How To Help Prevent Osteoporosis: Habits To Protect Your Bones

Bone health is one of those things most of us don't think about until someone we love breaks a hip. And it makes sense, because bone loss is quiet. You can feel your muscles getting stronger with regular strength training, but you can't feel your bones getting weaker.

To find out what actually matters, we spoke to Sheridan Skye, a women's health educator, registered nurse, nutritionist and personal trainer, and the expert behind Sweat's Perimenopause and Menopause Essentials Masterclass.

"There are a lot of messages online about bone loss that make it sound scary, and it can be, but I want to start with the good news you need to remember. Bone responds to load."

What is osteoporosis?

Osteoporosis is a condition where your bones gradually become weaker and more brittle, making them more likely to break from everyday events like a fall, a bump or even a strong cough, according to the National Institute on Aging and Mayo Clinic. The hips, spine and wrists are the most commonly affected areas.

Your bones are living tissue. Throughout your life, your body is constantly breaking down old bone and building new bone to replace it. We build most of our bone early in life, and peak bone mass is generally reached by our late twenties or early thirties. From there, the focus shifts to holding on to the bone you've built.

When bone is broken down faster than it's replaced, bone density drops. Low bone density that hasn't yet reached osteoporosis is called osteopenia, and it's a helpful early warning sign that it's time to take action. Osteoporosis is diagnosed by a doctor, usually with a bone density scan.

Why bone loss speeds up during perimenopause and menopause

Women are more likely to develop osteoporosis than men, and hormones play a big part in why.

"Women also tend to start adulthood with a lower peak bone mass than men, so we have a little less bone in reserve as we get older," Sheridan explains in the episode on bone health.

Oestrogen helps to maintain bone. As oestrogen levels decline through perimenopause and menopause, bone starts being broken down more quickly than it can be replaced.

"The most rapid bone loss generally begins around a year before the final menstrual period and continues for the first few years afterwards," Sheridan explains. Estimates vary, but women may lose around 10 to 20% of their bone density in the years surrounding menopause.

That's why this stage of life is such an important time to start thinking about your bones, and why it's worth starting resistance training at every life stage, even if menopause still feels a long way off.

Why you can't feel osteoporosis happening (and what to look out for)

"The tricky thing about osteoporosis is that you can't feel it happening," Sheridan says. "You can feel your muscles getting weaker or stronger, but you can't necessarily feel your bones becoming less dense. Sometimes the first sign is a fracture."

And fractures are common. Around 1 in 3 women over 50 will experience an osteoporosis-related fracture in their lifetime. Most heal well, but some, particularly hip fractures later in life, can have a big impact on mobility and independence.

Later signs of bone loss can include losing height, back pain, or a stooped posture. Some risk factors are out of your control, but it helps to know them so you can have an informed conversation with your doctor. These include:

• Early menopause, or being over 50

• A family history of osteoporosis or hip fracture

• A smaller body frame

• Low calcium or vitamin D intake, or not eating enough overall

• Smoking and drinking a lot of alcohol

• A sedentary lifestyle

• Certain medical conditions (such as rheumatoid arthritis, coeliac disease or thyroid issues) and some medications

If you'd like a clearer picture of your risk, Sheridan also recommends the free FRAX calculator, a tool healthcare professionals use to estimate your risk of a fracture over the next 10 years. It looks at things like your age, previous fractures, family history and medications, and can also factor in bone density results.

How strength training can help protect your bones

When you place the right kind of stress on your bones, you give them a reason to stay strong. That's why resistance training is one of the most effective tools we have for bone health.

You may have heard that women need to lift really heavy weights to protect their bones. There is good evidence that heavier lifting can work. In the LIFTMOR trial, postmenopausal women with low bone mass who completed supervised high-intensity resistance and impact training saw improvements in bone density compared with women doing a low-intensity home program.

But heavy isn't the only way.

"I don't want you worrying about whether the number on your dumbbell is heavy enough to 'count'," Sheridan says. "What matters is that you're resistance training and providing your body with an appropriate, progressive challenge for you."

In real life, that means:

• Train with weights (or your bodyweight) regularly. If you're new, bodyweight exercises are a great place to start before adding dumbbells. Doing a bodyweight push-up or pushing dumbbells are both strength training.

• Keep progressing. When a weight starts to feel easy, go heavier or add reps. "Heavy isn't the destination. Challenge and progression is, and that's unique to you," Sheridan says.

• Add impact if it feels good. Jumping and other impact exercise (like running) can give your bones an extra stimulus, but it's optional. "You can build and maintain bone health without a single jump," Sheridan says, so if it doesn't feel right for your joints or pelvic floor, skip it.

• Stay active in between. Weight-bearing activities like brisk walking, hiking, dancing and climbing stairs all add up.

If you'd like a plan that takes the guesswork out of it, our new Perimenopause Strong and Menopause Strong programs with Christine Roderick are built around progressive strength training designed specifically for this stage of life.

Why balance training matters just as much as bone density

This is the part most people miss. Exercise can help maintain bone density, and some types of training may improve it slightly, but building more bone isn't the whole goal.

"What we ultimately want to do is reduce your risk of breaking a bone," Sheridan says. "And bone density is only one part of that risk."

Two women can have the same result on a bone density scan and very different chances of actually breaking a bone. Stronger muscles, better balance and good mobility all help to reduce your risk of falling in the first place.

A few simple ways to challenge your balance:

• Add single-leg moves like single-leg deadlifts, split squats or step-ups to your strength sessions

• Try yoga, Pilates or Tai Chi

• Practise standing on one leg while you brush your teeth

This is exactly why Perimenopause Strong and Menopause Strong already include balance exercises alongside resistance training. As Sheridan puts it, "the goal isn't simply to improve a number on a bone-density scan. It's to build a body that's strong, stable and capable."

How to support your bones with calcium and vitamin D

"The good news is, there's no special menopause diet you suddenly need to follow," Sheridan says. But two nutrients are particularly worth paying attention to for your bones.

Calcium: Calcium is one of the major building blocks of bone. For women aged 19 to 50, the recommended intake is 1,000mg per day, rising to around 1,200mg for women over 50. Good sources include:

• Milk, yoghurt and cheese

• Calcium-fortified plant milks

• Calcium-set tofu

• Fish where you eat the bones, like sardines or tinned salmon

• Dark leafy greens

Not sure if you're getting enough? Sheridan suggests tracking what you eat for a few days in an app like Cronometer. "If you're consistently falling short, that's where a conversation about supplementation can be useful," she says. For most women, the sensible approach is food first, with a supplement to fill a genuine gap if your doctor identifies one, not if you think you have one from watching a reel on social media.

Vitamin D: Vitamin D helps your body absorb calcium and supports both bone and muscle function. Very few foods contain much of it, and how much you get from the sun depends on where you live, the season, your skin tone and how much time you spend outdoors. If your sun exposure is limited, ask your healthcare professional whether a supplement could be right for you.

Where to start if you want stronger bones for life

You don't need to overhaul everything in one day. If you take away just a few things, make them these:

• Strength train regularly, and keep gradually challenging yourself

• Include some balance work each week

• Eat calcium-rich foods most days and check in on your vitamin D if you're not getting much sunshine

• Talk to your doctor about your risk, especially if you're approaching menopause or have a family history

The best time to look after your bones is before anything goes wrong, and it's never too late to start. If you're keen to learn more from Sheridan, all 11 episodes of the Perimenopause and Menopause Essentials Masterclass are available on our website and in the Sweat app, covering everything from sleep and brain fog to muscle, joint pain and nutrition.