How to build stronger bones

7 things you need to know now to fracture-proof your frame

Published: December 2013

Just a few years ago, the formula for women concerned about strengthening their bones and steering clear of osteoporosis was to get regular bone mineral density checks and take a daily calcium supplement once they reached menopause.

We now understand that bone density is only one of many factors that determine bone strength. And while some people need supplements and medications to reduce their risk of breaks, others can protect their bones through tweaks to their diet and exercise routine, and by keeping close tabs on several other conditions that affect bone health.

Here’s what you can do right now to keep your bones strong and healthy.

1. 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 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.

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). One important and often overlooked risk factor is if you’ve actually broken a bone after a fairly minor trip or fall, because that can signal that your other bones are weak.

For strong bones, start young

Children need to strengthen their bones as they grow. A diet rich in calcium (1,300 milligrams for adolescents and teens), plenty of vitamin D from sun and food (600 IU daily), and an hour of daily physical activity help build strong bones. Yet most young people fall short. What’s worse is that drinking soda can sap bones of calcium. One theory is that a flavoring agent in soda, phosphoric acid, might cause the calcium to be lost. And as kids drink more soda, it can displace nutritious drinks such as milk and fortified juice.

Juvenile arthritis, diabetes, and celiac disease can also interfere with bone building. And corticosteroids used to treat asthma can decrease available calcium. Along with diet and exercise, some children with those conditions may need nutritional supplements.

2. Check out your heart health

If you’ve received a diagnosis of heart disease or heart failure, or 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.

3. 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. One way to get a good aerobic exercise is with a treadmill. Other examples of weight-bearing exercises include weight training, walking, hiking, jogging, climbing stairs, 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. If you have been diagnosed with osteoporosis, avoid high-impact activities such as running and exercises that require you to flex, twist, or bend your spine, which could put too much stress on fragile bones. Using an elliptical or exercise bike are ways to avoid putting too much stress on your bones while still getting a good workout. Consult a physical therapist with expertise in osteoporosis to learn how to stretch and strengthen muscles.

4. 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 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 IU 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), some mushrooms, as well as milk, some cereals, and other foods fortified with it.

Along with calcium-rich foods, those packed with magnesium, potassium, and vitamins C and K are also great bone builders. Five daily servings of fruit and vegetables, such as citrus fruit and leafy greens, is the best way to get them.

5. Make sure your meds 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 are:

  • Corticosteroids such as prednisone.
  • Diabetes drugs, such as pioglitazone (Actos) and rosiglitazone (Avandia).
  • The anticancer drugs anastrozole (Arimidex and generic) and letrozole (Femara and generic).
  • Hormone-agonist leuprolide (Lupron).
  • Anticonvulsants such as carbamaze­pine (Tegretol and generic), gabapentin (Neurontin and generic), phenobarbital (Luminal and generic), and phenytoin (Dilantin and generic).

6. 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 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. And 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.

7. Take bone-building meds 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. “Osteopenia is not pre-osteoporosis,” said Ethel Siris, M.D., a professor of medicine at the Columbia University College of Physicians and Surgeons in New York City. “It’s a risk factor for fractures, but by itself it is not a red flag.”

The best meds for building bones

If you have osteoporosis and need a medication, our Best Buy Drug recommendation is generic alendronate (Fosamax), pictured at right. It belongs to a class of drugs called bisphosphonates. Our new analysis of those drugs shows that all of them help prevent fractures of the hip, spine, and other bones. The most common side effects include stomach upset, diarrhea, and bone, joint, or muscle pain. Also, if taken for more than five years, bisphosphonates can cause rare but serious side effects that include permanent bone loss in the jaw and possibly an increased risk of thighbone fracture. Many doctors recommend temporarily stopping these drugs after three to five years.

Editor's Note:

This article appeared in the January 2014 issue of Consumer Reports on Health. These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

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