022.
6. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Calcium and vitamin D: Important at every age. Accessed August 5, 2022.
7. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Exercise for your bone health. Published December 2018. Accessed August 5, 2022.
8. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. What people recovering from alcoholism need to know about osteoporosis. Published November 2018. Accessed August 5, 2022.
9. Journal of Clinical Medicine Research. Gender disparities in osteoporosis. Published 2017. Accessed August 5, 2022.
10. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Smoking and bone health. Published December 2018. Accessed August 5, 2022.
11. U.S. Department of Health and Human Services. Osteoporosis workgroup. Accessed August 5, 2022.

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