How can you build and protect bone density at every age?

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.

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

1. If you have risk factors or are perimenopausal, schedule a DEXA that reports lumbar spine and each hip.
2. Build a progressive strength plan centered on heavy lower-body patterns and loaded carries.
3. Audit calcium, vitamin D, magnesium, and total protein. Correct gaps.
4. If your T-score or Z-score is low, discuss medications and hormone therapy options with your clinician.