10 Things Every Woman Should Know About Maintaining Healthy Bones

When it comes to protecting your body's 206 bones, it's never too early to start, says Abby Abelson, MD, chair of the department of rheumatic and immunologic diseases at the Cleveland Clinic. "Many women don't even think about their bones until they reach perimenopause," she explains. "But there's plenty women can do in their 30s and 40s." And that's key because, as we get older, we become particularly vulnerable to problems like osteoperosis and stress fractures, thanks in part to changing hormones. Here's what you can do now to make sure your skeleton stays sturdy for decades to come.

Periosteum: The dense outer membrane plays a role in bone repair and rebuilding.

Trabecular bone: This spongy tissue has a honeycomb-like structure and is typically filled with marrow and blood vessels.

Bone marrow: This soft and delicate tissue fills the cavities inside bones. It contains stem cells that give rise to the formation of red blood cells, platelets, and certain types of white blood cells.

Cortical bone: This hard layer protects the more fragile tissue inside. It's made primarily of collagen and calcium and includes bone-making cells known as osteocytes.

By the time you're 22, you've developed up to 90 percent of your bone mass. Your body is still adding the stuff until about age 30, "just at a slower rate," explains Dr. Abelson. Then you maintain an even bone mass until you reach menopause. But after that, estrogen levels drop and old bone is taken away faster than new bone is built. (Experts aren't entirely sure how estrogen helps maintain bone density, but research suggests it inhibits an enzyme that initiates the death of bone-forming cells.) That's why postmenopausal women are more susceptible to osteopenia (or bone thinning, the early stage of osteoperosis) and why it's so important to commit to healthy bone habits, such as getting enough exercise.

Even though groups like the National Osteoperosis Foundation (NOF) don't recommend a routine bone density test for women until age 65, many docs start screening women when they reach menopause, suggests a 2015 UC Davis study. And screening low-risk women in their 50s is not a good thing, says study senior author Joshua J. Fenton, MD, associate professor of family and community medicine at the UC Davis School of Medicine: "If their scan shows low bone density anywhere, they can be given prescription drugs with potentially serious side effects." Women who should get screened before age 65 include those who have a family history, who've had certain types of fractures, or who are taking drugs known to thin bones (such as steroids).

Surprise: A 2015 review in The BMJ revealed no significant link between calcium intake and reduced fracture risk in people over 50. But other experts caution that premenopausal women still need to make sure they're consuming enough of the nutrient. "There's plenty of evidence that calcium and vitamin D are important for younger women" says Mone Zaidi, MD, director of the Mount Sinai Bone Program in New York City. The NOF recommends 1,000 milligrams of calcium and 400 to 800 IU of vitamin D daily for women age 50 and younger. "I really encourage patients to get their calcium from dietary sources," adds Dr. Abelson, "but since it may be difficult to get enough vitamin D from the outdoors and your diet, some may still have to supplement."

For years, it was thought that a little extra padding helped reduce the risk of osteoperosis. But more recent research suggests the opposite, especially if your fat is concentrated in your middle. Harvard researchers found that premenopausal women who had more visceral fat also had decreased bone mineral density. One theory posits that overweight people are more prone to vitamin D deficiency, since the fat-soluble vitamin can get trapped in fat tissue, says Dr. Abelson. Other research has shown that people with high levels of fat in their liver, muscles, and blood have more fat in their bone marrow, which can up the risk of fracture.

Here's how various stages of life can affect your frame.

Pregnancy: While bone loss does occur during pregnancy, women regain it. But space out your kids if you can: Women who give birth twice within a year may have greater risk of osteoperosis, per a 2015 study. Researchers say it's best to wait at least two years.

Breastfeeding: You can lose 5 percent of your bone mass while breastfeeding, possibly due to the baby's need for calcium, drawn from your bones. But you may also be losing bone because your body is making less estrogen than usual.

Perimenopause: Declining estrogen levels during perimenopause can lead to early bone loss: That's why women who are in their 40s are more likely to break a delicate bone in their wrist than a man of the same age, accordgin to the NOF.

Menopause: Thanks to the sharp drop in estrogen that happens after menopause, a woman can lose as much as 20 percent of her bone density within five to seven years. Bone loss continues after about age 65, but at a slower rate.

After years of measuring 5 feet 4 at your annual physical, you find out from your doc that you're now closer to 5 feet 3 3/4. Whaa? It's actually not uncommon for women to get a bit shorter as they age. "The disks between the vertebrae in the spine become dehydrated and compressed," explains Dr. Zaidi. Your spine can also become more curved. If shrinkage happens gradually over three or four decades, there's no need to worry. "But if you suddenly lose an inch and a half in height, you should be concerned," he says. "It could be due to a vertebral fracture and can indicate osteoperosis." While contracting slightly is natural, you may be able to minimize height loss by sticking with your workout routine: One study found that people who stayed active shrank less than those who were sedentary or stopped exercising in middle age.

Celiac disease: If left untreated, this autoimmune disorder—in which gluten leads to damage in the small intestine—can interfere with your gut's ability to absorb crucial vitamins and minerals, including bone-building calcium.

Hyper-thyroidism: When your body is producing excess thyroid hormone, you may start to lose bone faster than it can be rebuilt.

Asthma: Corticosteroids (such as prednisone) taken to control asthma can decrease bone formation and interfere with the body's ability to absorb calcium.

Sleep apnea: A 2014 Taiwanese study discovered that people with this disorder were 2.7 times as likely to develop osteoperosis as those without it. The risk was particularly high among women.

Type 2 diabetes: Patients have a higher risk of fracture, on account of structural abnormalities in their bones thought to be related to the disease, and an increased risk of falling due to a sedentary lifestyle.

When you ramp up your workout too quickly (like doubling your mileage overnight), the muscles, tendons, and tissue around your tibia can become inflammed, especially where the muscles attach to the bone. The result: sharp (or sometimes dull and throbbing) pain along your shin. Standard treatment is to rest, ice, and take OTC anti-inflammatories until symptoms subside.

7 A.M.: Brew a pot of black tea. Australian researchers from 2015 found that drinking at least three cups of black tea daily is linked to lower fracture risk in older women, possibly due to its high levels of flavonoids.

10 A.M.: Snack on a banana. It's chock-full of potassium, which can help increase bone strength by reducing resorption, the process by which bone is broken down, according to a 2015 University of Surrey study.

Noon: Squeeze in an energizing plyometrics workout. Moves that involve jumping may significantly improve hip bone mineral density in premenopausal women, suggests a Brigham Young University study.

3 P.M.: Have a handful of prunes. They boast vitamin K, a nutrient that promotes bone health. The famous Nurses' Health Study linked getting sufficient K to a lower risk of hip fractures.

7:30 P.M.: Cook some salmon, and serve with a salad drizzled with olive oil. Salmon is rich in vitamin D, and research shows that oleuropein, a compound in virgin olive oil, may help prevent bone loss.

10 P.M.: Hit the sack. Chronic lack of sleep may slow down new bone formation without reducing the bone breakdown process, according to a 2012 Medical College of Wisconsin study.