Smart Guide to Bone Health

11. Add bursts of high intensity

In 2023, the journal Cureus published a systematic review of 10 studies showing that “short, intense, bone-loading exercise sessions with intermittent periods of rest” are highly effective for stimulating bone growth in postmenopausal women. High-impact activities include jumping, jogging, aerobics, stair-climbing and tennis. However, if you already have osteoporosis or low bone density, high-impact exercise could put you at risk of fractures unless you do them under supervision, Wooldridge and Hartley say. Additionally, those who already have osteoporosis should avoid exercises that involve significant twisting or hyperextension of the spine. Instead, they recommend exercising at a moderate intensity with a focus on strength training. (Always talk to your health care provider before you start a new exercise routine.)

12. Keep your body guessing

Stepping to the side and moving up and down can surprise and challenge your bones, which respond by building up density to handle those additional stresses, Wooldridge explains. A 2022 study in Medicine & Science in Sports & Exercise of 32 female long-distance runners backs this up. It shows that those who also participate in sports with multidirectional movements and start-and-stop actions had 10 percent to 20 percent greater bone strength than those who were just runners. However, it should be noted that the study focused on a younger population, so the results may not be applicable to older adults. Consider adding activities such as pickleball, tennis, dancing, step aerobics or tai chi to your routine, Wooldridge suggests. If you’re already fit, high-intensity interval training or plyometric exercises, such as jumping rope,  can also be excellent options.

13. Take up tai chi

A 2024 meta-analysis of 12 studies, published in the Journal of Orthopaedic Surgery and Research, found that tai chi may help increase bone density in postmenopausal women. Tai chi is a traditional Chinese practice that combines slow movements and postures with meditation. Researchers believe it helps build bone density because it requires shifts in body weight that put pressure on bones. Tai chi is also great for balance, which can help prevent falls, Hartley says. “A lot of people have a misconception that tai chi is easy,” he says. “If you do it right, it’s hard. It requires a lot of core abdominal strength, a lot of extremity strength and pretty good aerobic conditioning.” (Check out AARP’s Intro to Tai Chi, led by fitness expert Kathy Smith.)

EATING FOR BETTER BONE HEALTH

14. Pack enough protein

Protein plays a vital role in bone health, providing the amino acids your body needs to build and maintain bone tissue. It also boosts calcium absorption from food and supports healthy bone metabolism. A consensus paper published in Osteoporosis International and endorsed by the International Osteoporosis Foundation reviewed dozens of research studies and found that consuming more protein can reduce bone loss and lower your risk of a hip fracture, as long as you’re getting enough calcium. Weaver and the National Resource Center on Nutrition and Aging recommend older adults aim for 1.2 grams of protein per kilogram of body weight (one kilogram is about 2.2 pounds). That would be about 98 grams of protein a day for a 180-pound adult. Good sources of protein include meats such as beef, fish and chicken, as well as eggs, beans, Greek yogurt, nuts and quinoa.

15. Snack on prunes

Adding prunes to your diet could be an easy, natural way to maintain strong bones as you age, Weaver says, pointing to recent research. In a 2022 randomized controlled trial at the Pennsylvania State University, for example, she and her collaborators found that postmenopausal women who consumed five to six prunes every day for a year maintained their total hip bone mass six months and a year later, while a control group that didn’t eat prunes lost significant bone mass at the hip. 

16. Load up on vegetables

A 2023 review of 10 studies involving more than 511,000 people found that eating more vegetables is linked to a 16 percent lower risk of fractures. In fact, the study showed that for every additional serving of vegetables you eat per day, your risk of fracture drops by 14 percent. Dark leafy greens are packed with calcium and give you a solid dose of vitamin K, a nutrient that plays a crucial role in bone health by helping to regulate calcium. Yellow and orange vegetables such as carrots, sweet potatoes and squash have also been linked to strong bones.  Those vegetables, which have high levels of beta-carotene, are associated with higher bone density and a lower risk of fracture, according to 2021 review published in Nutrients.

17. Take vitamin D for calcium absorption

Vitamin D is essential for bone health because your body can’t absorb calcium without it. “If you don’t get enough vitamin D, you can eat all the calcium that you want to, but it’s not going to be absorbed from your stomach and intestinal tract into your bloodstream,” Wein says. Vitamin D is found naturally in only a few foods such as cod-liver oils, fatty fishes, egg yolks, liver and fortified milk. Sunlight also helps your body produce vitamin D, but sunscreen use, colder seasons and darker skin tones can limit absorption. In fact, studies show that many Americans are deficient. As a result, medical professionals say most older adults should take a supplement, and vitamin D is often included in calcium supplements. The Centers for Disease Control and Prevention recommends 600 international units (IU) for people ages 51 to 70, and 800 IU for those 70-plus. However, higher doses are sometimes required to maintain healthy blood levels. Talk to your primary care physician on what you should aim for.

MAKING BIG CHANGES

18. Quit smoking and vaping

Smoking cigarettes reduces blood flow to your bones, slows the production of bone-forming cells called osteoblasts and decreases calcium absorption, according to the American Academy of Orthopedic Surgeons and a 2022 review study. As a result, smokers have weaker, more fragile bones. The risks are especially concerning for older adults, with research showing that those who smoke are 30 percent to 40 percent more likely to suffer hip fractures than their non-smoking peers. E-cigarettes, or vapes, pose dangers as well: A November 2021 study published in the American Journal of Medicine Open found that people who vape with nicotine have a 46 percent higher rate of fractures than those who do not vape.

19. Limit — or avoid — alcohol

If you drink a lot of alcohol — more than three drinks a day — your risk of osteoporosis and broken bones is significantly higher, says Robert Adler, M.D., an endocrinologist and a professor of internal medicine at Virginia Commonwealth University. Alcohol is believed to be toxic to bone cells and can lead to increased excretion of calcium in the urine, Adler says. Alcohol also increases the risk of falls, which can lead to fractures. A 2022 meta-analysis that examined eight studies including 240,871 people found that consuming three alcoholic drinks a day increased the risk of hip fractures by 33 percent, while four drinks a day increased it by 59 percent compared to non-drinkers.

20. Use certain antacids sparingly

Antacids and acid suppressants reduce the amount of acid in your stomach and can prevent heartburn and stomach discomfort. One type of acid blocker, called proton pump inhibitors (PPIs), has been linked to changes in bone density and an increased risk of fracture, according to a 2024 umbrella review in the journal Bone Health. While short-term use doesn’t increase your risk of a broken bone, it rises by about 44 percent after a year of use — and the longer you take them, the higher the risk, research shows. Over-the-counter versions of these medications, sold under brand names such as Prilosec, Prevacid and Nexium, are only intended for a 14-day course of treatment and should not be used more than three times per year, according to Food and Drug Administration guidelines. That said, many patients require the long-term use of PPI and they should work with their primary care physician on how to get more calcium through their diet or through calcium citrate supplements, which medical experts say are preferred to calcium carbonate.

ADD TO YOUR HEALTHY HABITS

21. Review your medications

Many prescription medications can affect calcium absorption and lead to bone thinning and bone fragility over time, including:

• Oral steroid medications, such as prednisone, used for more than three months to treat conditions such as inflammatory bowel disease and rheumatoid arthritis;
• Certain seizure medications;
• Immunosuppressants, such as those taken after organ or bone marrow transplants;
• Hormone-blocking drugs used in breast and prostate cancer treatments.

Be sure to consult with your health care provider before making any changes to your medications.

22. Aim for 8 hours of sleep a night

Quality sleep is essential for overall health, and it plays a significant role in maintaining strong bones. During sleep, the body undergoes critical processes that support bone growth and repair, Adler explains. Strive for about eight hours of quality sleep each night. A 2021 analysis published in the journal Scientific Reports that included 12,793 subjects found that women over age 50 who sleep less than five hours a night are 7.35 times more likely to develop osteoporosis than those who get more sleep.

PREVENTING FALLS

23. Eliminate tripping hazards at home

When it comes to protecting your bones, one of the best things you can do is minimize the risk of falls, which are a leading cause of life-changing fractures. Since 6 out of every 10 falls happen at home according to the National Institute on Aging, start by promoting safety in your living space. Say goodbye to throw rugs, including the ones in your bathroom and kitchen, and replace them with non-slip mats, Wein advises. Eliminate or tape down loose electrical cords, and allow enough space to move around your furniture easily. Install bright lighting throughout your house, especially if you have dark stairwells leading from one floor to another.

24. Make your bathroom safer

Since bathrooms are a common space for falls, installing grab bars in your tub or shower is a smart move. If that’s too big of a project, there are alternatives, Hartley notes. Look for grab bars that attach via suction or handrails that clamp to the side of your tub, so you don’t have to drill or use screws. Hartley also suggests a shower chair or bench to keep you safe while washing your hair with your eyes closed. And if you tend to get up at night to use the bathroom, get a night-light to guide your way.

25. Wear shoes indoors

Research from the Department of Veteran Affairs indicates that going barefoot or wearing socks indoors can increase your risk of falls by up to 11 times compared to walking around in athletic shoes. If wearing shoes inside isn’t your style, Hartley suggests a pair of slippers with a rubber sole. Just make sure they’re not slip-ons. “Those that you just put your toes in and walk away, those are a little bit dangerous just because they don’t go around the foot,” he says. “Find something that can get around your heel.”

26. Get your vision checked

Your vision is closely linked to your risk of falling. In fact, a 2022 study published in BMC Public Health revealed those with low vision are almost twice as likely to fall and break a bone.  Regular eye checkups are important to ensure you have the right lens prescription and to monitor for potential eye diseases. In addition, if you wear bifocals, trifocals or progressive lenses, depth perception can be challenging, Hartley says, making it difficult to navigate stairs.

27. Do a few minutes of balance training every day

A 2019 study in the Cochrane Review that analyzed 39 studies involving nearly 8,000 older adults found high-quality evidence that balance and functional exercises reduce the rate of falls by 24 percent. Incorporating balance exercises into your daily routine is easier than you might think, Hartley says, and it just takes a few minutes. While you’re standing at the sink brushing your teeth or doing dishes, try standing on one foot and then the other, he suggests.  Side steps and rising onto your tiptoes are also good for balance, he says — try going from one end of the counter to another.  Additionally, depending on your specific physical needs, a physical therapist can give you other tips and exercises to improve your posture and balance.

BONE HEALTH TESTS AND TREATMENTS   

28. Ask your doctor about a PTH blood test

Your doctor may order a specific blood test to check your parathyroid hormone (PTH) level if they’re concerned about your bone health, Wein says. When your blood calcium levels are low, your body releases more PTH, so high levels can indicate you might not be getting enough calcium from your diet, he says. High PTH levels may also signal that you need more vitamin D.

29. Get a bone density scan at age 65 (women) or by age 70 (men)

One of the best ways to understand your bone health is through a bone density test, or DEXA (dual-energy X-ray absorptiometry) scan. This quick, painless series of X-rays measures how much bone you have at the spine and hip and can help detect osteoporosis before you break a bone, Calvi says. The U.S. Preventive Services Task Force recommends that all women get the test at age 65. Although the task force says there isn’t enough evidence to set a screening age for men, the Bone Health and Osteoporosis Foundation suggests men consider testing at age 70. 

30. Consider a bone scan before age 65 if you’re at higher risk

If you’re at higher risk of osteoporosis, you might not want to wait until age 65 to get a bone density scan. The U.S. Preventive Services Task Force recommends using the  Fracture Risk Assessment Tool (FRAX) to determine if you have certain risk factors. They include:

• You have extremely low body weight (body mass index under 18.5); 
• You have rheumatoid arthritis;
• You had a parent who had a hip fracture or osteoporosis;
• You have had a prior fracture;
• You’re a current smoker;
• You’re an excessive drinker (four or more drinks on any day or eight or more per week for women, and for men five or more drinks on any day or 15 or more per week);
• You have been on a steroid medication for more than three months;
• You’re a cancer survivor;
• You have hyperparathyroidism, hyperthyroidism, or you’re receiving high doses of thyroid hormone;
• You have secondary causes of bone loss caused by kidney disease, liver disease, diabetes, inflammatory disease, an organ transplant or poor nutrient absorption.

31. Ask for a density check following a broken bone

If you’ve broken a bone from a minor injury or a simple fall after age 50, your risk of having another fracture doubles, research shows. In many cases, this indicates the presence of osteoporosis. That’s why many medical professionals and the Bone Health and Osteoporosis Foundation recommend getting a bone density test if you fracture a bone after what seems like a small accident — say, falling from a standing height and breaking your wrist. “If you trip while you’re walking and you break a bone — that’s not normal,” Calvi says. “And so that’s for sure something that should trigger doing a bone density test.” 

32. Consider medications that stop bone loss

If you have osteoporosis or you are at high risk of a fracture, a variety of highly effective treatments can help strengthen your bones and reduce your risk. Medication selection depends on fracture risk — low, moderate, high or very high. Osteoporosis treatments fall into two major categories — those that prevent your bones from breaking down (anti-resorptive) and those that increase bone building (anabolic). Women and men with low or moderate fracture risk are often treated with anti-resorptive medications. The most common medications are called bisphosphonates and include alendronate (Fosamax, Binosto) and risedronate (Actonel). Bisphosphonates work well and have been around for decades, Adler says. Many are pills you take once a week or once a month, but there is also a once-a-year version given intravenously (Reclast). Denosumab is a different type of anti-breakdown drug. It’s a twice-yearly injection given to patients with more advanced osteoporosis. For severe cases of bone loss, your doctor might suggest a short-term treatment of bone-building or anabolic drugs. Even though the medications are highly effective, Wein says many patients who would benefit from them aren’t taking them. “There’s a major treatment gap,” he says. According to a 2021 article in Endocrine News, reasons for this gap range from doctors misdiagnosing osteoporosis to patients who are fearful of side effects. If you have recently broken a bone from a minor injury or have any concerns about your bone health, start a conversation with your doctor, he suggests, because bone health is “a very important part of routine health care maintenance.”