How to prevent osteoporosis and improve bone density

From the desk of Luis Villaseñor

I hear from many coaching clients wondering how to improve bone density. It’s important because over 50% of postmenopausal women (and 20% of men) have osteoporosis-related fractures. In seniors, these fractures can often spell the end of independent living. And so, knowing how to prevent osteoporosis helps you stay functional into your later years. It’s high-impact knowledge.

In this article I’ll take a holistic approach that anyone can follow, with a focus on practical methods of prevention. Forget about the expensive biohacks like those inflatable leg compression systems. I won’t cover bone-density-boosting drugs either. While they are warranted sometimes, they’re not preventative measures.

Instead, we’ll discuss specific nutritional and lifestyle choices you can make today to strengthen your bones for the long haul. The punchline? You need calcium, magnesium, sodium, potassium, vitamins D, A, and K2, protein, strength training, and to make choices that reduce inflammation. But first, let’s begin by talking a little bit about bone density.

Thinking About Bone Density

I suggest you think of bones not as fixed—but rather fluctuating—structures in your body. Bones continuously remodel. Nutrients flow in and out of your bones while hormones direct the show. It’s a dynamic process as you eat, sleep, and frantically Google the return policy for your inflatable leg sleeves (hope you kept that receipt!).

Throughout life, we perpetually form and break down bone. During puberty, formation peaks to support the growing skeleton. Then it levels out in young adulthood, and in our 30s and 40s it begins to decline.

Everything living decomposes as it ages. It’s the second law of thermodynamics that natural processes run in only one direction. Disorder increases over time. And while we can’t stop bone density loss entirely, we can slow it down while keeping tabs on its status.

The most common way of measuring bone mineral density (BMD) is via dual-energy X-ray absorptiometry (DXA or DEXA) scans. The scan gives you a T-score, which is the number of standard deviations your BMD is from the peak BMD of healthy young people. Here’s how to interpret these scores:

A T-score of at least −1.0 is considered normal.
A T-score below −1.0 but above −2.5 means osteopenia.
A T-score under −2.5 means osteoporosis.

Let’s talk more about osteoporosis now.

What Is Osteoporosis?

Osteoporosis is a disorder defined by low bone density and increased fracture risk. It’s a perilous state because even a low-impact fall can cause a lifestyle-altering hip fracture.

Post-menopausal women are more likely to have osteoporosis. Why? Because as women pass through menopause, their estrogen levels decline. (Estrogen helps maintain bone health.) That said, men rely more on testosterone for bone density, and so men with low-testosterone are also more likely to develop osteoporosis. According to one review paper on this topic, “Age-related testosterone deficiency is the most important factor of bone loss in elderly men.” In terms of bone density, both men and women can benefit from hormone-replacement therapy (HRT).

But osteoporosis isn’t the only bone density disorder. There’s also:

Osteopenia: A milder form of osteoporosis
Rickets: A softening of childrens’ bones, driven by vitamin D deficiency
Osteomalacia: Much like rickets, but for adults

The following diet and lifestyle tips can help with each of these disorders.

Micronutrients To Prevent Osteoporosis

To improve bone density, focus on the following vitamins and minerals.

#1: Calcium

The primary role of calcium is to structure the human skeleton, where 99% of bodily calcium is stored. Many factors regulate the flow of calcium in and out of bone, including dietary calcium intake.

Having the right amount of calcium in your blood is necessary for your nerves, muscles, and heart to work properly. It also helps blood vessels move blood throughout your body and helps release hormones that affect many body functions.

If you don’t consume enough calcium, your body pulls calcium from bone into your blood. It works like this for all electrolytes. If you don’t get enough sodium, magnesium, potassium, or phosphorus, you’ll break down bone to make up the shortfall. (Note: most people get too much phosphorus, which is also bad for bone density.)

Shoot for 1 gram of daily calcium from dietary sources. I don’t generally recommend calcium supplements because they’re linked to increased heart disease risk and a higher risk of kidney stones (calcium oxalate stones), but if you do need more calcium, you can try bone meal powder. Spreading it over multiple meals is safer than getting a large, single daily dose from calcium supplements.

#2: Magnesium, potassium, sodium, and zinc

Many people think that calcium is the ONLY mineral that matters for bone density, but you also need adequate magnesium, potassium, sodium, and zinc so your body doesn’t enter bone-breakdown mode. Let’s review some data now.

Magnesium deficiency is a well-documented osteoporosis risk factor. We require this mineral for over 300 enzymatic reactions, including reactions supporting bone and cartilage growth.
Low potassium intakes correlate with poor bone density in postmenopausal women. There’s also a randomized controlled trial showing that two years of potassium supplementation enhanced bone density in adults without osteoporosis.
On a low-salt diet, the body may ransack bone to stabilize serum sodium levels. Sodium restriction also disrupts calcium and magnesium balance at the expense of bone density.
Zinc facilitates DNA and protein synthesis in the skeleton, and stimulates osteoblastic (bone-growing) cells.

Based on the latest scientific evidence, we recommend these daily mineral intakes:

Bottom line? Get enough electrolytes (and zinc) to keep your bones happy.

#3: Vitamins A, D, and K2

The fat-soluble vitamins A, D, and K2 help move calcium out of the blood and into the skeleton. Without them, all the calcium in the world won’t reach your bones. That’s why many bone health supplements contain these nutrients.

Optimizing fat-soluble vitamins may take some tinkering. Your diet may supply adequate vitamin A (liver is a great source), but vitamins D and K2 often require supplementation. D also comes from the sun, so get outside when you can! Testing your nutritional status is beyond the scope of this article, but I recommend using the Cronometer app (or another dietary app) to record your meals and assess dietary levels for all essential nutrients.

Protein and Osteoporosis

Recall from high school that amino acids are the building blocks of protein, and protein is foundational for bodily tissues. About 50% of bone volume is made of amino acids, which we acquire by eating high-quality protein sources like meat, fish, eggs with every meal.

So yes, bones are made of protein, but the reasons protein improves bone density go deeper. For instance, consuming protein boosts a hormone called insulin-like growth factor 1 (IGF-1.) IGF-1, in turn, increases calcium absorption in the gut and helps you synthesize the active form of vitamin D, calcitriol. Both functions are crucial for bone density.

Protein also supports muscle growth following strength training. And when you build muscle, you also increase skeletal strength.

Strength Training and Osteoporosis

As we age, we lose both muscle, and bone density. Our functional health decreases, while our risk of bone fractures increases. Strength training is an important component of slowing these trends.

The science on this topic is quite compelling. Strength training adults show bone density improvements, not just maintenance. So if you’re looking for an anti-aging bone health intervention, this is it.

You need resistance to elicit an osteogenic (bone-growing) effect. Daily activities like walking the dog or scouring the garbage for your inflatable leg squeezer receipt won’t suffice. You must load the skeleton with sufficient force. But that doesn’t mean maxing out your bench press or spending hours in the gym.

If weightlifting is your thing (back squats, deadlifts, etc.), great. These will improve bone density. But other regimens (body weight lifts, resistance bands, and yoga) can help too. Heavier lifts will have a more significant effect—but it’s never worth risking injury to attain this benefit. Prioritize form.

Inflammation and Osteoporosis

People with chronic inflammatory conditions like rheumatoid arthritis, celiac disease, and IBD are more likely to have osteoporosis. Because inflammation accelerates bone loss, researchers have been experimenting with inflammation-blocking drugs as a remedy.

I suggest you experiment with an anti-inflammatory diet and lifestyle first. What does that look like? Here’s a few tips:

Eat a wide variety of nutrient-dense whole foods for gut health (veggies, nuts, etc.)
Consume omega-3 fatty acids (fatty fish or supplements)
Prevent micronutrient deficiencies (especially electrolyte deficiencies and fat-soluble vitamin deficiencies)
Exercise regularly
Manage your stress
Get adequate sleep

Now let’s tie it all together.

Preventing Osteoporosis Holistically

To reduce osteoporosis risk, take a holistic approach. Here are the factors we covered today:

Getting adequate calcium, magnesium, sodium, and potassium to maintain electrolyte balance.
Minding vitamins D, A, and K2
Not neglecting zinc
Consuming adequate protein and strength training to support bone and muscle growth
Managing inflammation

This isn’t everything, of course. I didn’t talk about bisphosphonates and other bone-density drugs, or strategies to decrease inflammation. And other micronutrients like zinc, copper, folate, vitamin B12, and vitamin C influence bone health as well.

But the key criteria for success, where most people will see the greatest return, we’ve got down pat. Pick one or two areas and start working on them today. Small changes every day can have a colossal impact on your health down the road.