Healthy ideas for your inbox
You’re doing your best: taking the extra time to carefully moisturize your skin, keeping those teeth sparkling clean and watching your diet — but just what are you doing to keep your bones healthy? Yes, your bones are living tissues that need to be nurtured and cared for too, especially if you’re a woman of a certain age (hint: in your 40s).
Not sure where to start? There are plenty of ways to assess your current bone health and figure out the best way to keep in tiptop shape.
The truth about your bones as you get older
First, you probably need to start thinking about your bones differently (or perhaps just more often). Healthy bones are essential, especially as you age, because they help you maintain your independence by preventing fractures, which become more common as you get older and can severely affect your mobility and quality of life.
“I like to use the concept of a ‘bone bank account,’” says Julie Carkin, MD, director of the Strong Bones Program at UW Medical Center Northwest and UW Clinical Associate Professor of Medicine “You form bone until around age 30 and maintain that ‘bone bank account’ you’ve built until about perimenopause age, and soon after that, you’re going to start rapidly losing bone.”
And just like with a bank account, you want to keep your balance as high as you can, which is why it’s essential to understand why you lose bone, if you’re losing bone and how to slow the loss.
Why your bones get weaker
Everyone loses bone density as they age. The amount they lose and the rate at which they lose it vary from person to person. Estrogen plays a key role in maintaining bone structure, so its decrease during perimenopause and menopause causes accelerated bone loss and unwanted “withdrawals” from your bone bank account.
Your bone mineral density may be normal for your age (lucky you!). If it’s lower than normal but not low enough to pose a high fracture risk, doctors call it osteopenia. Lower still, and it’s osteoporosis, which carries high fracture risk.
“Osteopenia is especially pertinent to know, because if you go into the osteoporosis category, you’ll certainly get a less comfortable margin in your bank account,” says Carkin.
But, to be clear, it’s not just aging (and changing hormones) that can hurt your bones; some other lifestyle factors can increase your risk. These include smoking, drinking alcohol (Carkin says more than two drinks per day can contribute to bone loss and decreased quality), not maintaining a healthy weight (specifically, being underweight), and not moving your body enough.
Here’s how to help your bones
But never fear: All is not lost. There are some simple ways to maintain your bone health and help you continue moving around for years to come. Plus, anything that you do that is preventive (rather than just reacting to bad health news) always gives you an advantage. Here are some of your options for keeping your bones happy:
Look into hormone therapy
According to Carkin, it’s important to start the conversation with your primary care doctor or gynecologist about your hormone therapy options.
“Hormone therapy will help keep your bones in that premenopausal state and decrease unpleasant estrogen deficiency symptoms like hot flashes, night sweats and sleep disturbance,” says Carkin. “Hormone therapy is not right for everyone, but if you are a candidate for it, it can help both menopausal symptoms and prevent bone loss.”
Consume a healthy diet
Carkin emphasizes the importance of calcium for bone health and notes that you can usually get it from your diet (you generally need 1,000 mg to 1,200 mg a day). Good sources of calcium include yogurt, milk, almonds, salmon and soybeans. However, if you’re lactose intolerant or vegan, you might have a harder time getting the right amount and may need to look into supplements (more on that later).
Exercise, with a focus on strength training
For women, strength training is super important, and not just for your bones. Even if you prefer cardio, try adding some resistance and strength training into your routine. Not only will you feel accomplished (congratulations, great job!), but strength training also helps prevent falls and other injuries, supports balance work and can make a huge difference in reducing fracture risk.
“If you’re someone who likes to go running five times a week, maybe drop it down to three times a week and add some strength training on those other days,” says Carkin. “There’s a variety of strength training options: it can be weights, but it can also be functional body exercises.”
Get a DXA (or DEXA) scan
The DXA scan is a simple, noninvasive test that uses very low radiation (about the same amount you’d accrue flying across the country). It involves measuring bone density at several sites, including your spine and hip, and then comparing those measurements against a national database.
There are plenty of reasons why you might decide that a DXA scan is a good idea for you.
- You’re a woman over 65
- You’re in perimenopause and have another risk factor like low body weight, loss of height or smoking
- You’ve spoken with your medical team and decided that you shouldn’t go on hormone replacement because of blood clots or a strong family history of breast cancer
- You’ve recently had a low-trauma fracture
- You have a few too many relatives who have dealt with osteoporosis
- You have a condition like rheumatoid arthritis, or you’re on certain medications that may affect bones (like glucocorticoids)
Carkin says that the DXA scan will let you know your bone bank account and how it compares to healthy young women and women your age. If you have a high amount of bone, great. You may be able to weather some bone loss and still be OK. If you already have a low bone bank account going into menopause, you can’t afford to lose more, and you need to do everything you can to maintain or improve what you have.
And don’t let insurance necessarily hold you back from getting the DXA scan, because they are usually covered for women 65 and over, and are often covered for younger women if they are associated with menopause treatment — just make sure to check with your insurance provider first.
Look into supplements that might be right for you
We know; everyone has an opinion about supplements, especially when it comes to what you should take to help your bone density and health.
“Seattle is a big supplement town, but for bone health, many people can meet their daily requirements without supplements. Despite the frequent PNW clouds, many healthy people have normal vitamin D blood levels and do not need to take supplements,” says Carkin.
Here are the supplements that come up most often:
- Vitamin D: According to Carkin, if you have a medical condition that can affect vitamin D absorption (like celiac disease) or you’ve had a vitamin D blood test result that was low, then your doctor will recommend it. Even if you do need a supplement, it rarely needs to be a high dose; usually around 1,000 units (25 micrograms) a day is adequate. Note: You can actually get too much vitamin D (which can cause kidney stones), so you’ll need to find your sweet spot.
- Vitamin K or vitamin K2 is another fat-soluble vitamin that is crucial for bones. However, vitamin K is a micronutrient, so if you have a reasonably nutritious diet, it’s easy to get enough through food (so no need for the pricey ones you’re being served ads for on social media).
- Calcium is clearly the most important supplement for bone, and ideally, you want to get your calcium from your diet if you can. If you’re under 65, aim for 1,000 milligrams of calcium a day; if you’re over 65, aim for around 1,200 mg. If you don’t do dairy, it’s hard to get enough calcium without a supplement. If you do need a supplement, Carkin recommends you take it with a meal, so it is absorbed more slowly and acts more like dietary calcium, which is more natural for your body.
“You can only absorb 500 milligrams of calcium at a time, so you have to separate it out throughout the day,” says Carkin. “So, if you were having a yogurt smoothie, which is probably 500–600 milligrams, you wouldn’t want to take a supplement at the same time because your body wouldn’t be able to absorb all of that at once.”
In conclusion
Remember, you’ve got this one set of bones, so give them the time and attention they deserve. Plus, check in with your healthcare team, because they’ll be able to share other options to help you keep your bones strong, prevent fractures and keep you able to do the things you love to do.
