We were meant to have strong healthy bones for a lifetime. Osteoporosis and the bone fractures that result from it are neither natural nor inevitable, though they are epidemic in this culture. By the year 2020, when 40 million American women will be over the age of 65, between 18 and 33 percent of them will suffer from a hip fracture by the time they reach the age of 90. Of those who sustain hip fractures, 12–20 percent will die of related complications.

Please remember, however, that statistics are derived from entire populations and may not have anything to do with you personally. In my practice I have seen eighty-year-old women with the bone density measurements of an average twenty-five-year-old. I have also seen twenty-five-year-olds with the bones of an average eighty-year-old. My latest thinking about osteoporosis (and osteopenia—the diagnosis of low bone mass that precedes the more serious bone losses in osteoporosis) is that bones don't just dissolve with age in healthy women.

Like other degenerative diseases so common in Western Civilization (such as coronary artery disease, hypertension, and obesity), osteoporosis is either unknown or very rare among indigenous and traditional peoples living time-honored lifestyles characterized by a strong connection with the wisdom of the Earth. Bone health, like that of our blood and immune system, is affected by our first emotional center—our sense of safety, security, and belonging in the world. It is not surprising that so many women feel and act disconnected from the wisdom of the Earth—the wisdom each knows deep in her bones.

Right now, thousands and thousands of women are being told that they have "osteoporosis" when their bone density tests come back "low." These same women are then being told to take Fosamax, Premarin, or other drugs to help them build bone. These drugs have side effects and may not build the quality of bone you need. For example, Fosamax causes esophageal irritation and erosion in a significant number of women each year. Before taking any osteoporosis drug, here's what you need to know:

1. Women who have small bones may have low bone density NOT because of true osteoporosis but because their bones have never been very dense. A bird's bone is less dense than that of an elephant, but that bone is still strong enough for a bird.
2. Low bone density is not necessarily a sign of brittle bone. Our bone density tests measure only density. They don't measure bone strength or quality, and these are the factors that determine whether or not a bone is apt to fracture. If bone quality is good, you can actually lose 25 percent or more of your bone mass and still resist fractures. In Japan, hip bone density is markedly lower than it is in the United States, and yet the incidence of hip fractures is two and a half times less than it is here. And the Japanese consume less calcium than we do! It's normal to lose a bit of bone as we get older—but it's not necessary for our bones to actually get brittle.

Normally, women reach their peak bone density at age 25 to 30, and then bone density starts to decline as perimenopause approaches. But because of the vagaries of our modern lifestyle—including lack of exercise or overexercise, smoking, poor diet, lack of vitamin D, or anorexia and bulimia—many women never reach their peak bone mass by age thirty. In fact, as much as 50 percent of a woman’s bone loss over a life span is lost before the onset of menopause. And in each of the first five years after a woman’s menstrual cycles cease, bone density falls an average of 2–5 percent. (After that, loss slows down markedly or disappears.) Over her lifetime a woman may lose 38 percent of her peak bone mass (while a man may lose only 23 percent of his).

As if that wasn’t enough, it appears that the matrix of the bone that is present at menopause may not be normal. In fact, some women spontaneously fracture their hips and then fall as a result, not the other way around. That would lead us to believe that osteoporotic fractures must involve more than decreased bone mineral density. There must be something else wrong with the quality of the bone.

Your body is designed to build and remodel bone in a dynamic and effortless way throughout your life. Because your bones are constantly being regenerated, once you learn to work with this essential body wisdom, even bones that have already weakened can regain strength. But first, you have to understand how this recycling process normally works.

Bone metabolism is a complex process in which construction and demolition crews work side by side. When we’re young, the bone builders usually keep ahead of the bone destroyers. But that balance can shift as we get older. A wide variety of conditions, including depression, vitamin and mineral deficiencies, and steroid use can allow the osteoclasts (the cells that break down bone) to outpace the osteoblasts (the cells that make bone). Over a year’s time 20 percent of our adult bone mass is recycled and replaced as our bones continually undergo this process of breakdown and renewal in response to the overall needs of our bodies. Bones are major storehouses for calcium, phosphorous, magnesium, and other minerals, all of which are necessary for the healthy functioning of every cell in the body. When blood calcium and other mineral levels run low, a series of complex and interrelated biological reactions is activated, allowing the body to take needed minerals from bone. As soon as mineral levels in the blood are restored, these feedback mechanisms are reversed.

Bones also constantly remodel themselves to adapt to physical stress and strain. Among the amazing properties of the basic bone cell, the osteocyte, is its ability to act like a strain gauge sensor, evaluating the amount of stress placed on a bone. Ultimately, this ability means that your body will put new bone generated by exercise where it needs to go. All of our bones, like every cell in our bodies, are functionally connected to one another. Strain on a leg bone not only helps build that bone, it also helps build bone in the spine and shoulders!

Immune status and bone health are also closely connected, as noted above, with both areas being governed by the first emotional center. Osteoclasts (bone destroyers) are derived from the same bone marrow cells that make white blood cells. This helps explain why individuals with such seemingly unrelated diseases as rheumatoid arthritis, lupus, diabetes, multiple sclerosis, hepatitis, depression, and lymphomas often have osteoporosis in addition to their other symptoms. Scientists have found that anything that stirs quiescent T cells—a component of the immune system—into action also triggers them to start dismantling bone.

The function of both osteoclasts and osteoblasts is influenced by other factors as well, including levels of estrogen, testosterone, thyroid hormone, insulin, and hormones produced by emotional stress such as norepinephrine and cortisol.

One last thing I want you to know about osteoporosis is that, except in very rare cases, it is a fully preventable disease. If you are one of the many women with a diagnosis of osteoporosis or osteopenia, I hope I’ve offered you some incentive to get your skeleton—your support system and your foundation for moving forward in your life—back in optimal shape. Even if you haven’t received a diagnosis, I hope you’re now motivated to do everything you can to stand tall for life.

I recommend getting a baseline bone density screening at age 40 or so—especially if you have risk factors for osteoporosis. The gold standard for assessing bone density and determining risk is known as dual x-ray bone densitometry test (DEXA). Your doctor must order this test, which is painless, quick and safe (because it uses a very low dose of radiation). Osteoporosis is generally diagnosed if your T-score falls below negative 2.5 (-2.5). Be aware, though, that if your reading is low, that one reading won’t tell you whether your bone density is decreasing. You need at least two successive tests at least six months apart to determine what the trend is and whether or not you need to take action. If you are small-boned, for example, you may register on the low end of a DEXA test even if your bones are not at risk.

Heel bone density testing, with a machine such as an Osteo-Analyzer, is an accurate and cheap method of screening for women of all ages. For example, it is being used to do baseline screening on teenage girls who are at risk for not achieving maximum bone density because of dieting. Heel density tests do not require a doctor’s prescription and may even be offered at your local drugstore or at a health fair. They are not as accurate as a full-scale DEXA test because they measure only one area of your body, but they are a valuable early warning system.

Another way to check your bone health is by using a urine test that checks for excessive bone break-down products. If this test comes back high, you’re breaking down bone more rapidly than normal. The test is known as Pyrilinks and can be done at home. It is a very good way to make sure that your bone-building program is working well.¹

Progressive bone loss in women is due to complex factors. A wide variety of conditions can allow the osteoblasts, the cells that make bone, to be outpaced by the osteoclasts, the cells that break down microscopic bits of bone, thus releasing minerals into the blood.

Deficiencies of nutrients in the diet are one such factor because bones suffer when more minerals are taken out than are replaced. Calcium intake is indeed important (each day over 300 mg of calcium is dissolved from our bones), but so is intake of magnesium, boron, vitamin D, vitamin C, and trace minerals. In fact, suboptimal vitamin D levels are increasingly implicated in osteoporosis.

In addition to a lack of bone-building nutrients, other risk factors include lack of regular weight-bearing exercise; chronic dieting; depression; a diet high in refined carbohydrates; and never having borne a child. A history of ovulatory disturbances and subsequent progesterone deficiency can also predispose women to osteoporosis. Women with a history of amenorrhea are also at greater risk for osteoporosis than the general population.

A drop in hormone levels is also a factor in many cases, because many women undergo accelerated bone mass for about five years or so following menopause. Bone mass is maintained, in part, by estrogen, progesterone, and testosterone. Women who produce adequate amounts of these hormones have denser bones than those who do not. At perimenopause, the collagen matrix that forms the foundation of healthy bone may start to weaken, especially when a woman’s nutrition and exercise regimens are lacking and her bone density is already compromised. Collagen in bone can be likened to the string in a pearl necklace. It is the foundation upon which the pearls (bone minerals) are strung. Healthy bones, like healthy youthful-appearing skin, require healthy collagen.

Reviewing the following list can help you determine your personal risk for osteoporosis. If you feel you cannot identify with several of these factors, chances are good that your bones are just fine, and you can continue to follow your healthy lifestyle. On the other hand, if these factors pertain to you, you should begin now to take significant steps toward improving your bone health in the future.

• Your mother has been diagnosed with osteoporosis or has had a hip or other osteoporotic fracture.

  Osteoporosis tends to run in families, though it is unknown whether this is because of a genetic inheritance or because we tend to "inherit" habits, lifestyle choices, and life expectations, which may predispose us to less-than-optimal bone strength. Even if osteoporosis runs in your family, realize that you can still do a lot to prevent it.

• You are fair-skinned and blue-eyed.

  Because of genetic factors, blue-eyed blondes and those with red hair have less collagen in both their bones and skin than do those with brown, black, red, or yellow skin tones.

• You are quite thin or tall, or have a slight build and/or less than 18 percent body fat.

  If this is the case, you may enter menopause with less bone to lose. In addition, body fat is where much of a woman’s natural estrogen during and after perimenopause is manufactured. The less fat she has, the less estrogen her body will produce to support her bones.

• You smoke.

  Chemicals in cigarettes poison the ovaries and decrease hormone levels prematurely. Estrogen, testosterone, and progesterone all have bone-protective effects.

• You spend most of your time indoors.

  Women exposed to very little sunlight may be deficient in natural vitamin D, which is necessary for healthy bone mineralization.

• You are sedentary and spend less than four hours per day on your feet.

  Bones stay healthy when they have vertical vectors of force placed on them regularly. A sedentary lifestyle provides insufficient weight-bearing exercise to stimulate bone growth. Many studies have shown that bed rest is associated with osteoporosis. In contrast, weight training has been shown to build bone density even in postmenopausal women who aren’t on estrogen.

• You are (or were) a "fitness fanatic."

  That is, you become irritable and unreasonable if you are unable to get in your daily run or other exercise. The lifestyle of the fitness fanatic includes dieting for weight loss and/or engaging regularly in strenuous exercise such as marathon training. Dietary restrictions and the chronic stress of overtraining can impair mineral intake and absorption. It also messes up what is known as the hypothalamic-pituitary axis—the exquisite feedback loop between the brain, the body, and our hormone levels. Chronic overexercise with inadequate caloric or mineral intake results in stress fractures in ballet dancers, gymnasts, soccer players, and competitive runners, among others. Such fractures are currently on the rise in young athletes and can set the stage for later osteoporosis.

• You have a history of amenorrhea (absence of periods) associated with excessive exercise and/or anorexia nervosa.²

  Amenorrhea results in a derangement of the hypothalamic-pituitary axis similar to that seen in depression. The end result is lower estrogen, androgen, and progesterone, and an eicosanoid profile that favors osteoporosis and other diseases.³

• You drink more than 25 g of alcohol a day.

  The following servings each contain about 10 g of alcohol: 12 oz of beer, 4 oz of wine, and 1.5 oz of 80-proof spirits.⁴

• Your liver is overstressed.

  The liver’s ability to produce and metabolize estrogen is essential for the growth and maintenance of strong bones at any age. Drinking more than two alcoholic drinks per day, taking medication known to be hard on the liver (such as certain cholesterol-lowering drugs), and infection with viral hepatitis are among the significant liver stressors that can harm bone health.

• You drink more than two units of caffeine per day.

  (8 oz of coffee = 1 unit; 12 oz of cola = 0.4 units)

• You are or have been clinically depressed for a significant period of time.

  Numerous studies have shown that depression is an independent risk factor for osteoporosis. Depressed people have high levels of the immune system chemical known as IL–6, which overstimulates the osteoclasts. Depression is also associated with abnormalities in the hypothalamic-pituitary-adrenal axis and with elevated cortisol secretion, which predispose one to bone loss.⁵

• Your diet is poor—little fresh food, few leafy green vegetables, and lots of junk food.

  Such a diet doesn’t provide minerals and other nutrients necessary to support the growth and maintenance of a solid bone foundation.⁶

• You went through premature menopause (before age 40), have had your ovaries removed surgically, went through menopause as a result of radiation or chemotherapy, and/or have prematurely grey hair.

  A woman who enters menopause prematurely for any reason is at increased risk for osteoporosis unless she gets adequate hormone replacement during the years when her body would normally have been producing higher levels of hormones. Non-surgical premature menopause, and the premature greying of hair that often accompanies it, are the result of an autoimmune reaction affecting the ovaries and hair follicles. The cause of these reactions isn’t clear.

• You take steroid drugs regularly for conditions such as asthma or lupus.

  Steroid drugs result in accelerated breakdown of tissue in the body—including the collagen matrix for both skin and bone.⁷ Prolonged steroid use may also significantly decrease estrogen and androgen levels.⁸

• You use anticonvulsant medication regularly or benzodiazepines such as diazepam (Valium), chlordiazepoxide (Librium), or lorazepam (Ativan).

  These drugs have also been found to interfere with bone metabolism.⁹

• You’ve had at least two consecutive bone density tests at least six months apart, done on the same machine, that reported below-normal scores for your age.
• You have a thyroid disorder.

  Women who suffer from hyperthyroidism are at risk because the excess thyroid hormone (thyroxine) that their bodies make stimulates the osteoclasts to break down bone. Those with hypothyroidism may also be at risk if their dose of thyroid medication is too high. If you have thyroid disease, make sure you on the lowest dose of thyroid replacement possible for your situation, and follow a sound program for maintaining bone health.¹⁰

Physical factors aren’t the only causes to consider, however. Emotionally, bone health is also affected by your sense of safety and security in the world and your ability to balance dependence with independence.

Hormone replacement therapy has gotten a lot of attention for its bone protective properties. Estrogen replacement definitely helps prevent bone loss associated with menopause, and continuous use of estrogen decreases the risk of fracture by 50 percent or more for as long as a woman stays on it. Androgens such as testosterone also play a role in preserving bone health. Those women with naturally high testosterone levels have a decreased risk for osteoporotic fractures. Low-dose testosterone supplementation has been found to help maintain bone mass.

But that doesn’t mean women need hormone therapy for healthy bones. Get your hormones levels tested before making a decision. If your body continues to make even a small amount of estradiol or testosterone naturally, you have a significantly decreased risk of osteoporosis. If this is the case, you won’t need to worry about taking a drug to support your bone mass.

Also, keep in mind that bone mass is affected by far more than just hormones. Some authorities even hypothesize that only 10–15 percent of a woman’s skeletal mass is affected by estrogen. While it is clear that hormones play an important role in bone health, they are just one factor.

If you do take hormones, I recommend taking the lowest dose possible, since bone protection has been demonstrated even at very low doses. Also, ask your doctor about bioidentical hormones. Consider natural progesterone, either in the form of a 2% transdermal cream or a prescription pill or cream. While synthetic progestin has been shown to stimulate osteoblasts, studies also show that low-dose natural progesterone with estrogen prevents hip and other fractures, and low-dose natural progesterone with lower-than-normal doses of estrogen significantly increases spinal bone density. Endocrinologist Jerilynn Prior, M.D., founder and scientific director of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR) in Vancouver, B.C., believes progesterone therapy is just as effective as the bisphosphonates, the strongest bone medicines available. Dr. Prior recommends dosages of either 10 mg per day of synthetic progestin or 300 mg a day of natural progesterone (taken at bedtime because it promotes sleepiness)—enough to get blood levels up at least 18 or ideally 45 nmol/L.47.

A number of other drugs have also been shown to help prevent loss of bone and decrease fracture risk. As with hormone replacement, they are effective only as long as a woman is on them. Although these drugs have their place and may be appropriate for some women who are truly at very high risk and are not willing or able to change lifestyle factors, very real potential drawbacks of these drugs exist. Here’s a rundown:

• Bisphosphonates: These are the most widely prescribed antiresorptive agents and are currently considered the first-line treatment for postmenopausal osteoporosis. These drugs interfere with osteoclast function, thus preventing bone breakdown. Alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) reduced the incidence of hip, vertebral, and nonvertebral fracture in women with osteoporosis by almost 50 percent, particularly in the first year of treatment.

  However, these drugs may cause side effects. Fosamax, for example, may cause nausea, constipation, and heartburn. In some studies, up to a third of the participants had stomach-acid-related complaints, and one in eight required treatment. About 50 percent of women stop treatment within a year. Some even develop severe esophageal ulcers. Fosamax has also been shown to cause severe jaw bone loss in some women. Actonel’s side effects include back pain, joint pain, stomach pain, nausea, and vomiting. I’m very concerned about untoward long-term side effects from these drugs.

• Evista (Raloxifene): This selective estrogen receptor modulator (SERM), like the related drug tamoxifen, has been shown to help build bone. Though it decreases spinal fractures by 40 percent, it has not resulted in a decrease in the incidence of hip fractures, for reasons that aren’t yet clear. Side effects include hot flashes. I’m also very concerned about the possibility of dementia risk with this drug because, like tamoxifen, it blocks the well-known beneficial effects of estrogen (including the estrogen our bodies make on their own) on brain cells.
• Calcitonin: Calcitonin is a naturally occurring peptide that partially blocks osteoclast activity and regulates calcium loss in the urine. This is an injectable or nasal synthetic form of the parathyroid hormone. It reduces the risk of spinal but not hip fractures and also reduces pain from new spinal fractures. Side effects include nausea and flushing. Most experts agree that the bisphosphonates work better.

Consider hormone replacement or other bone-building drugs if you’ve had any of the following conditions associated with decreased hormone levels:

• History of amenorrhea lasting a year or more
• Premature, surgical, or medical menopause
• History of steroid use
• Strong family history of osteoporosis (mother or grandmother with obvious osteoporosis)
• A diagnosis of osteopenia or osteoporosis

Again, I recommend hormone supplementation or other prescription drugs only as a last resort if more natural approaches such as weight training, vitamin D, and calcium/magnesium supplementation have failed. (You also have to stop drinking excessive amounts of alcohol and cease smoking.)

Even if you’ve received a diagnosis of osteoporosis or osteopenia (early-stage osteoporosis), the disease does not need to be a life sentence. The good news is that many safe and natural solutions are available to help you either maintain the bone you have or build it to new, healthier levels. Here are the components of my program for building healthy bones, at any stage of life:

• Take bone-building nutrients.

  Currently, only 11 percent of women in the U.S. get adequate calcium daily—not to mention all the other nutrients needed for healthy bone. Even if your diet is good, make sure your daily supplement program includes the following:

  
  - Magnesium, 400–1,000 mg
  - Calcium, 500–1200 mg
  - Vitamin D3, 800-5000 IU)
  - Vitamin C, 1000–5000 mg
  - Boron, 2–9 mg
  - Zinc, 6-50 mg
  - Manganese, 1-15 mg
  - Copper, 1-2 mg
  - Vitamin K, 70–140 mcg
  - Beta carotene, 15 mg¹¹
  
  

  Nondairy sources of calcium are also particularly rich in other necessary minerals needed for optimum health. You might have read that plant oxalates in spinach and some other greens interfere with calcium absorption. (The same argument has been used for phytates in grain.) But more recent research suggests that this is not very significant. Nevertheless, getting all your calcium from food can be especially tricky because there can be wide variation in the mineral content of foods, depending upon where the food was grown, when it was harvested, the quality of the soil, and so on. Organically grown vegetables have higher nutritional content.

  Note: Although antacids such as Tums are promoted as calcium supplements, I do not consider them a good choice. Tums decreases hydrochloric acid levels in the stomach, which interferes with optimal absorption of calcium. Tums also contains no magnesium or any of the other nutrients needed for bone building. Magnesium deficiency is as much a problem in bone health as inadequate calcium, and because calcium and magnesium work in critical balance, they should be supplemented together. Finally, very high doses of calcium carbonate (4–5 g per day), which is the type of calcium in antacids, can cause a serious, kidney-damaging disorder known as milk alkali syndrome.

• Ensure you’re getting enough Vitamin D.

  The most recent research reveals that calcium is virtually useless without enough vitamin D. So if a bone density screening or a urine test shows any evidence of osteoporosis, get your vitamin D level checked with a simple blood test. Blood levels of vitamin D below 20 ng/mL show a deficiency. Adequate levels are 30–50 ng/mL. But Vitamin D expert Michael Holick, M.D., Ph.D., Chief of Endocrinology, Metabolism and Nutrition at Boston University School of Medicine, believes the ideal level is 100 ng/ml. If your levels aren’t high enough, get some sunlight, and take supplements.

  We were meant to manufacture our vitamin D under skin that is exposed to ultraviolet light. I recommend up to twenty minutes of exposure without sunscreen during early morning or late afternoon, three to five times per week for four to five months out of the year (between April and October in northern latitudes—above the fortieth parallel). But be sure to never get so much that you redden your the skin. In the winter, you can use a tanning booth for eight to ten minutes once per week. Also be aware that as we age, our bodies become less efficient at making their own vitamin D. So if you are older than sixty-five, you may need more time in the sun to get the same benefit.

  To ensure you’re getting enough, take 800–5,000 IU of Vitamin D per day. Good food sources of vitamin D are liver, cod liver oil, and egg yolks. Don’t rely on fortified dairy foods, however. When Dr. Holick, studied the vitamin D content of fortified milk, he found that there’s often not enough vitamin D present because of processing problems. In fact, up to 50 percent of the milk tested had less vitamin D than noted on the label. Fifteen percent of the milk had no vitamin D at all! And in skim milk there is a problem getting vitamin D into the solution because vitamin D is fat soluble and requires some fat to blend with the product. Skim milk products may actually have little or no vitamin D whatsoever.

• Moderate or eliminate alcohol and caffeine.

  Alcohol interferes with the function of osteoblasts and osteoclasts,¹² while most forms of caffeine lead to urinary excretion of calcium. The exception is tea. Though tea contains caffeine, it has been shown to increase bone mass.¹³

• Quit smoking.

  Chemicals in cigarettes poison the ovaries, thereby decreasing hormone levels prematurely and affecting bone quality and density. Acupuncture can help you quit if you need assistance.

• Follow a mostly whole-foods diet that is adequate in protein and healthy fats and low in refined carbohydrates.

  Though excess protein, particularly in the form of red meat, may cause some calcium loss, this effect is miniscule compared with the adverse bone effects brought about by imbalanced eicosanoids (a specific group of intracellular hormones associated with every cellular function in the body). Eicosanoids get thrown out of whack by prolonged stress, excess alcohol, or a diet high in refined carbohydrates. All you need is adequate amounts of protein, anyway, and many women don’t even get that. For a 5´4˝, 140 lb female, that means about 27 g of protein at each of three meals per day (about 81 g per day total). People who are physically active need more protein than those who are sedentary. Larger women also need more. Also be sure to include five servings of low-sugar fruits and vegetables per day. These are all high in potassium and boron, which help protect your bones by reversing urinary calcium loss.

• Eat phytoestrogens.

  Soy and ground flax seeds have a very beneficial effect on bone structure. Soy has been found to have a dose-related positive effect on bone density. The higher the dose, the higher the benefit.¹⁴ Soy can be especially helpful for those who choose not to eat dairy products, long touted as a panacea to prevent osteoporosis.

• Drink green tea.

  Green tea is especially rich in phytoestrogens and antioxidants. Research has shown that women who drank green tea or black tea regularly had stronger bones than those in a control group.¹⁵ If you don’t care for the taste, try a standardized green tea extract.

• If you are depressed, get proper treatment.

  Regular exercise and exposure to natural light are sometimes all that is necessary to enhance one’s mood, but if you experience persistent signs of depression, seek assistance from your health care practitioner or a qualified counselor without delay. High levels of epinephrine and cortisol, produced by the adrenal glands in greater quantities in depressed individuals, can increase calcium loss in the urine and also cause breakdown of bone.

  Interestingly, the antidepressant herb St. John’s wort also lowers a cytokine known as IL6 that interferes with bone building.¹⁶ It is unclear whether standard antidepressant medications have this effect.

  If you work under fluorescent fixtures, try replacing them with full-spectrum bulbs. Though most full-spectrum lights won’t stimulate vitamin D and calcium uptake, they definitely can help lift your mood.

• Get strong.

  Weight-bearing exercise in general and strength training in particular play a crucial role in creating and maintaining healthy bones. Miriam Nelson, Ph.D., of Tufts University has done groundbreaking research that shows how weight training can slow and even reverse bone loss. You need three exercise sessions per week, minimum. If you are lifting weights, two sessions per week are sufficient—but activities such as walking and yoga can help, too. Weight-bearing exercise of all kinds sets up a mini-electrical current in your skeleton, which draws strengthening minerals right into the bone matrix. Like everything in life, your muscles, joints, and bones are designed to work best when they regularly meet some resistance. To get you started with proper form, I’d recommend a certified weight-training instructor.

• Reduce phosphate consumption from drinking cola and root beer.

  Both the coloring agent in these soft drinks and the phosphate they contain directly interferes with calcium metabolism.