What to Know About Bone Density

The scoop on keeping bones strong and healthy as you age—from testing and diet to supplements and exercise.
By Jenna Haines

Full PDF here.

27HealthyAging1It might be time to begin paying attention to your bones. Healthy bone density is important in avoiding fractures caused by impacts like falls, which pose a significant health risk for adults as they age. To make sure you’re in tip-top shape in the event of an accident, begin by assessing your risk with a bone density test and taking steps to strengthen your bones.
What is bone density? 
The term “bone density” refers to the amount of mineral matter in your bones per square centimeter. It’s imperative to be aware of your bone density as you get older for a number of reasons. Perhaps the biggest one is that your risk of falling increases with age. Over one in three adults ages 65 and over fall every year, and more than 1.6 million older adults end up in the emergency room annually in the U.S. due to fall-related injuries.
Your top defense against these fall-related injuries is strong bones. However, bones naturally lose some density with age. For women, the rate of bone loss increases after menopause. Men experience bone loss less rapidly until they reach the age of about 65, at which point both men and women start losing bone mass equally. Osteoporosis, which makes bones porous and weak, is also more common in older adults. It is often known as a “silent disease” because it usually occurs gradually over many years and there are few symptoms until an injury reveals its effects. That’s why bone testing is so important. Knowing how strong your bones are is the first step in proactively preventing future injuries.
What is bone density testing? 
The National Institute of Arthritis and Musculoskeletal and Skin Diseases says that a bone mineral density test, or a BMD test, is the most effective way of determining the health of your frame. A BMD test can help establish your risk for fractures and identify the presence of osteoporosis, a progressive bone disease that deteriorates the bone mineral density and alters the amount and kinds of proteins in the bone. The most common BMD test is known as a dual-energy X-ray absorptiometry, or a DEXA scan. This painless X-ray procedure measures the density at the hip and lower spine or wrist, fingers, leg, or heel.
Should I get it? 
The National Osteoporosis Foundation recommends that women over 65 and men over 70 have their bone density tested. However, the National Institutes of Health (NIH) recommends getting tested as soon as possible if you know or suspect you’re at high risk of fracture (i.e., if you’ve broken bones before or have a family history of osteoporosis). While doctors are unsure of exactly how long to wait before getting re-screened, most patients can safely wait about 15 years. However, if your initial test reveals moderate to advanced osteopenia (low bone density), it would be wise to get re-screened annually.
What is a healthy bone density? 
Results are measured in averages and deviations through T-scores, rather than raw results. Therefore, a T-Score of 0 is the norm, and a score between -1 and +1 is considered normal and healthy. Results between -1 and -2.5 reflect low bone mass, and a score of less than -2.5 signifies osteoporosis. However, your fate is not sealed if you are diagnosed with low bone density. Whether you’re younger or older—you’ve had your bone density tested already or you’re more concerned about preventative care—there are steps you can take to improve your bone health.
How can I build stronger bones? 

Natasha Ballard, M.D. Doctors Express Urgent Care
Natasha Ballard, M.D.
Doctors Express Urgent Care

The most important way is to get more calcium. If the body doesn’t have enough calcium piled away, it begins to take calcium from your bones in order to maintain basic biological functions. This causes loss of bone mass.
Doctors say how much you need will depend on your gender and age. “As adults age, their need for calcium increases to levels near what they required as teenagers,” says Dr. Natasha Ballard of Doctors Express Urgent Care. “Postmenopausal women should consume around 1,200 milligrams of calcium daily, while men need 1,000 milligrams.”
One of the best ways to introduce calcium into your diet is through food. Most of us already know that milk is a great source of calcium; other dairy products that offer calcium are yogurt and cheese. If you’re lactose intolerant, there are calcium-rich options for you too, such Chinese cabbage, broccoli, kale, orange juice, salmon, tofu, and certain nuts.
“Older adults can also boost their calcium intake by combining calcium-rich foods, such as yogurt, cheese, broccoli and kale, with supplements,” says Dr. Ballard. “Calcium carbonate—found in some over-the-counter antacids—is inexpensive but should be taken with food in order to be absorbed. Calcium citrate is more expensive, but can be taken on an empty stomach.”
It’s extremely important for patients to understand, though, that in order for calcium to be absorbed in the body,  your body needs vitamin D. Three easy ways to get vitamin D are sunlight, calcium supplements with vitamin D in them, and food, such as fatty fish like salmon and tuna.
Lastly, adults can build stronger bones by getting active. The NIH recommends at least 30 minutes of physical activity, such as walking or dancing, per day. Strength training is also a great tool in building muscle and maintaining bone health, but should be done carefully under the initial guidance of an expert. And as with most health issues, quitting smoking and limiting alcohol are suggested. Both habits can decrease bone mass and increase the chance of fractures—not to mention numerous other side effects.
Are calcium supplements safe?
The short answer is yes, if they are taken in the correct dosage after a consultation with your health care provider. It’s extremely important to speak with a professional about your individual needs, because while too much calcium from food is rare, you can easily consume too much calcium from supplements. The NIH says to be weary of this because extremely high calcium levels can cause renal insufficiency, vascular and soft tissue calcification, hypercalciuria and kidney stones. More commonly, high levels of calcium cause constipation and gas. Calcium also has the potential to interact with different kinds of medicine, so check with your doctor before introducing a new supplement into your routine.
“Calcium is best absorbed in doses less than 600 mg at a time,” says Dr. Ballard. “Gastroesophageal reflux medications may interfere with calcium absorption, and calcium supplements interfere with iron and thyroid medications. All of these should be taken at different times.”
Beyond helping reduce injury in falls and preventing osteoporosis, strong bones are also important in a person’s ability to move freely, build muscle, preserve good posture and maintain a healthy immune system. In other words, your bone health is intrinsically related to your quality of life. There are a number of small changes you can implement to improve your bone health. Make an appointment with your doctor today. Proactive steps are always the best choice when it comes to your health. 

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