We all know we age, and there is no real way to resist it. The question is how we age and how long we live: will we do it gracefully and in good health, or with poor physical and mental health that reduces our quality of life and may shorten it? For this simple reason, the concept of anti-aging, popular for the last 25 years, has recently become less relevant. Increasingly, experts talk about longevity in good health.
For example, Dr. Peter Attieh, an American longevity specialist, says that today the goal is not just long life but long life in good health, so that at 80 we can enjoy life and engage in enjoyable activities. According to him, the most important factor for optimal healthy longevity is body and bone strength because fractures in old age are the leading cause of disability, immobility, and even death.
“Fracture in old age is a fracture in life. The problem is that bone mass loss is gradual and unnoticed, until one day a minor trauma causes a fracture because the bones are weak and cannot handle mechanical stress,” says Dr. Iris Ward, a senior physician at an endocrinology institute.
Behind the minor trauma that ended in a hip fracture is osteoporosis, a disease associated with aging. Contrary to popular belief, osteoporosis affects men as well, although the number of women affected is twice that of men. One reason is that bone loss begins in women before age 50, during menopause, and occurs rapidly due to decreased estrogen. In men, bone loss is more gradual with age due to a slow decline in testosterone, and therefore manifests later. Approximately 30% of hip fractures in the elderly occur in men, and complication rates are higher in men compared to women.
“The background for osteoporosis is complex, including genetic, environmental, behavioral, and nutritional factors,” Dr. Ward explains. “There are many risk factors, including steroid medications, proton pump inhibitors, antidepressants, anti-anxiety medications, epilepsy medications, aromatase inhibitors for breast cancer, low body weight, smoking, eating disorders, diabetes, and excessive alcohol consumption. People with previous fractures are at higher risk for additional fractures. Family history, especially a hip fracture in a parent, significantly increases risk.”
The standard bone density test, DEXA, is covered only for people over 60. Some argue women should be tested earlier because bone density drops rapidly at menopause. Testing earlier may help women decide on hormone replacement therapy.
How to Maintain Bone Health and Reduce Osteoporosis Risk
1. Calcium
Adequate calcium intake is important for building strong bones during growth and preventing fractures in old age. Adults are recommended to consume 1,000 mg of calcium per day, but surveys show the average adult consumes only about 500 mg daily. The best source is food, though most people cannot meet the daily requirement through diet alone. Dairy products are rich in calcium and contain additional beneficial nutrients. Fermented dairy like yogurt and cheeses are particularly beneficial for bone health.
2. Calcium Supplements
Supplements are recommended only if dietary intake is insufficient. For vegans, supplementation is essential. The two main forms are calcium carbonate and calcium citrate. Carbonate should be taken with food for better absorption; citrate can be taken on an empty stomach. Standard doses are 500–600 mg per day. Most supplements combine magnesium, vitamin D, and sometimes vitamin K, but it is better to take calcium alone and add vitamins separately if needed. Splitting doses is optional, but single doses above 500–600 mg are not recommended due to absorption limits.
3. Vitamin D
Vitamin D is essential for calcium absorption. Sunlight is the best source, but older adults often do not get enough. Recommended doses are 400–1,000 IU per day, unless a doctor prescribes more. High vitamin D levels do not necessarily provide added benefit and may increase fall risk.
4. Physical Activity
Exercise is a safe and low-cost non-pharmacological method for preventing and treating osteoporosis. Research shows home-based, unsupervised exercise can increase spinal and hip bone density. Types of exercise include static weight-bearing (standing on one leg), low-intensity dynamic weight-bearing (walking, Tai Chi), high-intensity dynamic weight-bearing (running, jumping, dancing), and resistance exercises. Studies indicate exercise may prevent up to 25% of osteoporotic fractures.
Recommended Exercises for Bone Strength
- While washing dishes, place one foot in a cabinet to load the other leg. Alternate sides.
- While sitting, place a pillow between knees and press them together.
- Place hands palm-to-palm and press together like clapping.
- Resistance training strengthens bones; weights or household items like sugar bags can be used. Lift, lower, and extend arms to work multiple muscles.
Additional Risk Factors
- Fatty Liver: Non-alcoholic fatty liver disease may increase osteoporosis risk.
- Pre-Diabetes: Pre-diabetic states can impair bone structure before full diabetes develops.
Coffee and Bone Health
Moderate coffee consumption (3–4 cups) may reduce osteoporosis risk, but excessive intake (9 cups or more) may increase hip fracture risk by about 10%.