Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

You might recall a childhood nursery rhyme that served as your first anatomy lesson: “the toe bone’s connected to the…foot bone, and the foot bone’s connected to the…heel bone.” Most of us haven’t thought much about our bones since then, focusing more on heart health or cancer prevention or a number of other public health initiatives that have gotten much more press over the years. But the bones in our skeleton play a massive role in our health, and problems with them can alter our independence, especially later on in life. Come with us on this journey and learn more about your bones, what disorders and diseases can affect them, and how you can keep them in pristine shape. 

What are bones?

Your skeleton is a living organ, just like your heart, liver, or lungs. Contrary to popular belief, they are dynamic, molding, and reshaping themselves in response to what you throw at it. Bones hold a number of critical jobs within your body. They support and protect other organs, enable us to move, produce blood cells, and store various minerals like calcium and phosphorus. Bones are made up of protein structures into which minerals are deposited. These minerals provide hardness and rigidity, while the proteins offer elasticity. These two components combine to give bone its remarkable strength and flexibility.

The center of some of your bones has spongy tissue called bone marrow. It is the home of stem cells that create white blood cells, red blood cells, and platelets. These cells are very important to a healthy body, and any problems in their production can cause poor immunity, anemia, and bleeding disorders, among many other issues.

What affects bone health?

A complex array of different factors comes into play when discussing bone health. The primary measure of how your bones are doing is something called bone density or bone mineral density. Bone mineral density is how healthcare providers talk about how much mineral is inside your bones. Generally, the more mineral is packed into your bones, the stronger and healthier they are. 

So what goes to how healthy your bones are right now? One important factor that plays into how strong your bones are now is how strong they were at their peak strength. Most people reach their peak bone mass in their 20s, after which the density of their bones declines slowly, year by year. How dense your bones are at their peak is around 60-80% due to genetics, with the rest determined by diet (especially in regards to vitamin D and calcium), exercise, and avoiding smoking, among other healthy lifestyle choices. 

After your 20s, how well you maintain your bone strength and decrease the amount of bone loss becomes the major factor. This is again dependent on getting enough calcium, vitamin D, and other nutrients in your diet, along with weight-bearing exercise, avoiding smoking and staying away from excessive drinking. 

Women have another risk factor to worry about—menopause. Estrogen plays a major role in maintaining bone health, and after menopause, estrogen levels drop as the ovaries produce much less of the hormone. That’s why it’s even more important for older women to be on top of their bone health and up to date with their health screenings.

What happens when you lose your bone health?

As you get older, you might develop a condition called osteoporosis. It’s the most common bone disease in the United States, affecting around 10 million Americans. Osteoporosis occurs when your bones become weak, brittle, and porous after you’ve lost too much of your bone density. Osteoporosis is associated with a much higher risk of fractures, even with the slightest impacts. Around 1 in 3 women and 1 in 5 men will suffer an osteoporosis-related fracture in their lives.

Osteoporosis most commonly causes fractures at the hip, spine, and femur. These fractures are extremely serious. Spinal fractures, also called vertebral fractures, can cause debilitating back pain and permanent deformities in posture. Hip fractures can be even more life-altering—studies say that 1 in 5 hip fracture patients require long-term nursing home care, and only 2 in 5 regain the independence they had before their fracture. 

How do you maintain your bone health?

With these serious consequences in mind, what can you do about it? First, make sure you’re getting adequate nutrition and exercise. On the nutrition front, the most important nutrients you need to keep track of to maintain healthy bones are vitamin D and calcium. Vitamin D, in particular, is hard to get enough of—around 42% of people in the United States are deficient in vitamin D. Studies have shown that vitamin D plus calcium supplements reduce the risk of fracture by 15%. Fortified dairy products, in particular, can be a good source of calcium and vitamin D to build strong bones. Weight-bearing exercise is very important, as well. Studies in both men and women have shown that exercise programs can help improve bone density. The Surgeon General recommends at least 30 minutes of physical activity, most days of the week.

Second, stop smoking or drinking excessively, both of which are bad for bone health. Smoking has been shown to decrease bone density and increase fracture risk. Drinking more than two alcoholic drinks a day has also been shown to cause an increased risk of fracture. 

Third, make sure you’re up to date with your health screenings. For women over 65, this means getting a bone density test called a dual-energy X-ray absorptiometry (DEXA) scan. Men and women that are at high fracture risk are also recommended to get this screening test. The scan is able to identify people with osteoporosis. This means that they can get medications to treat the disease before they have a fracture.

Now that you’ve taken your first steps towards learning more about bone health, we’ll continue with deeper dives into everything else you need to know to keep your bone strong, from conditions like osteoporosis and osteomyelitis to vitamin D, calcium, and other helpful nutrients.

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