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Aging Gracefully

A Decade-by-Decade Guide to Protecting Your Bones

Take a stand: what you should (and shouldn’t) do to avoid breaks, fractures, and bone loss throughout your lifetime.

By Stacey Colino
Illustration of a girl with X-raysSophie Blackall

In Your 40s

  • Keep an eye out for skipped periods. This could be a sign that you’re entering perimenopause, which means it’s time to step up your bone-protection plan by doing more strength-training exercises and taking calcium supplements. “When periods become irregular,” David Hamerman, M.D., the director of the Center for Bone Health at Montefiore Medical Center, in New York City, says, “the real slide in bone mass begins.”
  • Watch out for sneaky bone robbers. An overactive thyroid can accelerate bone loss, and type 2 diabetes may increase your risk of fractures. These conditions become more common in your 40s.
  • Assess risk factors. If you’ve ever suffered a fracture as an adult, if you have a family history of osteoporosis or fractures, if you are very thin or currently smoke, if you’ve ever had an eating disorder, or if you went through menopause before age 40, you have an increased likelihood of developing osteoporosis. Share these issues with your doctor; you may need to have your bone density measured if you haven’t entered menopause yet.
  • Discuss hormone therapy with your doctor. Short-term hormone replacement therapy (HRT) to control perimenopausal symptoms, like hot flashes, is not considered risky and can be good for the bones, says Edward S. Leib, M.D., director of the Osteoporosis Center at Fletcher Allen Health Care, in Burlington, Vermont. But over time HRT can increase the risk of a heart attack or breast cancer, so discuss the pros and cons with your doctor.


In Your 50s

  • Increase your calcium intake. Estrogen levels drop with menopause, and the rate of bone loss accelerates―to about 1 to 2 percent a year. This is the time to step up your calcium intake to 1,200 milligrams a day. Some experts believe you should also increase your vitamin D intake to 1,000 to 1,500 I.U. (international units), but talk to your doctor first.
  • Pay attention to back pain. Sudden pain in the back may be caused by a vertebral fracture. This is very common in women over 50 (as are most fractures) and is often ignored. “It should be checked out by a doctor,” says Hamerman, “because one vertebral fracture will predispose you to a second.”
  • Have your bone density tested three to five years after menopause. The gold-standard method is a dual-energy X-ray absorptiometry (DEXA) scan, which typically measures bone density in the hips, the spine, or the whole body. Other tests, involving high-resolution CT (also known as CAT) scans or ultrasound, are also available; all are painless, quick, and covered by most insurance plans.
  • Discuss treatment with your doctor. Once you know your bone density, devise a plan of action. While there’s no cure for osteoporosis, a variety of medications―including bisphosphonates, hormone therapy, and selective estrogen receptor modulators (SERMs)―can help limit bone loss in postmenopausal women.
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