Bone health is an integral yet often overlooked component of women's overall health. Unfortunately, many women aren't aware of the risks associated with poor bone health or the steps they can take to prevent it.
In this article, we'll take a look at why bone health is so important for women and the measures they can take to protect and maintain good bone health.
Last full review/revision March 2023Content last modified March 2023
Why is bone health important for women?
Your skeleton is the core foundation of your body. It also plays a crucial role in maintaining your system which includes your day-to-day movements, structural foundation, organ protection, mineral storage and even being a medium for the production of blood cells.
Bone health is important for women, as women are more at risk of developing osteoporosis than men. Osteoporosis causes bones to break more easily, leading to an increased risk of fractured bones and even death.
A study done in 2017 showed that
- Women start losing bone faster and at an earlier age than men.
- Women above the age of 50 years have a four times higher rate of osteoporosis and a two times higher rate of osteopenia, and they tend to have fractures 5 - 10 years earlier compared to men.
Another study in 2015 showed that
- Women mostly have smaller and thinner bones compared to men
- Women can face bone loss as they approach menopause, due to the sharp decrease in the hormone estrogen.
Hence, without a doubt, improving and maintaining bone health and bone density is important and absolutely crucial for women.
What happens if your bone density is low?
If your bone density is low, it can very well lead to medically serious conditions like osteoporosis and ending up in bone fractures.
Simply said, low bone density makes your bones thin and weak making the bone at a greater risk of breaking.
What are common bone health issues for women?
Some of the widely known medical bone health issues for women are
A disease in which you have thinner bones(less bone density) than normal
A disease that causes a loss of bone mineral density (BMD), mostly caused by ageing but with minimal disease activity.
A disease in which your bones become softer due to vitamin D imbalance, making it harder to absorb calcium
A bacterial infection in the lungs that destroys bones and joints during infection
What is osteoporosis?
Osteoporosis is a disease that causes your bones to become more brittle and less dense, making them more likely to break.
It is caused by a loss of bone mass, which leaves your bones fragile and susceptible to fracture.
Osteoporosis can affect people at any age, but it becomes more common as you get older.
Types of osteoporosis
Osteoporosis with normal bone density (also known as "normal bone loss")
This type of osteoporosis occurs in women who have low bone density. It's also called primary osteoporosis because there's no history of other medical conditions or medications that may contribute to the disease.
Osteoporosis with an unknown cause
This type of osteoporosis is defined as having an abnormal bone density test result that can't be explained by the person's age, weight and prior fracture history.
It usually develops during middle age or later in life and is characterized by an increased risk for future fractures and reduced bone mineral density (BMD).
This is the most common type of osteoporosis, which affects some 85% of women after they reach menopause (the end of menstruation). This condition results from a gradual loss of calcium from the body over time as well as a decline in estrogen levels during menopause.
Women are more likely than men to get this type of disease because their hormonal balance shifts during this time, causing them to have lower levels of estrogen than men do at this time in life.
What are the signs and symptoms of low bone density?
There are actually no known symptoms to make you understand that your bone density is getting low.
That being said, if your bone density is weakened by osteoporosis, there are a few symptoms that you can face as per a study by the National Institute of Health
- Severe back pain - mostly lower back
- Spine malformations - stopping forward or hunched posture
- Loss in height - could be associated with the posture change found to be 1 inch or more
- Bone fractures - more prone than usual
How does menopause impact bone health?
Menopause is the time of life when women's production of estrogen levels begins to decrease. This change in hormone levels can have a profound effect on bone health.
During menopause, hormones like estrogen and progesterone which promotes bone health, become less available because they are produced by the ovaries and adrenal glands, which no longer produce them after a woman has reached her childbearing years.
As a result, there is an increase in bone loss that occurs during menopause, especially in the hips and spine. This condition is called osteopenia (bone density loss) or osteoporosis (bone density loss).
Osteopenia is most common in women who first enter menopause before age 50; it affects about 70% of postmenopausal women. Osteoporosis affects about 10% to 15% of all postmenopausal women and causes more than 1 million fractures each year in the United States alone.
What are the main factors that affect bone health?
An in-depth study by the National library of medicine revealed that there are many factors that can affect your bone health and bone density.
Genetic factors (race, family history)
Your bones getting weaker and thinner, the more you age. Women after the age of 65 face a sharp decline in bone density.
Calcium is an important nutrient contributing to good bone health and bone density. Low amounts of calcium in your diet can lead to diminished bone density, early bone loss and an increased risk of fractures.
Vitamin D is one of the most crucial vitamins for bone health, immunity and mental well-being
People who are physically active tend to have more bone strength and have lesser chance of getting osteoporosis.
Bone health can vary depending on your sex/gender as well. Women are more at risk of osteoporosis than men.
Hormones can dramatically affect your bone health. Excess thyroid hormones can affect your bone health. Amenorrhea, before menopause can also increase your chances of osteoporosis. The sharp drop in oesterogen hormone levels after menopause can lead to osteoporosis.
Maintaining a healthy body weight
Maintaining a good healthy weight is a healthy choice, which can help support your bones and strengthen them over time. If your BMI is 19 or less, your frame would be small and your body would have lesser bone marrow to improve on over time.
Too less of different nutrients due to various eating disorders can lead to low bone density. Not keeping a good relationship with your food is the core issue behind almost all eating disorders, we shall discuss more this in a later section.
Smoking & Alcohol
Research shows that tobacco and excessive use of alcohol can lead to low bone health and osteoporosis. We shall discuss more this in a later section.
Certain medications like prednisone, cortisone, prednisolone and dexamethasone, if used on a long-term basis, can be deteriorating to bone health. Other medications like aromatase inhibitors to treat breast cancer, methotrexate, and some anti-seizure medications can also lead to osteoporosis.
Why is bone maintenance important at all stages of a woman's life?
Bone maintenance is essential for women of all ages as it helps maintain overall health and well-being.
Bones are living tissue that must be nourished and kept strong to prevent osteoporosis, fractures, and other bone-related diseases. Women's bones become more fragile and prone to injury or damage as they age.
Here is why bone maintenance is important at each age stage of a woman's life:
Teenager girls (puberty)
Puberty is one of the most crucial times for bone development and maintenance.
About half of the total body’s calcium stores in women are made during puberty. At the end of puberty, men have about 50% more body calcium than women.
As per a study, On average, a menstrual period starts at about age 12 and girls begin puberty at about age 10. The average girl grows faster in height between the ages of 11 and 12 and stops growth between the ages of 14 and 15.
About 95% of a young woman's peak bone mass is present by age 20, and some of the overall gains in mass continue until the age of 30.
however, Obesity can accelerate the onset of puberty. The effect that obesity and early puberty have on peak bone mass for girls is variable.
Women in their 20s and 30s
Although puberty is the most crucial time in a woman's life for bone development, it is the during the age of 20 to 30, that your bones will reach their peak strength.
Muscle training activities at least 2 days a week along with adequate calcium and exercise are required to help achieve peak bone density.
This is also an important period for many women as they get ready for childbearing. Getting the recommended calcium and Vitamin D requirements is especially important when you are pregnant or breastfeeding. Especially because a growing baby in the womb may pull calcium out of the mother's bones in order to build its own skeleton.
Women in their 40s
Throughout these stages of years, your body removes and replaces bones to help it reach its peak potential with fresh bone structures. This process of skeletal change is called bone remodelling.
Until the age of 40, remodelling continues for women. After 40, fewer bones are replaced.
Women in their 50s and post-menopause
As mentioned in the previous section, after menopause there is an absence of hormones like estrogen and progesterone which promotes bone health.
This causes a rise in bone loss, especially in the hips and spine and other bone-related issues as mentioned earlier.
When do bones stop growing in females?
As per a study, an average girl has the fastest growth in height at the age of 11 and 12. The same study also showed that female bones stop growing by the age of 14 and 15.
About 95% of women have their peak bone density by the age of 20.
How is your bone density at risk based on ethnicity?
Your bone density at risk can also depend on your ethnicity. In fact, a study in 2016 showed that caucasian women, and older women, are most at risk for osteoporosis.
Let's look at a few more facts showing how your bone density is at risk based on your ethnicity as per a research study.
- Caucasian women lose one-third of their hip bone density from the age of 20 to 80
- Lactose intolerance is common in caucasian women (estimated at 15%), which makes it difficult to attain calcium easily.
- An estimated 20% of caucasian women tend to have osteoporosis at age 50 or over and an estimated 50% of them tend to have a low bone density.
- Lactose intolerance is very common among African American women (estimated at 70%), which makes it difficult to attain calcium easily.
- A major concern shown in the study is that even among African American women who do have risk factors for osteoporosis, few are screened for the disease. They also don’t get enough vitamin D, which can make it hard for the body to absorb calcium.
- An estimated 5% of African-American women tend to have osteoporosis at age 50 or over, and about 30% of them tend to have low bone density.
- An estimated 20% of Asian-American women tend to have osteoporosis at age 50 or over, and more than half of the Asian-American women tend to have low bone density.
- Lactose intolerance is most common in Asian-American women (estimated at 90%), which makes it difficult to attain calcium easily.
- An estimated 10% of Latina women tend to have osteoporosis at age 50 or over, and more than half of the Latinas tend to have low bone density.
- Hip fractures are very well-reported among Latina women
- Many Latina women are known to be lactose intolerant.
How can you prevent bone density loss?
There are a few simple rules you can follow to prevent bone density loss and keep your bones stronger as they age:
- Consume food that supports your bone health
Getting enough calcium and vitamin D is absolutely crucial for bone density. Protein is also important for bone density loss prevention.
- Stop smoking
Smoking can adversely affect your bone density. If you are finding it hard to stop smoking, find help here
- Limit alcohol intake
Alcohol consumption can affect your bone density as well. Consider drinking in moderation or try to avoid it completely.
- Do a physical activity every day
Do activities that can help challenge your bones and muscles, thereby making them stronger as you age.
How can I check my bone health?
The best way to check your bone density and health is by taking a Bone marrow density (BMD) test.
BMD tests can help determine your risk for fractures, identify osteoporosis as well as measure your response rate towards osteoporosis treatment.
The most common BMD test is a central dual-energy x-ray absorptiometry or central DEXA test. The test is almost similar to an X-ray and can measure bone density at your hip and lumbar spine.
At what age should a woman have a bone density test?
Since osteoporosis is most found common in women aged 65 and above/going through menopause, Dr Jennifer Jerele explains that women should have their first DEXA scan at the age of 65 as that's when your bone density starts rapidly decreasing
Best vitamins for bones and joints
The best vitamins you need to include for your bone and joint health are:
Calcium is one of the main components of the bone. It is found to be present at more than 99% as calcium-phosphate complexes and provides the skeleton strength and structure
- Vegetables: Broccoli, kale, collard greens, Chinese cabbage, dandelion greens
- Fruits: Lemons, papaya, figs, guavas, berries, dates, dried apricot, kiwi
- Nuts: Almonds, flaxseeds, sesame seeds
Vitamin D is one of the most crucial vitamins for bone health, immunity and mental well-being. It is available through direct sunlight, is also available through nutrition
- Vegetables: Mushrooms, tofu
- Non-vegetable: Pork , eggs, fatty fish, oysters
- Fruits: Orange, banana, papaya, peaches, mangoes
- Nuts: cashews & hazelnuts
Magnesium plays a major role in the digestion and absorption of calcium.
- Vegetables: potatoes, spinach, avocados, collard greens, sweet potatoes, tomatoes.
- Fruits: Bananas, guava, kiwi, raisins, strawberries, watermelons, jackfruit
- Nuts: Almonds & pumpkin seeds
Vitamin K is essential to generate bone-building proteins. It also regulates the building and remodelling of cells osteoblasts and osteoclasts in your body
- Vegetables: Green peas, spinach, avocados, broccoli, parsley, kale, green beans
- Fruits: Kiwi, grapes, blackberries, blueberries, mulberries, raspberries, pomegranates, plums
- Nuts: Pine nuts, cashews
Which fruit is best for bones?
Calcium is one of the most crucial nutrients in defining bone strength, hence Apricot, which is the fruit with the most known calcium content can be considered one of the best for your bone.
How do you improve bone health naturally?
Improving bone health naturally is a process of following a good healthy routine abiding by the few simple natural steps given below
- Include strength training and weight bearing exercises in your workout routine
- Include a good amount of calcium in your diet daily
- Consume a good amount of protein, vitamin D, vitamin K, Magnesium & Zinc
- Include a good portion of vegetables in your diet daily
- Maintain a good, stable and healthy weight
- Consult and consider taking a collagen supplement.
- Try to avoid very low calorie diets
Results from following health natural methods will take time to show results and will vary in benefits for different people.
Based on any pre-existing health conditions (like lactose intolerance), you might have to try alternate methods to improve your bone health. Hence if in doubt, consult your doctor.
What type of exercise builds bone mass for women?
Weight-bearing exercises and resistance training exercises are known to be the best type of exercise for women to build good bone density. These are exercises that force you to work against the gravity of the earth.
Weight-bearing exercises include: walking, hiking, jogging, climbing stairs, playing tennis, and dancing
Resistance exercises include: Strength training
As a bonus tip, swimming and bicycling can also help with bone development along with other cardiovascular benefits.
Is yoga good for women to improve bone density?
Yes, yoga is exceptionally good for women facing osteoporosis.
A 2009 study revealed that yoga can actually be beneficial in improving bone strength and density. Hence including a few sessions in your weekly workout schedule would be a great idea.
- PubMed (2013) - A multiscale model of the bone marrow and hematopoiesis
- PubMed (2017) - Gender Disparities in Osteoporosis
- PubMed (2015) - Primary osteoporosis in postmenopausal women
- WebMD - health report for women: Ageing smart, Ageing well
- National Institute of Arthritis and Musculoskeletal and Skin Diseases - Osteoporosis
- National library of medicine - Determinants of Bone Health
- PubMed (2012) - Bone mineral density and body composition in girls with idiopathic central precocious puberty before and after treatment with a gonadotropin-releasing hormone agonist
- Paul Rowe; Adam Koller; Sandeep Sharma (2022) - Physiology, Bone Remodeling
- National Institutes of Health (NIH) - Dietary Supplement Fact Sheet: Calcium
- NCIB (2012) - Racial/ethnic differences in bone mineral density among older women
- National Institute of Arthritis and Musculoskeletal and Skin Diseases : Bone Mass Measurement: What the Numbers Mean
- PubMed (2014) - Bone density and timing of puberty in a longitudinal study of girls
- PubMed (2014) - Osteogenic effects of a physical activity intervention in South African black children
- PubMed (2015) - Effectiveness of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass: A 12-month randomized, clinical trial
- PubMed (2003) - Low protein intake: the impact on calcium and bone homeostasis in humans
- PubMed (2015) - The role of calcium in human aging
- Fishman, Loren M. MD, BPhil(Oxon) (2009) - Yoga for OsteoporosisPubMed (2021) - Effects of sex, tobacco smoking, and alcohol consumption osteoporosis development: Evidence from Taiwan biobank participants