How can I reduce my risk of osteoporosis?

DEAR DOCTOR K:

I’m a woman in my 40s. Both my mother and grandmother had osteoporosis. What can I do now and in the coming decades to reduce my risk?

DEAR READER:

All people lose bone as they age. For women, that process starts to accelerate when they enter menopause. One important reason for that is the lower level of estrogen in a woman’s body after menopause begins, as estrogen helps to build bone.

Osteoporosis is not inevitable, and there’s much you can do to shield your bones from this disease.

The basics of protecting your bones, such as getting enough vitamin D and engaging in weight-bearing exercises, remain the same throughout your life. But there are additional factors you should consider as you get older.

  • If you haven’t yet started menopause, focus on attaining and maintaining as much bone mass as possible. The more bone mass you have as you enter menopause, the less likely it is that you will develop osteoporosis. That’s both scientifically proven and common sense.
  • Monitor your diet. Get the recommended amounts of calcium and vitamin D. (See table of recommended calcium intake below.) Dairy products are a rich source of calcium. Particularly if your cholesterol levels are on the high side, use low-fat dairy products. And a growing number of foods, such as orange juice, are calcium-fortified.
  • Avoid cigarettes and too much alcohol. Both decrease bone mass.
  • Perform weight-bearing exercises regularly, as they protect your bones. Inside your bones are two types of cells: One type builds up bone and the other breaks it down. Exercise stimulates the first type and inhibits the second type.

Women experience their greatest period of bone loss during the early years of menopause. You can slow that process with the steps given above for what to do before menopause. In addition, do the following as well:

  • Assess your risk. Talk to your doctor about whether you should have a bone density test. The preferred test is dual energy X-ray absorptiometry (DXA). This test is recommended for all women aged 60–65. You’re in your 40s, so you and your doctor should consider if you are at particular risk for developing osteoporosis. If so, this test could provide valuable information.
  • Re-evaluate your exercise regimen. As you age, you may need more exercise to keep from losing ground. Incorporate weights into your routine if you haven’t already.

Once you reach age 65, bone loss tapers off, but you are still losing bone. All of the previous suggestions still apply. In addition, consider these:

  • Enhance your exercise routine. Learn tai chi or another exercise that improves balance and coordination to help prevent falls.
  • Consider medication. If your bone density is below normal, talk to your doctor about whether you should take a preventive medication.

Getting the calcium you need

Because your body’s calcium demands shift with age, you should adjust your calcium intake as necessary.
Age Institute of Medicine recommended calcium intake
1–3 years 700 mg/day
4–8 years 1,000 mg/day
9–18 years 1,300 mg/day
19–50 years 1,000 mg/day
51–70, women 1,200 mg/day
51–70, men 1,000 mg/day
71 years or older 1,200 mg/day
Pregnant or lactating, 14–18 years 1,300 mg/day
Pregnant or lactating, 19–50 years 1,000 mg/day
Note: Because excessive amounts of calcium can cause problems, it’s wise to keep your intake below 2,500 mg a day (the tolerable upper limit set by the Institute of Medicine).