Key Takeaways

  • Small boosts in bone health can yield big benefits, particularly when it comes to protecting yourself against major issues like hip fractures.
  • There are many factors that account for bone loss, including advancing age, disease, menopause, lack of exercise, and inadequate nutrition.
  • Weight-bearing activities plus extra calcium and vitamin D can boost bone strength.
  • For some people, testosterone therapy—possibly combined with estrogen (for women)—can be a good choice to stave off or reverse bone loss.

While breaking any bone is no fun, fracturing a hip can be particularly serious for older people. A study published last year found that for people in their 60s who have had a hip fracture, 6.5% of women and 9.4% of men died within a year. Among people in their 80s, 13.1% of women and 19.6% of men died within a year.

The good news is that increasing your bone strength can help stave off these issues, and it’s very possible to do. Even a small boost in bone mineral density has been shown to pay big dividends in terms of reduced risk of fracture, especially hip fracture. A decades-long Australian study suggests that achieving just a 3% increase in bone strength markedly lowers your chance of breaking a hip.

For the study, researchers enrolled two groups of people aged 60 and older, one beginning in 1989 and the second in 1999. At the outset, they measured the bone mineral density of each subject’s femoral neck joint, which sits at the top of the thigh bone near the hip. Then, they followed the subjects for years to see who experienced hip fracture. While bone mineral density of the second group was only 3% higher than that of the first group, these subjects experienced a 46% reduction in hip fracture.

Given these results, it’s clear that making just a few small changes in your life can have an outsized impact on bone health and, by extension, overall well-being. Here’s how to start.

Why Does Bone Loss Happen?

Bone loss is progressive in both men and women, with the incidence rising as people age. Osteoporosis, a condition in which bone tissue deteriorates, affects 10 million Americans, and another 43 million have low bone density, which is a precursor to osteoporosis.

“Our bones are constantly undergoing breakdown and formation as a normal remodeling process,” Eric Tam, MD, a primary care physician with Might Health in Los Angeles, told Verywell. “Osteoporosis is caused when there is an impaired balance of this process, resulting in more bone breakdown than bone formation.”

While both sexes experience bone loss, it’s more common in females. Menopause is a particular risk factor thanks to the decline of estrogen that characterizes this life stage. Estrogen bolsters bone strength by acting as a bulwark against bone breakdown; with this loss of estrogen, according to Tam, bone breakdown increases.

Ethnicity can also play a role in the severity of bone loss.

“Decreased bone strength is most common in non-Hispanic White women and Asian women,” Amelia Lindberg, PT, a physical therapist and founder of Body Fluent Wellness in New York, told Verywell. “White men and Asian men have a lower incidence than that, and Black Hispanic men have the lowest chance.”

Anyone of any age or background, however, can experience bone loss due to endocrine disorders, gastrointestinal diseases, inflammatory diseases such as rheumatoid arthritis, and some cancers. Medication taken to treat these conditions, such as steroids or oncology drugs, can hasten bone loss as well.

Buoying Bones With Exercise

While some loss of bone strength may be common—perhaps inevitable—as we age, experts say there are a number of strategies to counter it. At the top of the list is exercise, specifically weight-bearing activities.

“Bones are a great example of use-it-or-lose-it,” Lindberg said. “Any time you use your bones and muscles to hold a position against gravity, you are mechanically stressing the bone, causing the bone to form stronger.”

Tam agrees. “I am a huge supporter of seeing movement as medicine, and when it comes to bones there is absolute truth in this statement,” he said. “During physical exercise, the forces transmitted through your bones generate mechanical signals that tell the cells in your bones to increase bone formation relative to breakdown.”

For people with osteoporosis, Tam recommends exercises that zero in on posture, balance, gait, and coordination, such as the seated march. For this exercise, you sit in a chair and, keeping your back straight, raise one knee to your chest at a time as if marching. This strengthens the core, quadriceps, and hip flexors.

For balance and coordination, Tam likes the one-leg stand, in which you hold onto something for support while lifting one foot off of the ground and holding it for 10 seconds at a time.

Lindberg is a big fan of walking as a way to strengthen the spine and hips in particular.

“Walking outside or on a treadmill is more beneficial than walking at the same pace on an elliptical machine,” she said. “The impact of taking a step provides more of a loading force to the bone than gliding on an elliptical.”

She also recommends planks and push-ups to strengthen the forearm and wrist bones, and side leg lifts to boost hip and forearm bones at the same time.

What about weight training? Giving your bones a workout by having them support a weight load doesn’t necessarily mean piling a barbell with super-heavy plates.

“[It] doesn’t need to be intimidating or complex,” Tam said. “Start with one water bottle in each hand, lifting them up and down 10 times each, and do that a few times a day.”

Does Diet Matter?

What you put into your body definitely affects your bones, with calcium and vitamin D at the top of the list. Lindberg notes that while calcium is a key to bone building, you need vitamin D in order to absorb the calcium you ingest. Calcium can be found in dairy (many dairy products and non-dairy alternatives are fortified with calcium), along with leafy greens, beans, and almonds.

“Vitamin D mainly comes from sunlight, but is also found in fish, mushrooms, fortified milk, and supplements,” she said.

Lindberg said the recommended daily intake of calcium is 1,200 milligrams for adults over age 50, while the recommended intake of vitamin D is 15 micrograms up to age 70 and 20 micrograms for people over 70. While this target may be tough to hit through food or sun exposure, studies have found that boosting your intake with calcium and vitamin D supplements can play a role in bone health and maintenance. Talk to your healthcare provider if you think you might need supplements.

Hormone Therapy May Also Help

While it’s more typical to hear about testosterone as a male hormone, females produce it naturally as well. Because testosterone acts to promote bone formation, the fact that levels drop as we age negatively impacts bone strength. A treatment called hormone therapy can help.

“Testosterone takes a slow curve down, starting with women in their 20s and starting with men in their 30s,” Bruce Dorr, MD, a Littleton, Colorado-based urogynecologist, told Verywell. The typical drop in testosterone levels in women is 1% to 3% per year before menopause and stabilizing somewhat afterwards.

Dorr said the guidelines for treating women with testosterone are not as clear as they are for men. But for his female patients at risk of bone loss, he often prescribes testosterone in the form of pellets that continuously emit the hormone in a bioidentical form.

For these patients, he’s careful to keep the dose low enough so they don’t experience unwanted hair growth or skin changes.

Dorr is in favor of combining testosterone with estrogen in female patients, as the combination is particularly effective at boosting bone growth. Not everyone is a candidate for hormone therapy, though, like people with a history of breast cancer, heart disease, blood clots, or liver disease.

“When you give estrogen, it helps [prevent] bone absorption, or bone breakdown,” he said. That benefit, combined with testosterone’s bone-building properties, make the combination a solid choice for women concerned about osteoporosis. “When we combine testosterone with estrogen, we see almost a doubling—4% to 5% per year—of bone growth.”

Women may not want to wait until they experience bone loss to begin taking hormones, Dorr said. He advocates starting a hormone regimen well before menopause to stave off or delay osteoporosis, and recommends that women interested in going this route find a provider knowledgeable about both testosterone and estrogen.

What This Means For You

Small habits can improve your bone strength. If you don’t know where to start, seated marches can improve posture and coordination before moving on to weight-bearing activities.