Bone building and maintenance in adulthood

Additional bone health topics for other ages can be found here:

• Children’s bone health
• Teenagers bone health

There are certain general trends for both sexes, but men and women also have distinct concerns about bone health. The general trends are listed below; but we also have additional information on special concerns for women, and facts about men and osteoporosis.

What are your special concerns?

• In your 20s . . .Even into your late 20’s, you can add to your peak bone mass through exercise and nutrition supplementation.
• In your 30s . . .In the third decade many women and some men begin to lose bone mass. Receding gums are a sign of bone loss and are often seen in the mid 30’s. In women, estrogen and progesterone deficiency during the fertile years will lead to bone loss; thus missing periods are associated with bone loss.
• In your 40s . . .Perimenopause often begins in the mid-40’s. This time period is often associated with increased bone mineral loss as the body adjusts to lower hormone levels.
• In your 50s and 60s . . .For both men and women, the more bone density you have built up in your teens, 20s, 30s, and 40s, the less likely it is that this normal bone loss will lead to osteoporosis. In women, the three to five years after menopause are also a time of hormonal adaptation and are often associated with increased bone loss. This is a normal adaptation and does not necessarily imply the development of severe bone weakening.
• Age 76 and beyond). . .Within the next 50 years, 25% of the US population will be aged 65 and above. Osteoporotic fractures tend to occur as we age into the 70s and 80s. Spinal fractures occur earlier, while the average age of hip fractures is in the 80s.

As we age…

There is a common tendency to lose muscle mass as well as bone mass as we age. Indicative of our true regenerative potential, however, William Evans, MD, working with his team at Tufts University, found that through strength-building exercises, they could make a 95-year-old as strong as a 50-year-old and a 65-year-old as physically fit as a healthy 30-year-old. Furthermore, osteoporosis can be stopped, even if one has already fractured a bone. Women with an average age of 84 gained hip density (2.7%) and reduced their hip fracture rate by 43% on 1200 mg tricalcium phosphate and 800 IU vitamin D daily. Similar control patients lost 4.6% hip density and had 67% more fractures.

Nutrient needs change as we age, and with the advancing years, nutrient deficiency becomes very common. For example, while young people often consume too much protein, the elderly generally consume too little. Most notably, the need for vitamin D increases with age. Bone-weakening vitamin D deficiency is prevalent among the housebound, but also among active seniors, and up to 80% of all hip fracture patients may exhibit vitamin D deficiency. The elderly living in northern climates and those exposed to little sunlight require from 800 to 2000 IU of vitamin D a day. In addition, all elderly should keep their intake of calcium and other key bone nutrients at least at RDA levels. The first, and for many the most important, bone health test for seniors is a test for vitamin D adequacy.

How to promote bone-healthy aging

• Eat at last one serving of meat or two servings of beans per day.
• Get daily direct sunlight if possible and use daily supplemental vitamin D (800-2000 IU).
• Use a balanced multivitamin/mineral and additional calcium as necessary.
• Be physically active. Exercise, even if from a wheelchair.
• If you are on an osteoporosis medication, its effectiveness can be increased if used along with a strong bone-building nutrition program.
• Do that which provides a sense of well-being and joy.

Taking care with medications

An estimated 11% of all hip fractures are attributed to the use of mood-altering medications, which cause falls. Those using long-acting psychotropic drugs like Valium and Librium run a 70-80% greater risk of hip fracture. It is especially wise for the elderly to take care with medications, enhance fitness for better balance, and make household environmental changes to reduce falls.

Bone tests

While the DEXA bone density scan is the standard means of assessing bone density, the new urine tests for bone breakdown can estimate the likelihood that you are currently losing bone. These tests include:

• The NTx Osteomark test, which reports N-telopeptides of type 1 collagen. These collagen fragments appear in the urine as bone is broken down.
• The deoxypyridinium collagen crosslinks Dpd test. These collagen crosslinks are also excreted in the urine when bone is broken down. In adults, high levels of these bone breakdown by-products suggest excessive current bone loss.

Top bone-building nutrients for people of all ages

The accompanying table provides reference ranges for our top-20 nutrient picks for adults. For children and young adults, follow recommended daily allowances (RDA) and dietary reference intakes (DRI) specific to each age. For specifics on recommendations and the bone-healthy nutrients and daily amounts that are found to be most therapeutic, see our full article on the 20 key bone-building nutrients.

What we discover more each day is that it is never too early nor too late to enhance bone health. Because bone health is intimately linked to overall health, osteoporosis can be best seen as an invitation to not only build better bones, but also a better body at any age.