As we age, we all want to keep our bodies in the best shape possible, especially with life expectancies continuing to increase. But when it comes to looking after our health, juggling all the different areas – from diet and hormones to brain health and cardio fitness – can often seem impossible.

However, if there’s one area of our health women should be prioritising as we age, it’s bone health – particularly, bone density. You might be hard-pressed to find an Instagram influencer who promises you denser bones in 12 weeks, but the experts say strong bones matter. Strong bones provide vital support for our muscles and organs, protect against injuries and fractures and even affect our posture, preventing us from hunching over and having back pain. 

Now, it’s easy to feel like that’s a problem for our older selves, but many of us are derailing our chances of having active, mobile futures by unwittingly sabotaging our bone health every day. Ageing in itself will lead to bone density loss (we typically start to lose bone density around 35), but women are at increased risk of low bone density due to having smaller bodily frames and fluctuating levels of oestrogen that work to protect them. When we hit menopause, that oestrogen zaps away and our chances of developing osteoporosis (a condition where bones break easily) increases.

So how do we know that we are harming our bones? And what can we do about it? 

First things first, let’s understand exactly what we’re talking about when we refer to bone density. To put it simply, bone density simply refers to the volume of bone tissue within our bones.

“Bone density refers to the measure of mineral content in bone tissue, particularly calcium and phosphorus, which contribute to its strength and rigidity,” explains Rachele Louise, a women’s fitness and nutrition coach and one of the experts on the women’s health platform Agora Health.

While low bone density (a condition known as osteopenia) can eventually lead to osteoporosis, the challenge for medical professionals is that osteopenia rarely produces symptoms, so the only way to tell if there’s an issue is to measure bone density using a scan known as a dual-energy x-ray absorptiometry (DEXA). However, because the early stages of bone density loss don’t produce symptoms, it’s important to take a preventative approach to bone health as we age.  

Alongside age and perimenopause, there are several factors which can increase your risk of bone density loss. Indeed, Louise explains, dealing with hormonal dysfunction at any point in your life can take its toll on your bone health.

“For women, oestrogen is critical for maintaining bone density,” she says. “This means that for premenopausal women, having a regular menstrual cycle is a great indication of hormone function and therefore the ability for the body to increase bone density.”

This link between low oestrogen and bone density loss explains why women who lose their period during their premenopausal years can be at increased risk of low bone density and osteoporosis. Other conditions which lead to low oestrogen – such as hypothalamic amenorrhea, a condition in which your periods stop due to problems with your hypothalamus, the hormone centre in the brain – can also take their toll on bone health.

It’s for this reason why you should schedule an appointment with your GP if you suspect you have low oestrogen, to share your concerns and make sure your bone health isn’t being affected. 

According to Dr Luke Powles, Associate Clinical Director of Bupa Health Clinics, things like consuming too much salt, sedentary lifestyle, smoking and being underweight can all contribute to poor bone health. While the strength of our bones is difficult to measure without testing, there are some warning signs to look out for. 

Regularly taking steroid medication (including corticosteroid medications), untreated premature menopause as well as sustaining a fragility fracture (breaking a bone with minimal force) can all contribute towards weakening bones, too. And studies have suggested that air pollution can even play a role.

“You’re generally at a greater risk of poor bone health if you’re a woman, extremely thin (with a BMI of 19 or less) and if you’re white or of Asian descent,” he says. “Having had an eating disorder or severely restricting your food intake will increase your risk, and so will a family history of weak bones or osteoporosis.”

Having low bone density doesn’t just mean that your bones are a little weaker than normal – it can also mean they’re more easily damaged and more difficult to repair.

Maintaining as much bone density as possible is therefore key to retaining your ability to move freely as you age – low bone density can mean even the smallest trips, falls and bumps can lead to broken bones, which in turn will further limit mobility. 

Most of our bone mass is developed by the time we turn 20. That’s why Dr Powels tells us that “the best time to build bone density is in childhood, adolescence and early adulthood”. However, he also says that it’s possible to “significantly improve your bone mass through a varied diet and regular exercise”. 

1. Lift and walk your way to a stronger frame

For those of us aged between 18 and 35, weight-bearing exercises like weightlifting, running, and dancing will improve bone health. When you reach 35, bone density starts to gradually decrease, so it’s crucial to that you do plenty of muscle-strengthening exercise before and after to stay strong – ideally twice a week. Dr Powles adds that we need to “remember to target all areas of the body in workouts, from your arms and legs to your core and back”.

Marylebone-based osteopath Anisha Joshi agrees, telling us that an increase in sedentary lifestyles has been one of the biggest barriers to better bone health. “Lifting weights or doing walking lunges, squats and dumbbell presses can also aid in the strength of your bones. It is important to do these exercises in a slow and controlled way, with good form to gain maximum benefit.”

When push comes to calisthenic shove, it all boils down to doing workouts that are weight-bearing. “Activities like walking and tennis also help us maintain bone mass as they force you to work against gravity.” As an added bonus, Joshi says that exercise improves coordination, muscle strength and balance — all helping us prevent falls and fractures in the first place. 

Strength training can also provide hormonal benefits like a slight boost in testosterone and increased human growth hormone levels, both of which can have a positive impact on bone health. 

2. Eat a bone-friendly diet

Every cereal box and dairy advert will tell you that calcium is crucial for strong bones. While calcium keeps the bones healthy, vitamin D is needed to help your body absorb that calcium. “Calcium doesn’t just come from milk,” says Joshi. “Other good sources are leafy green vegetables, tofu, soya beans, soya drinks, nuts and fish like sardines.”

Most vitamin D is absorbed through sunshine on our skin, but it also comes in food form, too. When it comes to eating for better bones, Joshi says the following foods are crucial to stock up on:

• Eggs
• Oily fish
• Rice and oat drinks
• Sesame seeds
• Pulses
• Fortified breakfast cereals
• Powdered milk
• Fortified soya
• Dried fruits
• Fortified fat spreads

Dr Powles explains that supplements can be a great way to top up any deficiencies. This is particularly important when it comes to getting the right amounts of vitamin D, especially for those of us living in greyer, cloudier climates. He suggests opting for a daily supplement of 10 micrograms of vitamin D, and says “current guidelines advise that absolutely everyone takes a vitamin D supplement”.

As for calcium, the amount we need changes at different stages of our lives. But as a general guide, most adults should aim to have 700mg to 1000mg of calcium every day. On the topic of micronutrients, Dr Powels says salt is a big contender for bone health too. Having too much of it can be harmful. “Limit your salt intake to no more than six grams every day,’ he warns. 

3. Live a healthy lifestyle

As with every other health goal, smoking and drinking are to be avoided too. “Lots of studies have shown a direct link between smoking and decreased bone density because it slows down the cells which build bones in your body. It also increases the risk of a fracture and has a negative impact on bone healing,” Joshi tells us. 

“Interestingly, if you’re a woman, smoking also increases your chances of early menopause and women going through the menopause are more likely to develop osteoporosis.”

While no one is advocating for you to go teetotal, watching how much you drink isn’t necessarily the worst idea. Dr Powels recommends drinking no more than 14 units a week (the equivalent of 10 small glasses of low-strength wine) and making sure you spread these out throughout the week. “Try to spread your units evenly over at least three days of the week, too,” he advises.

4. Look after your gut

Surprise, surprise: your gut health can also influence your bone density. “Gut microbiome diversity also plays an important role in helping our body improve bone density and remodelling,” Louise explains.

Indeed, a study published last year by Harvard Medical School researchers linked various types of bacteria to both lower and higher bone density – suggesting the types of bacteria we have in our gut could play a role in how strong our bones are.

While more research is needed to determine exactly how this link works, supporting your gut microbiome can have so many benefits outside of your bones, so it’s worthwhile keeping in mind.

Eating plenty of different plants, keeping your stress levels under control and keeping to a consistent sleep schedule can all help to bolster gut microbiome health. 

Image: Getty