How can you build and protect bone density at every age?
Bone is living tissue that adapts to the loads you place on it. Peak bone accrual happens before 20 to 30, then loss accelerates with menopause in women and later in men. The best defense combines earlier screening, high-force resistance training, adequate protein and minerals, and targeted medications when needed. Bedrest or long sedentary stretches require a plan to protect bone.
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Why Bones Matter
Bone mineral density (BMD) is the amount of mineral in your bones. Low BMD increases fracture risk, especially at the hip and spine.
A fracture after 65, particularly a hip fracture, carries a high one-year mortality. Prevention starts decades earlier.
How Bone Remodels
Osteoblasts build bone. Osteoclasts resorb bone. These cells stay in balance and constantly remodel tissue.
Estrogen helps translate mechanical strain into new bone formation. Loss of estrogen after menopause sharply increases trabecular bone loss.
Screening
Start earlier if you have risk factors: parental hip fracture, low BMI, smoking history, early menopause, prolonged steroid or PPI use, endurance sports with low energy availability.
For many women, getting a baseline DEXA in the 30s to early 40s is reasonable, then repeat based on trend. Ensure the scan reports lumbar spine and each hip, not just whole-body.
Training That Actually Moves the Needle
BMD improves with high-force resistance and power work. Think squats, deadlifts, step-ups, heavy carries, and jumps progressed safely.
Powerlifting styles outperform steady aerobic work for bone. Walking, cycling, and swimming are great for cardiorespiratory fitness but are not sufficient for BMD unless you add load.
Practical weekly target: 3 days of resistance training that includes heavy lower-body patterns plus loaded walking or rucking on hills.
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Nutrition and Supplements
Protein: aim for 1.6 to 2.2 g/kg/day adjusted to kidney function and goals. Muscle is bone’s best friend.
Calcium: 1000 to 1200 mg/day from food and supplements combined.
Vitamin D3: typically 800 to 1000 IU/day, titrated to serum 25-OH-D level.
Magnesium: 300 to 500 mg/day from diet and supplements as tolerated.
Energy availability matters. Chronic low intake, especially in female endurance athletes, depresses hormones and bone formation.
Medications
If DEXA shows osteoporosis or if you fracture with minimal trauma, medications can reduce future fracture risk.
Bisphosphonates reduce resorption and increase BMD at hip and spine.
Monoclonal antibodies and anabolic agents (parathyroid hormone analogs) are options based on risk profile and sequence strategy.
Menopausal hormone therapy can preserve bone when started near menopause in appropriately selected women. Discuss benefits and risks with your physician.
Special Situations
Weight loss without resistance training reduces BMD. Pair any caloric deficit with heavy strength work to preserve bone.
Bedrest or immobilization accelerates loss, especially in trabecular bone. Use every allowable strategy: physical therapy, isometrics, blood-flow-restriction training for uninvolved limbs, and early loading when cleared.
What to Do Next
If you have risk factors or are perimenopausal, schedule a DEXA that reports lumbar spine and each hip.
Build a progressive strength plan centered on heavy lower-body patterns and loaded carries.
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