Harvard Health Letter

Easy ways to build better bones

Strength training, weight-bearing exercise, a healthy diet, and medication can help.

build better bones
Image: Tatomm/iStock

An estimated 10 million people in the United States are coping with the brittle, fragile bones of osteoporosis—a disorder that causes severe bone loss. It's most common in women, and the risk is higher in those who are thin, age 50 or older, or of Caucasian or Asian descent. It also occurs in men, who make up about 20% of osteoporosis cases. The condition puts a person at a high risk for bone fractures, disability, loss of independence, and even death. That's why it's important to make your bones as strong as possible. "There are many ways to build bone mass, and the people who do tell us they feel stronger and more capable on their feet," says Rachel Wilson, a physical therapist at Harvard-affiliated Brigham and Women's Hospital.

There isn't one magic way to build bone mass. It takes a number of the following strategies.

Detect bone loss

A dual energy x-ray absorptiometry (DEXA) scan detects osteoporosis and less severe bone loss (osteopenia). A DEXA scan is typically performed after menopause or in people with high risk factors, such as these:

DEXA bone density scan
  • a family history of osteoporosis or hip fractures

  • long-term smoking

  • excessive drinking

  • use of glucocorticoid drugs

  • certain chronic diseases

  • a previous fracture caused by little or no trauma.

Exercise

When we exert force on the bones, it stimulates them to add cells, which speeds up the process of building bone mass. An ideal way to do this is with a combination of weight-bearing activities (tennis, stair climbing, or an activity that involves jumping, like an aerobic workout or dancing) and strength training (in which you work your muscles against resistance, such as free weights, resistance bands, or your own body weight).

Get clearance from your doctor before exercising, and work with a physical therapist to develop a program tailored to your needs. Aim for 150 minutes of moderate-intensity exercise per week for cardiovascular health. Do strength training for 20 to 30 minutes, two or three times a week. Find that overwhelming? Wilson suggests a shortcut: "On strength training days, split up exercises throughout the day. Two or three minutes per exercise will do the job," she explains.

Get enough calcium and vitamin D

Calcium helps make strong bones, and vitamin D aids calcium absorption. Take a daily vitamin D3 supplement (D3 is the form most easily absorbed) between 600 to 1,000 IU, depending on your blood levels of vitamin D. For calcium, some evidence indicates that large doses of calcium pills may increase the risk of death from heart disease. So as much as possible, get calcium from food—dairy products, leafy dark green vegetables, tofu, and sardines. The Recommended Dietary Allowance (RDA) of calcium for men ages 51 or older is 1,000 to 1,200 milligrams (mg) per day. For women ages 51 or older, it's 1,200 mg per day. If your diet doesn't provide enough calcium, take a low-dose calcium supplement to reach your RDA, but not exceed it.

Consider medication

Medications called bisphosphonates, such as alendronate (Fosamax), help slow the rate of bone loss. They're typically prescribed for someone with osteopenia who is deemed to be at high risk for fracture, someone who has osteoporosis, or someone who has already had a fracture from a fall. These medications come with the rare risks of femur (thighbone) fracture and bone loss in the jaw. "The risk of those two problems is very, very low, while the risk of fractures is extremely high. The medications reduce spine fractures by 60% to 70% and reduce hip fractures by up to 40%," says Dr. David Slovik, an endocrinologist at Harvard-affiliated Massachusetts General Hospital.

Make lifestyle changes

Smoking and excessive alcohol use can interfere with bone health. So quit smoking, and limit alcohol intake (no more than one drink per day for women, two drinks for men). And get rid of fall hazards in your home, such as floor clutter, throw rugs, and slippery bathroom floors (use nonslip rubber mats or strips on floors, and install grab bars).