Everyone loses bone with aging. A review of 40 studies on almost 80,000 subjects found that more than 35 percent of people over 60 suffer from osteoporosis that increases risk for bone fractures and death (J Orthoped Surg and Res, Nov 13, 2021;16(669)). People who suffer osteoporotic hip fractures have a 20 percent chance of dying within the next year. If you have suffered bone fractures with minimal trauma, the odds are strong that you have osteoporosis. A bone density test will help you and your doctor to decide whether you are at high risk for osteoporosis and may be a candidate for drugs to strengthen bones.

To help prevent osteoporosis, make sure that you try to exercise regularly, get enough calcium in your diet, keep your vitamin D levels above 30 ng/mL, maintain a healthful weight and eat an anti-inflammatory diet.

Check Hydroxy Vitamin D, Calcium and Parathyroid
These tests should be part of your routine annual physical. Parathyroid hormone helps to prevent osteoporosis by keeping calcium in the bones. High blood levels of calcium can be a sign that you have low levels of parathyroid hormone, or that you have too much parathyroid hormone from a tumor that causes bones to release calcium into the blood (Nephrology Dialysis Transplantation, Jan 2006;21(1) :29–32). The highest incidence of parathyroid disease is in postmenopausal women and high blood calcium can come from excess calcium coming from bones to cause the osteoporosis in the first place. Parathyroid disease can also cause kidney stones.

Be aware that some drugs can lower calcium levels. If your calcium levels are low, you and your doctor will want to review any drugs you are taking. Drugs that can lower calcium include:
• some chemotherapy drugs
• some antibiotics such as rifampin or aminoglycosides
• bisphosphonates to treat osteoporosis
• drugs to control seizures
• calcitonin
• chloroquine for malaria
• proton-pump inhibitors
• corticosteroids

Why an Anti-Inflammatory Diet Helps to Keep Bones Strong
Your bones remodel and change all the time, with cells called osteoblasts constantly bringing calcium into bones and other cells called osteoclasts taking calcium out. If your immune system is over-active, it can slow down the osteoblasts to lower the amount of calcium coming into bones (Endocrinology, Jan 2004;145(1):447–452). Your immune system is supposed to kill germs that attack you, and then when the germs are gone, it is supposed to dampen down. If your immune system stays active when the threat is gone, it can use the same defenses against invading germs to attack you. This is called inflammation. Pro-inflammatory foods turn on your immunity to cause these cells and proteins to attack and damage your own normal cells, while anti-inflammatory foods dampen down this response to protect your cells from damage from an overactive immune system. Anti-inflammatory foods include vegetables, fruits, nuts, whole (unground) grains, beans, fermented dairy products (cheese, yoghurt, kefir), coffee and tea, and seafood. Pro-inflammatory foods include sweetened beverages and sugar-added foods, foods made with flour and other refined carbohydrates, meat from mammals, processed meats, unfermented dairy products (milk, butter), and fried foods.
• Anti-inflammatory, plant-based diets helped to prevent loss of bone density and fractures in postmenopausal women (J Bone Miner Res, May 2017;32(5):1136-1146; American Journal of Clinical Nutrition, Dec 22, 2016; Eur J Nutr, Aug 24, 2016; Open Journal of Epidemiology, May 2013;3(2):79-84).
• Researchers followed 3648 women for eight years and found that those who ate the most pro-inflammatory diets (sugar and red meat) were at increased risk for osteoporosis and bone fractures (Osteoporosis International, October 13, 2017;1-9).
• Older men who ate the most whole grain cereals, fruits, vegetables, nuts and beans had the least hip bone loss as they aged (J Bone Miner Res, October 13, 2017).
• Getting adequate amounts of calcium and protein from food was associated with reduced falls and hip fractures in elderly people(BMJ, Oct 21, 2021;375:n2364).

Get Calcium from Food, Not Pills
Most scientists feel that you need an adequate amount of calcium to keep your bones strong (Maturitas, 2018;107:7), but several studies suggest that you should get your calcium from foods, not pills. A study of more than 50,000 older adults showed that calcium pills with or without vitamin D had only weak, inconsistent effects on fracture risk (Climacteric, 2015;18 Suppl 2:22-31). Researchers at Johns Hopkins followed 2700 people who took calcium pills for 10 years and found that they had a 22 per cent increased risk of arteriosclerotic calcium plaques forming in the arteries leading to their hearts (Journal of the American Heart Association, October 11, 2016). This confirms other studies associating arterial plaque formation with calcium pills (Heart, Jun 2012;98(12):920-5; JAMA Intern Med, 2013;173(8):639–646; J Clin Hypertens, 2017;19(6):640–646; Endocrinol Metab, 2017;32(3):339–349).

People who took in large amounts of calcium from food (>1400 milligrams per day) were 27 percent less likely to have plaques. This suggests that calcium in pills may be handled differently from calcium in foods, to accumulate in body tissues and increase risk for heart attacks (J Clin Hypertens (Greenwich), May 2, 2017) and strokes (Journal of the American Heart Association, Oct. 11, 2016). Calcium pills can also increase risk for forming kidney stones in susceptible people (Am J Clin Nutr, July 2011;94(1):270-277). See Get Calcium from Foods, Not Pills

If you think you may not be getting enough calcium in your diet, consider eating more of these foods:
• Dairy (I recommend fermented dairy products including cheese, yogurt and kefir)
• Seafood, particularly fish with bones such as salmon or sardines
• Green vegetabless such as kale, collard greens, broccoli, sprouts, bok choy
• Beans and lentils, including soybeans, edamame, tofu and other soybean products
• Nuts

Avoid Overweight and Diabetes
Since obese people often have big bones, doctors used to think that excess weight would help to strengthen bones, but it does not. Excess weight is associated with increased risk for damaging high blood sugar levels after eating. When blood sugar levels rise too high, sugar sticks to the outer membranes of cells and destroys them. This applies to bone cells and explains why diabetes is a major risk factor for osteoporosis (World J Diabetes, Aug 15, 2013;4 (4): 101–113). All risk factors for diabetes are also risk factors for osteoporosis: excess belly fat, insulin resistance, high blood sugar levels, and lack of exercise (Clinical Endocrinology, April 15, 2019). The bones of diabetics are significantly weaker than those of non-diabetics (Bone, Dec 2015;81:152-160). Overweight diabetics have a very high rate of osteoporosis (Diabetes & Metabolism, June 2008;34(3):193-205) and bone fractures (J Bone and Min Res, November 2012;27(11):2231–2237).

Exercise for Stronger Bones
Everything that causes you to lose muscle size and strength also causes you to lose bone size and strength (Am J Clin Nutr, May 2008;87(5):1567S-1570S). Anything that enlarges muscles also makes bones larger and stronger. Try to exercise regularly against increasing resistance and do weight-bearing aerobic exercise such as walking, jogging, dancing or playing tennis. See Strengthen Bones with Weight Training

My Recommendations
At this time, the best ways we have to keep your bones strong are:
• eat a plant-based anti-inflammatory diet with a variety of calcium sources
• try to exercise regularly against increasing resistance
• restrict alcohol
• do not smoke and avoid second-hand smoke
• keep blood levels of hydroxy vitamin D over 30 ng/ml. Sunlight is the best source of vitamin D, but if that is not an option, use vitamin D pills.
If you have evidence of osteoporosis, discuss the various bone-strengthening drugs with your doctor.