Give Your Bones a Lift

At age 32, Perry Ann Jeveli was a picture of health. She regularly hiked, ran, biked, and lifted weights. So when a friend asked her to undergo a free bone-density test to help train X-ray technicians, Jeveli readily agreed. Turns out that was a smart move: Results showed that Jeveli, who lives in Lafayette, California, had low bone density, meaning that her bones didn't contain enough calcium and other minerals to keep them strong. Her skeleton was thinner and more frail than it should have been for her age, putting her at greater risk of developing osteoporosis. The disease causes bones to become more likely to break, can lead to a hunched posture, and can be severely painful. "To say I was surprised would be an understatement," says Jeveli, who's now 46 and the mother of a 13-year-old daughter and a 10-year-old son. "I was in good shape and felt strong, so I immediately met with a specialist to figure out what I needed to do differently to strengthen my bones."

A generation ago, most people (doctors included) believed brittle bones were an unavoidable part of aging — but they weren't something that 30-year-olds like Jeveli had to worry about. Now we know better: Bone is living, growing tissue that's constantly broken down and renewed. The best bone-building years are the tweens and teens, when new bone forms the fastest. By the time you hit 30, your bones have peaked in thickness and strength and remain fairly constant throughout your 30s and 40s. After that, achieving the balance between bone formation and bone loss becomes increasingly difficult. If you lose too much, you can develop osteoporosis.

The National Osteoporosis Foundation estimates that 10 million Americans have osteoporosis and another 34 million are at risk. Almost all — 80 percent — are women, with whites and Asians being most susceptible. Moms are slightly more vulnerable because their calcium reserves are needed to help infants build a strong skeleton in utero and afterward if they nurse. But women usually don't undergo bone-density testing until after menopause, when the bone-protecting properties of estrogen drop significantly and bones become more fragile. Younger premenopausal women are rarely tested unless they have a high-risk condition such as a family history of osteoporosis (about 60 percent of bone health is inherited); estrogen loss due to early menopause or surgically removed ovaries; a past or a current eating disorder; or a very thin build. (Jeveli is slender and small-boned like her maternal grandmother, who had the disease.)

Of course, you don't need a bone scan to tell you that your bones are worth protecting. "The right habits, like getting proper nutrition and engaging in daily physical activity, can bolster bone health regardless of your age," says Andrea Singer, M.D., an internist and osteoporosis specialist at Georgetown University Hospital, in Washington, D.C. Put this advice into action today.

Don't skimp on calcium.

Collagen makes up the soft framework of bone, but it's calcium that strengthens and hardens it. Almost all of your body's calcium is found in bones and teeth. Because calcium is continuously being deposited in and remodeling bones in order to make them stronger, all women ages 20 and up need 1,000 milligrams (mg) of the mineral every day. Unfortunately, nearly nine out of ten of us fall short of the recommended amount, and when you're pregnant or nursing, hitting that daily amount is even more critical. "If you're low on calcium, your body will leach it from your bones to give to your growing baby," Dr. Singer says. Dairy products like milk, yogurt, and cheese are the best sources (a cup of milk has about 300mg); but the mineral's also found in kale, broccoli, soybeans, and fortified cereals and orange juice. Calcium supplements help close the gap, though it's best to get the nutrient from food when possible because your body absorbs and uses it better.

Get your daily D.

You need 600 international units (IU) of vitamin D daily to help your body absorb calcium (a glass of milk has about 100 IU). Your skin also makes vitamin D from sunlight, but it's hard to produce enough if you're dark- skinned or aren't outside often during the day without sun protection. "Now that we're better about applying sunscreen to prevent skin cancer, we're blocking the rays needed to make vitamin D," says Kathleen Cody, executive director of American Bone Health, a nonprofit public-education organization in Oakland, California. Although the best sources of vitamin D are fatty fish and fortified foods like milk, cereal, and orange juice, you likely need supplements to reach the recommended daily amount.

Skip salty foods.

We're supposed to consume no more than about 1 teaspoon of sodium per day; most of us take in at least five they contain different progestins than Depo-Provera and the hormone is dispersed more slowly over time," says Dr. Scholes. Taking oral or inhaled steroids for three months or longer for conditions including asthma, lupus, rheumatoid arthritis, and Crohn's disease can also weaken bones. If you fall into this category, talk to your doctor. She may recommend a bone-density test as well as a prescription osteoporosis drug (typically reserved for postmenopausal women) to be taken as long as you're on steroids. Those meds need to be monitored by your doctor, too; a recent study found that postmenopausal women who took bisphosphonates, a class of osteoporosis drugs that includes Fosamax and Boniva, for five or more years were more than 2.5 times more likely to fracture their thigh bone. Researchers aren't sure why.

Jeveli realizes now that her diet was lacking in calcium, so she's vigilant about making sure she and her children do better. She never forgets to take her daily calcium and vitamin D supplements; her children take lower doses. "Foods rich in calcium, like yogurt, cheese, and spinach, are an everyday staple at our house," she says. Her family regularly makes time for bone-building activities like tennis, hiking, and skiing, and they often take neighborhood walks too. These efforts are working: Jeveli hasn't lost bone strength since that first test 14 years ago. "I'd like to be as active with my grandchildren someday as I am now with my kids," she says. "So I'm doing everything I can to ensure that my bones will be as strong as possible later."

Originally published in the August 2012 issue of Parents magazine.