It's never too early to start thinking about our bone health. Consider this: Our bone mass begins slowly declining as early as our mid-30s, according to the National Institutes of Health. Although bone loss is an inevitable part of aging, we can help slow the process.
"Our bones are constantly being remodeled throughout our entire life — this process removes damaged bone and replaces it with new, stronger bone," says Ashley Shrader, NP, Lifeforce Clinician. However, osteoporosis is insidious and often develops without any symptoms until it’s too late. Some early symptoms or signs of osteoporosis include receding gums (due to bone loss of the jaw), brittle nails (which can reflect nutrient deficiencies), and loss of strength, stooped posture, loss of height, back pain, and fractures from minor falls, Shrader says.
If you want to keep your bones strong as you age, think of it like maintaining a house. "Regular upkeep can significantly extend its lifespan and structural integrity," says Serena Holtsinger, Lifeforce Senior Health Coach.
Making certain lifestyle and diet changes can help your bones stay strong and resilient as you age. Here, experts explain what you can do to potentially help prevent osteoporosis.
6 Ways to Prevent Osteoporosis and Strengthen Bones
1. Get enough calcium and vitamin D
Calcium and vitamin D are two of the most important nutrients for bone health — and they work together synergistically to help maintain your bone density with age.
Calcium is a mineral that helps physically harden your bones. Not getting enough calcium, especially as you age, can increase your risk of osteoporosis. Dairy foods, such as yogurt, cheese, and milk, are some of the best sources of calcium, but you can also get this mineral from leafy greens like kale and collard greens, sardines and canned salmon (with the bones!), almonds and Brazil nuts, and tofu made with calcium sulfate (read the ingredient list).
Vitamin D enhances calcium absorption in the intestines and in turn, your bones absorb calcium better. "Think of vitamin D as the key that unlocks the door, allowing calcium to enter and strengthen our bones," Holtsinger says.
Vitamin D isn't nearly as easily obtained from foods as calcium is, but going outside and spending some time in the sun is a great way to boost your levels. "We receive over 25 different beneficial D metabolites from sun exposure, versus one in a supplement," Holtsinger says. Aim to get 10 to 30 minutes of midday sun exposure several times a week. But if you live in a northern latitude or don't get much sun exposure, consider starting a vitamin D supplement.
Pro tip: If you're taking a vitamin D supplement, make sure it also contains vitamin K2 as a cofactor. "I like to think of K2 as a traffic controller, ensuring calcium goes to the bones (instead of being deposited in soft tissue) where it's needed most," Holtsinger says.
2. Make resistance training part of your regular routine.
Just like muscle, bone is dynamic, living tissue that gets stronger through resistance training. Weight-bearing exercises help stimulate bone formation in a process called mechanotransduction. "When bones experience mechanical stress, osteocytes (bone cells) sense this stress and signal for increased bone formation," Holtsinger says. "It's similar to how muscles grow stronger in response to resistance — bones also adapt to increased load by becoming denser and stronger."
Resistance training with weights or resistance bands is one of the best ways to preserve and build bone density. But if you're not a fan of the gym, you can also try high-impact activities like jumping or running (if you don't have joint issues) or yoga and Pilates, which can help improve your balance. Rucking, or walking or hiking outdoors with a weighted backpack is also a bone health-supportive option that provides an excellent combination of both cardiovascular exercise and weight-bearing activity with the added benefit of improved posture, Holtsinger says.
3. Limit processed foods as much as possible.
Making packaged snacks and fast food part of your day-to-day diet may not only deprive, but also rob, your bones of the nutrients they need.
People whose diets are high in processed foods such as processed meat, pastries, pizza, French fries, snacks and refined grains have lower bone mineral density, according to a 2020 Nutrients study. Many of these typical Western diet foods tend to be high in fat, sugar, salt, and additives.
"A high-fat diet can interfere with intestinal calcium absorption, reducing bone building activity, while processed food additives can disrupt calcium homeostasis," Shrader says. What's more, high-sodium diets may increase calcium loss in the urine, which may lead to bone breakdown, Shrader says.
4. Reduce your alcohol consumption.
Imbibing too much too frequently can significantly affect bone health through multiple mechanisms.
For one, drinking too much alcohol interferes with vitamin D metabolism and calcium absorption, two nutrients crucial for maintaining strong bones. Alcohol can also increase levels of the stress hormone cortisol, which may lead to bone loss over time, Holtsinger says, adding that being drunk increases the risk of falls and fractures.
The connection between alcohol and disrupted sleep is well-known, and one study found in the Journal of Bone and Mineral Research found that getting five or fewer hours of sleep a night was associated with a lower bone mineral density and higher risk of osteoporosis.
If you do drink alcohol, try limiting your intake to no more than one drink for women or two drinks for men, and try not to drink every day.
If you're looking to reduce your alcohol consumption, setting clear, achievable goals is a good starting point, as is finding alternative stress-relief methods such as meditation or exercise, Holtsinger suggests.
5. Prioritize protein.
Protein is the building block of every cell in our body, and it happens to form the structural matrix of our bones as well. Not getting enough protein is associated with osteoporosis in middle aged and older people, according to a 2022 study in The Journal of Nutrition, Health and Aging.
Protein also provides amino acids necessary for collagen formation, which gives bones their flexible strength. "It's like the rebar in reinforced concrete — without it, the structure would be brittle and prone to fracture," Holtsinger says.
For optimal bone health, a general best practice is to aim for about 1.2 to 1.6 grams of dietary protein per kilogram of body weight daily, says Holtsinger. To get more of this important macro in your diet, prioritize high-protein foods in every meal — look to wild-caught seafood, poultry, lean meats, eggs, beans, tofu and soybeans, and Greek yogurt.
6. Quit smoking.
If you're concerned about your bone health, putting down the cigs is one of the best places to start. Smoking has a significant negative effect on bone health through several ways.
"The numerous toxins in cigarette smoke, including nicotine, decrease blood supply to bones, which reduces nutrient delivery and inhibits the function of osteoblasts, the cells responsible for building new bone tissue," Holtsinger says. Smoking also interferes with calcium absorption and lowers estrogen levels, both of which are crucial for maintaining bone density. It's also worth noting that other forms of tobacco, including smokeless varieties, can have similar harmful effects due to their nicotine content, Holtsinger says.
If you currently smoke, or have in the past, consider visiting your doctor for a bone density screening. And if your goal is to quit, Holtsinger suggests trying nicotine replacement therapy, cognitive behavioral therapy (or CBT), gradually reducing your nicotine use, and exploring the root cause of the smoking habit and addressing it directly.
Frequently Asked Questions (FAQ)
What are some treatments for osteoporosis in older adults?
If you already have osteoporosis, your doctor may suggest doing weight-bearing exercises, supplementing with vitamin D and/or calcium, or starting hormone replacement therapy if your estrogen or testosterone levels are low. People with severe osteoporosis or those at a high risk of fractures (like older adults) may be prescribed medications such as parathyroid hormone (PTH) analogs, denosumab, or romosozumab.
What are the top four methods for strengthening bones?
Quitting smoking and limiting alcohol, eating a nutritious diet (while limiting processed foods), doing weight-bearing exercises regularly, and ensuring D levels are adequate with sun exposure and/or with vitamin D and K2 supplements are great ways to help strengthen bones.
What physical activities are beneficial for bone health?
Weight-bearing exercises are best for bone health because they help stimulate bone formation. Some exercises to try include lifting weights or working with resistance bands, HIIT workouts, rucking, running, and stair climbing.
How do I keep healthy strong bones?
Simple measures you can take to maintain strong bones include eating a nutrient-dense diet rich in calcium and vitamin D, prioritizing time spent outdoors, doing weight-bearing exercises, and avoiding alcohol and smoking.
This article was medically reviewed by Ashley Shrader, DNP, FNP-C, Institute for Functional Medicine Certified Practitioner.