Bones are the scaffolding that holds us up and when they’re lashed together by connective tissue in joints, they allow us to move. When everything is working the way it should, they’re pretty easy to take for granted … until in your middle or senior years, maybe you take a tumble and fracture your wrist or your hip. That’s when a lot of people, especially women, discover that their bones are precariously thin – a condition called osteopenia – or dangerously fragile – osteoporosis. But, as I tell my patients, the time to wake up to the reality of thinning bone is now, before there’s a calamity on the horizon, when there’s plenty of time to slow down the loss of bone tissue that is, sorry to say, a natural part of aging.

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How much bone you have and how fast you lose it is influenced by your genes…but you’ve got a big say in the matter. What follows is what you need to know about testing for bone health, physical activity, diet and supplements, so you can hold on to those healthy bones for as long as possible:  

What’s the deal with bone thinning?  

It’s easy to think about bone as this inert mineral thing. Certainly, doctors used to, in the 19th century, before medical scientists figured out that bone tissue was made of living cells that were constantly in flux. Specialized bone cells called osteoblasts are continually making new bone and opposing cells, osteoclasts are continually eating up (or “resorbing”) old bone. When we’re young, the osteoblasts have the upper hand, which allows us to get taller and stronger. In our twenties, this push me-pull balance reaches an equilibrium, and then from our thirties on the osteoclasts are the winning side. Decade after decade, we lose more bone than we add. In middle-aged women, the process is speeded up by the hormonal changes in menopause although by our 70s, the rate of bone loss in women and men is about the same. But because women, on average, have lighter bones to begin with, they’re still more susceptible to fractures.

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Obviously, the more we can do to limit bone loss as we age the better, and it goes beyond protecting against bone breaks. Recent research has discovered that a particular hormone generated by bone, osteocalcin, plays a key role communicating with the rest of the body, helping to regulate muscular, metabolic and even cognitive health. It’s looking like preserving bone density is its own kind of anti-aging program.

Test those bones.

The traditional gold standard for bone health testing is the DEXA scan – an imaging machine shoots low-level X-rays to capture bone density. But because the scan is a hi-tech procedure requiring a radiologist to interpret the results, it’s not cheap, and often, doctors and patients don’t request it unless there’s an obvious risk of osteopenia or osteoporosis, like a minor fall that shouldn’t have resulted in a fracture, but did. The new kid of the testing block is the N-telopeptide or NTx test, a quicker, cheaper urine or blood test that measures the byproducts of bone break-down, giving you a valuable picture of whether you’re losing bone at an unhealthy rate.

Move those bones.

Your body is cued to make more bone by any weight-bearing activity, walking for instance. Just the act of your feet repeatedly striking the ground stresses your leg bones in a good way, sending a signal that encourages the laying down of more bone. So, in our late thirties and beyond, as the system as a whole tilts towards bone loss, it becomes that much more important to move those bones. Any kind of sustained walking is great and anything that ups the intensity that you can comfortably handle (think brisk walking, jogging, even spurts of brink running) amplifies the bone-building signal.

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Spinners, cyclists and swimmers take note. Your chosen sport is aces when it comes to toning the cardiovascular system but because you’re not pushing against a stiff resistance (like the ground), you’re not getting a major bone pay-off. So, diversify, whether that’s walking/jogging on the side or developing upper body bone with body weight exercises like squats and push-ups or getting into a weight-lifting routine, be it at home (hands weights and lights dumbbells are great) or at the gym.

Feed your bones.

Bone is made up of collagen, the same protein building block found in our connective tissue, as well as calcium, which makes bone hard. So, most of us grew up with the idea that eating a lot of dairy, high in calcium, was good for our bones. But the research hasn’t found that to be the case. And dairy often causes digestive problems and is generally pro-inflammatory. Not only that, veggies, especially leafy greens, are a richer source of calcium (a cup of spinach or collard greens contains twice the amount as a half-cup of cow’s milk) and are relatively high in bone-growth promoting vitamin C.

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Bottom-line: healthy calcium comes from healthy food – so eat your way to stronger bones. Unfortunately, calcium supplements are particularly problematic. A study published in the Journal of the American Heart  Association found these supplements were associated with an increased risk of heart disease. So, at least until we know more, the wisest path is to leave the calcium supplements on the shelf.

And feed them some more.

Other stars in the bone health brigade include foods high in omega 3 fats, like sardines and anchovies, and plant sources like flaxseeds, chia seeds and walnuts. Another item on the bone-friendly menu is, not surprisingly, bone broth. The amino acids released by the boiled bone, and consumed by us, may encourage collagen production in our bodies, so there’s a lot to like here. The research of collagen supplements is, so far, limited, but that’s an option worth exploring, but ideally, eat as well as you possibly can, and supplement when you know you’re falling short dietarily. Remember, supplements support a good diet, they don’t make up for a bad one.

Don’t feed your bones the sweet stuff.

If you needed one more reason to severely cut back, or outright eliminate, refined sugar from your diet, try this one on for size. By some estimates, ingesting sugar increases the mineral loss in our sweat and urine by 300%! Sodas are a double threat. Not only are they sugar bombs, but their high phosphorous content can inhibit the body’s absorption of calcium, which is lousy prospect no matter what age you are.

Give your bones a strengthening boost.

Vitamin D, really a hormone, is essential for the calcium absorption that makes for strong bones. It’s not easy to come by in food (though fatty, oily fish is a good food source) so supplementation is the way to go if sun exposure isn’t bringing your blood D levels to a minimum of 30 ng/mL. For a closer look at how to best manage your Vitamin D levels, check out my recent primer on it.

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Vitamin K is another important bone ally, found in leafy greens and fermented foods like sauerkraut. Another good-for-what-ails you (and your bones) mineral that most Americans are deficient in – magnesium. A 200-400 mg. daily supplement is a cheap and worthwhile health insurance policy.

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Another promising supplement on the bone-saving horizon is ipriflavone, an herbal remedy made from a hormone found in soy. It inhibits the action of the osteoclasts (remember, the bone-eaters) which may promote the formation of new bone.

Bones and body weight.

Here, follow the Goldilocks philosophy: not too heavy, not too light. Some studies have shown that carrying a lot of extra weight can contribute to poor bone quality and increase the risk of fractures. The risk posed by being too thin is more clear-cut. A low body weight is one of the major risk factors for unhealthy bone loss in post-menopausal women. Trying to achieve thinness with a very low calorie diet, under say 1,200 calories a day, is also a recipe for bone woes. And yo-yo dieting is a kind of worst-of-both-worlds approach: the evidence suggests you lose bone on the way down, and don’t regain it as you creep back up. My advice, working on getting to a healthy weight, slowly and sensibly to help keep your bones happy for years to come.