Here’s what you can do to keep your bones strong and healthy:
Find out your fracture risk. Talk with your doctor about using the Fracture Risk Assessment Tool, or Frax, which can estimate your 10-year risk based on bone density and other measures. You or your doctor can fill out a questionnaire at shef.ac.uk/frax. To determine how dense your bones are, doctors might use an imaging test called a DXA scan, or dual-energy X-ray absorptiometry. According to updated guidelines, women should have their bone density checked at age 65, men at age 70. Women younger than 65 and men ages 50 to 69 should consider it if they’re at higher risk for fractures.
But bone scans won’t tell the whole story, so determining your full risk from the Frax tool is essential. Age-related changes, such as a thinning of the honeycomb-like inner layer of bone, which provides structural support, don’t show up on those scans. Besides age, factors that increase your risk of fractures include a family history of osteoporosis, taking medication that affects bone health, being very thin, smoking and consuming excessive amounts of alcohol (more than one drink a day for women and two for men).
Check out your heart health. If you’ve received a diagnosis of heart disease or heart failure, or if you’ve had a heart attack or a stroke, get your fracture risk evaluated using a bone scan and the Frax calculator. Studies have found that people with heart disease have a higher risk of breaking a hip. Researchers think that’s partly because people who have suffered a severe cardiovascular event such as a stroke might be more prone to falls. Studies also suggest that some people might have an underlying genetic predisposition that makes them more vulnerable to osteoporosis and cardiovascular disease.
Build strong muscles and get strong bones. Strive for at least 30 minutes a day of physical activity, even if it’s just a brisk walk. Exercise that puts pressure on your bones can help maintain them and in some cases even make them stronger and denser. Some examples of weight-bearing exercise include weight training, walking, hiking, jogging, climbing stairs, playing tennis and dancing.
Non-weight-bearing activities, such as swimming and bicycling, are great for strengthening muscles and your cardiovascular system, but they don’t directly improve bone strength. So make sure to add weight-bearing exercises a few times a week to your workout routine.
Eat the best food for your bones. A diet that promotes strong bones starts with plenty of calcium, of course. The recommended daily intake is 1,000 milligrams for women 50 and younger and men younger than 71, 1,200 milligrams for those who are older. You can get that by eating at least three daily servings of dairy or calcium-fortified food, such as orange juice or soy milk.
Vitamin D is also vital for protecting your frame. Aim to get 600 international units daily, 800 if you are older than 70. Sunlight is the primary source of Vitamin D, but you can also get a good deal from fatty fish (salmon, tuna and mackerel) and some mushrooms as well as from milk, some cereals and other foods fortified with it.
You can probably skip supplements for calcium and Vitamin D unless there’s a reason you might be deficient — your diet is short on calcium, for example, or you get little exposure to midday sunlight.
Make sure your medications aren’t bone-sappers. Several types of common medications have been linked to bone loss, including aluminum-containing antacids such as Maalox and Mylanta; antidepressants such as fluoxetine (Prozac and generic) and sertraline (Zoloft and generic); and the stomach protectors esomeprazole (Nexium), lansoprazole (Prevacid and generic) and omeprazole (Prilosec and generic). Some of the worst offenders include such corticosteroids as prednisone and diabetes drugs such as pioglitazone (Actos) and rosiglitazone (Avandia).
Keep tabs on your height. An estimated 80 percent of people at the highest risk for fractures (those who have already had at least one fracture due to osteoporosis) aren’t identified and treated. That’s because aging bones, particularly in the spine, are vulnerable to “silent fractures,” or breaks that aren’t painful and cause no noticeable symptoms. One of the first clues to silent fractures is a loss of height or a slightly stooped posture. So after age 50, have your height measured when you visit your doctor. He or she should also check to see if your spine is curving forward. Contact your doctor if you experience sudden, unexplained back pain that doesn’t resolve in a few days, because that could be a sign of a fracture in your spine.
Take bone-building medications only if you have to. If you’ve been told you have osteopenia, or mild bone loss, but your Frax score shows that you’re at low risk for fractures, you probably don’t need a drug treatment. Its benefit won’t outweigh the potential harm. Instead, focus on diet and exercise to keep your bones strong. Although doctors used to treat osteopenia with medication, we now know that the condition doesn’t necessarily lead to more severe bone loss.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.