Don’t Let Osteoporosis Sneak Up on You—How to Build and Protect Bone Strength at Any Age

What Is Osteoporosis?

Osteoporosis is a disease that weakens bones. It can cause them to become so brittle that they fracture easily. Fortunately, there are lifestyle habits you can adopt to preserve your bone strength and keep osteoporosis at bay.

Osteoporosis is often called a silent disease because many people don’t know they have it until the condition has already progressed to a stage where the bones have become brittle, and they end up with a fracture. Others may notice their spine starting to curve, or that they’re getting shorter, which can indicate bone loss.

The name “osteoporosis” translates to “porous bone.” Osteoporosis is a bone disease that occurs when your body loses too much bone, makes too little bone, or both. As a result, bones become weaker, spongier, and prone to fracturing. This means that they may break much more easily if you fall. In serious cases, osteoporosis can put your bones at risk for breaking from minor things like sneezing or bumping into something that would otherwise just cause a small bruise.

According to the National Osteoporosis Foundation, osteoporosis causes two million broken bones and $19 billion in related healthcare costs in the US annually. Currently, there are nearly 54 million Americans living with osteoporosis.

Although osteoporosis mostly affects older people, the process of bone loss typically begins much earlier in life. Bone mass stops increasing around age 30, after which lifestyle choices and habits can either retain healthy bones or start promoting bone weakness and porosity that may one day lead to a clinical diagnosis. That’s why, even if you’re in your 20s, 30s, or 40s, it’s important to adopt habits that will set you up to ensure your bones stay robust as you age.

What Causes Osteoporosis?

Many factors can contribute to the process by which bones weaken over time. Some of the factors are out of our control. These include being over the age of 50, being female, being postmenopausal, having a family history of osteoporosis, and having a small frame. Hormone changes that occur naturally with age may also increase osteoporosis risk, specifically the increase in parathyroid hormone, which controls calcium and phosphorus levels in your bones.

There are also some lifestyle factors we do have control over that can contribute to osteoporosis risk. Smoking, leading an inactive lifestyle, being under or overweight, drinking excessive alcohol, not eating enough fruits and veggies, and eating large amounts of sodium, as well as not getting enough calcium, vitamin D, magnesium, or vitamin B12, can all raise your risk for osteoporosis.

Certain medications may also promote bone loss. Some of these include steroids like glucocorticoids, proton pump inhibitors (PPIs) used reduce stomach acid (antacids), the class of antidepressants known as selective serotonin receptor inhibitors (SSRIs), some type 2 diabetes meds (like thiazolidinediones), anticonvulsants, drugs to prevent blood clots (like heparin), and some chemotherapies. If you use one of these medications and aren’t sure how it may be impacting your bone health, it’s a good idea to have a conversation with your physician so you can make an informed choice.

Pre-existing health conditions can also put you at higher risk for osteoporosis. If you have Celiac disease, multiple myeloma, inflammatory bowel disease, cancer, lupus, or kidney or liver diseases, you may have a higher likelihood of developing osteoporosis. This means that incorporating healthy lifestyle habits — like a nutritious diet and weight-bearing exercise — is especially important for osteoporosis prevention.

How To Prevent and Reverse Osteoporosis

When it comes to preventing and reversing osteoporosis, it turns out there’s a lot you can do. And it all starts with the building blocks of your skeleton (and every other part of your body) — the food you eat.

The Role of Calcium in Osteoporosis Prevention

Calcium is the most abundant mineral in your body, and it’s found particularly in your bones and teeth. Your bones undergo constant remodeling, in which they manage calcium resorption and deposition needed for bone formation and maintenance. As you age, your bones tend to lose more calcium than they maintain, which raises the likelihood of developing osteoporosis. This is especially common among postmenopausal women.

How much calcium do you need? Here are the recommended dietary allowances (RDA) based on age groups:

0-6 months = 200 mg

7-12 months = 260 mg

1-3 years = 700 mg

4-8 years = 1000 mg

9-13 years = 1300 mg

14-18 years = 1300 mg

19-50 years = 1000 mg

51-70 years = 1000 mg for men; 1200 mg for women

71+ years = 1200 mg

Best Foods for Calcium?

Animal-based foods are excellent sources of calcium, an essential mineral for bone health, muscle function, and nerve signaling. Dairy products are the most well-known animal-based sources of calcium. For example, one cup (244g) of milk contains approximately 300 mg of calcium, which is about 30% of the recommended daily intake (RDI) for adults. Similarly, one ounce (28g) of cheddar cheese provides around 200 mg of calcium, while a 6-ounce (170g) serving of plain yogurt delivers an impressive 450 mg of calcium. These dairy options are not only rich in calcium but also contain vitamin D and protein, which enhance calcium absorption and support overall bone health.

Beyond dairy, small fish with edible bones are another excellent source of calcium. Sardines (canned in oil, with bones) provide about 325 mg of calcium per 3.75-ounce (92g) can, making them a fantastic option for those who don’t consume dairy. Canned salmon with bones also offers a substantial amount, with 181 mg of calcium per 3 ounces (85g). These fish are also high in omega-3 fatty acids, which support heart and brain health. Additionally, egg yolks and organ meats like beef liver contain smaller amounts of calcium but are valuable due to their high vitamin D content, which aids in calcium absorption. Including these animal-based foods in your diet can help maintain strong bones and prevent deficiencies.

What Sources of Plant-Based Calcium Should You Be Eating?

Some of the best plant-based sources of calcium are listed below. Note that all calcium content listed comes from the USDA Food Data Central nutrient database.

Green Leafy Vegetables

1 cup loose kale = 53 mg

1 cup mustard greens = 64 mg

1 cup romaine lettuce = 21 mg

Beans & Legumes

½ cup canned kidney beans = 45 mg

½ cup chickpeas = 80 mg

½ cup cooked black beans = 40 mg

½ cup cooked lentils = 20 mg

⅔ cup green peas = 40 mg

Broccoli

1 cup raw broccoli florets = 35 mg

½ cup cooked chopped broccoli = 31 mg

Whole Grains

1 cup cooked quinoa = 31 mg

1 cup cooked oatmeal = 21 mg

1 cup cooked amaranth = 116 mg

Dried Fruit

¼ cup dried figs = 57 mg

5 dried apricots = 20 mg

1 box (28 g) raisins = 20 mg

Seeds and Nuts

2 Tbsp chia seeds = 177 mg

2 Tbsp sesame seeds = 176 mg

1 oz almonds = 75 mg

1 oz hazelnuts = 56 mg

1 oz tahini = 42 mg

Calcium Inhibitors

Some calcium-rich plant foods also contain oxalic acid, or oxalates, that can inhibit the amount of calcium absorbed from them. Plant foods with the highest amounts of oxalic acid include spinach, rhubarb, chard, and beet greens. Research indicates that calcium absorption may be limited to as little as 5% from these particular greens. However, if you cook chard or beet greens in with other greens such as kale or collards, the oxalic acid in the chard or beet greens is not enough to compromise the value of the calcium in those other greens.

Another compound that inhibits calcium absorption is phytic acid, which is found primarily in beans. You can reduce phytate content in dried beans by soaking them for several hours, or overnight, before draining and cooking them in new water. Furthermore, extended soaking and cooking of beans also appears to increase the bioavailability of minerals like calcium.

What Foods Should You Avoid for Osteoporosis Prevention?

While including a variety of the foods above helps meet your calcium needs, it’s also a good idea to avoid certain foods that could work against your calcium balance. Some foods and beverages may actually promote calcium loss from your bones.

Sodium

Foods that are high in sodium, like fast food and many packaged convenience products, can promote calcium loss. This also means you should avoid adding excessive amounts of salt to food you make at home. Instead, use spices and other salt-free seasonings to add flavour to homemade dishes.

Wheat Bran

Wheat bran is high in phytic acid, which, like oxalic acid found in certain leafy greens, inhibits calcium absorption. Interestingly, unlike beans, wheat bran is the only phytate-rich food that appears to inhibit calcium absorption from other foods eaten at the same time.

Alcohol

Alcohol consumption can lead to bone loss and increase your risk of osteoporosis. If you drink any alcoholic beverages, keep in mind that they are no friend to your skeleton.

Caffeine

Caffeine can reduce calcium absorption from foods and contribute to bone loss. If you’re worried about osteoporosis, this could be a reason to limit your consumption of caffeinated beverages like soda, tea, and coffee, and to not drink them within two hours of eating calcium-rich foods or taking calcium-containing supplements.

Soda

While soda certainly isn’t a health food, certain types of sodas can contribute more to bone loss than others. In particular, dark colas seem to have the most negative impact. This is due to their higher phosphorus content, which appears to harm bone health when consumed in large amounts, especially if you don’t get enough calcium in your diet.

Avoid Acidic Foods

Try to avoid foods which have an acidifying effect on your blood. Your body interprets acidic blood as threat to vital systems and homeostasis and will rapidly activate mechanisms to bring the blood pH back into the safe range. The fastest way to do this is to release calcium (and other alkaline minerals such as magnesium) into the blood to neutralise the acid.

To do this your body will access the large available supplies of calcium and magnesium in your bones.  Your body will dissolve your bones to access calcium and magnesium to release into your bloodstream to reduce acidity.

How to Prevent Osteoporosis with Lifestyle Strategies 

Diet is a big part of the anti-osteoporosis equation, but it’s not the whole story. It turns out that regular physical activity is an important factor, too.

The best activity for your bones is weight-bearing exercise. This means engaging your body in things like walking, running, weight-lifting, dancing, climbing stairs, and playing tennis. These types of exercise utilize your body weight and encourage maintenance of your bone strength. The strain of muscular activity stimulates your body to shore up your bones. It’s a classic case of “use it or lose it.”

How much exercise is best? Many experts recommend at least 30 minutes of weight-bearing exercise per day, most days of the week.

If you have severe osteoporosis, however, you will need to use caution when considering appropriate types of exercise. While it’s never too late to start exercising, people with osteoporosis should start slowly. Before beginning a new exercise routine, speak with your health care practitioner, who might recommend doing a fitness assessment and bone density test to determine the best next steps. Some of the activities most often recommended for people with osteoporosis include stability and balance exercises, flexibility and weight-bearing aerobic exercises, and strength training exercises that focus on the upper back. If you have advanced osteoporosis, your doctor may refer you to a physical therapist to help ensure your exercise regimen is safe and appropriate before starting.

Vitamin D

Vitamin D plays an important part in protecting your bones. It’s critical to your body’s ability to absorb calcium, and it also supports the muscles that you need in order to avoid falls. If you don’t get enough vitamin D, you’re more likely to break bones as you age, however, excessive vitamin D can also lead to bone loss.

If you’ve never had your serum vitamin D levels checked, it may be a good idea to request a 25-hydroxy-vitamin D test. You can get it done at the same time as other standard blood tests. While recommendations can vary, the Endocrine Society reviewed available studies and concluded that between 40 and 60 ng/mL was optimal for both children and adults. According to this metric, the vast majority of people in the modern world are deficient.

To make sure you get enough vitamin D, there are two main things you can do. First, get plenty of sunlight. Your skin produces vitamin D when exposed to direct ultraviolet light. While recommendations for the best sunlight regimen vary, studies indicate benefits from getting anywhere between 10 and 30 minutes of sun exposure per day, over much of your body. People who live far from the equator (where the sun is weaker), or who have dark skin, may need more sun exposure.

Note: Tanning beds are not recommended and shouldn’t replace natural sunlight, and evidence indicates they may increase your risk for skin cancer.

If you do take vitamin D supplements on a regular basis, it may be advisable to get your blood levels checked periodically, to ensure you are in a desirable range.

Vitamin D Supplements

Vitamin D supplements for adults are also an option, especially if you get your blood levels checked and find that they are low. A typical supplement regimen for vitamin D maintenance is around 2,000 IU per day of vitamin D3, or cholecalciferol. This amount can often be found in a multivitamin or on its own. Some people find they do better with 5,000 IUs, or even more, per day.

If you take vitamin D supplements, it’s wise to get your blood levels checked periodically to ensure that you are getting enough and that you aren’t overdosing. Vitamin D is a fat-soluble vitamin, and excessive amounts may build up in the body.

Note that most vitamin D3 supplements come from animal products like lanolin, found in sheep’s wool. Vitamin D2, or ergocalciferol, is a synthetic version that is vegan-friendly but is not effective at raising blood levels of vitamin D as vitamin D3.

Vitamin K2

In addition to vitamin D, vitamin K also helps to regulate bone health and both prevent, and even treat, osteoporosis. In fact, it works in conjunction with vitamin D to ensure calcium isn’t building up in your blood and organs and is instead making its way into your bones.

One of the clinical markers of osteoporosis and other bone diseases is an increase in osteocalcin levels. Both vitamin K1 and K2 have been shown to reduce osteocalcin levels. And high doses of vitamin K2 have also been used to prevent further bone loss and fractures in postmenopausal women with osteoporosis.

Vitamin K1 is readily available in a number of plant-based foods, including leafy greens, cruciferous vegetables, prunes, peas, parsley and scallions. And many people make vitamin K2 from vitamin K1, in their gut. But this process isn’t efficient in everyone (especially those with compromised gut health).

The main dietary sources of vitamin K2 for most people are high-fat dairy products and organ meats, while plant-based eaters may get it from Japanese fermented soybeans in a dish known as natto, as well as fermented foods such as tempeh, sauerkraut, and kimchi.

Since conversion of K1 to K2 is variable, and there’s no widely available blood test to ensure that you’re getting enough K2, it’s plant-based eaters may benefit from a K2 supplement. And because of the interplay between vitamin D and K2, taking them together, or in a single supplement, may be the most beneficial to help prevent, slow, or reverse osteoporosis.

Vitamin B12

Vitamin B12 deficiency may also increase the risk of osteoporosis. A condition called pernicious anemia which is caused by either inadequate intake of vitamin B12, or insufficient uptake of the vitamin in the gut and is a risk factor for osteoporosis. Studies have found that B12 deficiency is especially a risk factor among elderly women and providing supplementation to patients who have severe osteoporosis and pernicious anemia causes a significant improvement in bone health. Even though women are at an overall higher risk for osteoporosis than men, a 2005 study determined that men are at equal risk for low bone mineral density if they are deficient in B12. Although more research is necessary on the correlation between vitamin B12 and bone health, it does appear that B12 deficiency can raise your risk for bone loss.

While vegans and vegetarians have a higher risk of not getting enough B12, studies show that many omnivores are deficient, too. In fact, researchers at Tufts University concluded that 40% of all Americans are deficient in B12. Fortunately, it’s easy and economical to add a B12 supplement to your diet.

Conclusion

Osteoporosis is a very common condition, but even having risk factors doesn’t mean you can’t do things to minimize your likelihood of developing it. Choosing calcium-rich, whole foods, incorporating regular, weight-bearing exercises, enjoying a healthy dose of sunlight, and supplementing where necessary are great habits to adopt. If you have an existing medical condition, take medications, or are struggling with habits that may be putting you at a higher risk for poor bone health, speak with your health care provider about how to best support your skeleton, so your skeleton can continue to support you.

While the risk of osteoporosis and bone loss increases as you age, you can help prevent it, and in some cases, reverse its course by paying special attention to lifestyle factors such as diet and exercise. In particular, foods high in calcium, vitamin D, and B12 will strengthen and maintain bone health. Even if you don’t currently have osteoporosis, a little bit of prevention now can go a long way in ensuring a healthy future.