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Arthritis Today

8 Ways to Keep Bones Healthy and Strong

Osteoporosis can make you weak, but here are ways to keep bones healthy and strong.

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As many as half of all women and one-fourth of all men older than 50 will fracture a bone at some point due to osteoporosis, a condition characterized by weak or porous bones that break easily, according to the National Osteoporosis Foundation.

Young adults have most of their adult bone mass by the time they’re 20 years old, and the risk of osteoporosis rises with age, as bone cells are lost faster than new ones are formed.

The risk also increases with certain diseases – including rheumatoid arthritis, or RA, lupus and ankylosing spondylitis – as well as the steroid medications used to treat them. But there are measures you can take to reduce the risk.

Whether you are young and still building bone or older and trying to preserve it, following this advice can help keep your bones healthy and strong.

1. Drink milk. Milk and other dairy products – including cheese, yogurt, cottage cheese and even ice cream – are some of the best sources of calcium, which is crucial for strong bones. Non-dairy calcium sources include leafy green vegetables like broccoli and kale, canned sardines with bones, and fortified soy milk. If you’re concerned that you don’t get enough calcium from the food you eat, ask your doctor about a calcium supplement. Your diet and supplement together should provide 1,000 milligrams, or mg, of calcium daily – 1,200 mg if you are 50 or older.

2. Spend some time in the sun. Your skin makes vitamin D in response to sun exposure, and your body needs vitamin D to absorb calcium and build healthy bones.

Food sources of vitamin D include fatty fish such as salmon, mackerel and tuna, egg yolks, cheese and fortified milk, juice and cereal products, but vitamin D also comes from sunlight exposure. Depending on where you live and you skin pigmentation, you may get enough by spending as little as five to 30 minutes in the sunlight a couple of times a week. If you live in a northern state, don’t spend much time outdoors, always use sunscreen or have darker skin, you may need a vitamin D supplement to get your recommended daily intake of 600 to 800 international units, or IUs.

3. Take a hike. Like muscles, bones become stronger when they are active. The best exercises for building stronger bones are weight-bearing exercises – those that make your bones carry your body weight – including brisk walking, dancing or aerobics and muscle-strengthening exercises, such as working with resistance bands. (Check with your doctor before starting a new exercise program. She might tell you, for instance, that weight lifting could aggravate your arthritis.)

4. Drink only in moderation. If you drink alcohol, stick to no more than one drink a day, or up to seven a week for women, and no more than two a day, or up to 10 a week for men. Doctors have long known that excessive, long-term use of alcohol can harm your bones by affecting the production of hormones and vitamins needed to absorb calcium. Alcohol abuse also can increase your risk of falling, which can break fragile bones.

5. Don’t smoke. A number of studies in recent decades have shown that smokers have lower bone mass and a higher risk of fractures than non-smokers, and the risk increases with the number of years and cigarettes one smokes, according to the National Institutes of Health. Of course, it’s best not to smoke in the first place. But if you already smoke, quitting is the next best thing. The sooner you quit the better. A 2006 study of postmenopausal women who quit, published in the Journal of Women’s Health, found that their bone health improved in a year.

6. Mind your medications. Corticosteroid medications, such as prednisone, weaken bones by decreasing the amount of calcium absorbed in the intestines and increasing the amount excreted by the kidneys. One way to minimize the risk of bone damage is to take the lowest dose for the shortest time possible to decrease inflammation. If only one or a few joints are affected, injecting corticosteroids directly into the joint(s) may relieve inflammation without the bone damage of oral corticosteroids. If you need corticosteroids in high doses or long term, ask your doctor about medications to prevent or treat osteoporosis.

7. Consider treatment options. If you are taking corticosteroids or have already been diagnosed with osteoporosis or osteopenia – low bone mass that is not yet serious enough to be classified as osteoporosis – speak to your doctor about treatment. A number of medications are approved for treating or preventing osteoporosis. They are the bisphonates alendronate, brand name Fosamax; ibandronate, brand name Boniva; risedronate sodium, brand name Actonel; and zoledronic acid, brand name Reclast; hormones, including estrogen products and calcitonin, brand name Mialcin; the bone-formation agent teriparatide, brand name Forteo; the selective estrogen receptor modulator raloxifene hydrochloride, brand name Evista; and the biologic agent denosumab, brand name Prolia.

Although there are many differences in these drugs, they work basically in one of two ways to increase bone mass: by slowing the breakdown of old bone or promoting the growth of new bone.

8. Say goodbye to belly fat. Fat around one's midsection is bad for bones. A study by doctors at Massachusetts General Hospital shows abdominal fat is associated with lower bone density. Other studies show that some of the things you do for your bones – exercising and getting plenty of calcium – also help reduce belly fat. And if you smoke and can stop, and begin an exercise program, that's doubly good for you. The best way to shed abdominal fat? Eat a balanced diet.

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