One in three women over 50 will break a bone because of weak bones. One in five men will too. And most of them didn’t see it coming. Osteoporosis doesn’t hurt until it’s too late - a fall, a stumble, even a sneeze can snap a rib or crush a spine. By the time you feel pain, the damage is done. But here’s the truth: you don’t have to wait for that moment. Bone density loss isn’t inevitable. Fractures aren’t fate. What you do now - today, this week, this year - can change your future.

Why Your Bones Are Weakening (And Why It’s Not Just About Age)

Your bones aren’t just static structures. They’re alive, constantly being broken down and rebuilt. Until about age 30, your body builds bone faster than it breaks it down. That’s when you hit peak bone mass. After that, it’s a slow drift downward - about 0.5% a year. But for women after menopause, that pace jumps to 2-3% a year for the first five years. Why? Estrogen drops. And estrogen is the brake that keeps bone loss in check.

It’s not just women. Men lose bone too, but slower. And it’s not just about getting older. If you had low bone mass as a teen, or didn’t get enough calcium or vitamin D growing up, your foundation was weak from the start. Studies show up to 80% of your lifetime bone health is set by age 30. That means what you did in your 20s matters now.

And then there’s the hidden stuff - medications like long-term steroids, conditions like rheumatoid arthritis or type 1 diabetes, even smoking or heavy drinking. These don’t just age you faster. They actively wreck your bone-building machinery.

The Real Risk Factors You Can’t Ignore

Some risks you can’t change. You can’t undo your gender, your genes, or your age. But you can understand them - and act smarter because of them.

• Age: After 65, your risk of breaking a bone jumps 4 times compared to someone under 50.
• Gender: Women are 4 times more likely than men to develop osteoporosis. Why? Lower peak bone mass and the estrogen drop.
• Family history: If a parent broke a hip, your risk goes up by 60-80%.
• Early menopause: Going through menopause before 45? Your risk doubles.
• Race: White and Asian women have higher risk than Black or Hispanic women.

But here’s the part people miss: a single fracture is the biggest warning sign. If you’ve already broken a bone from a minor fall - a wrist, a hip, a spine - your chance of breaking another one skyrockets. By 86% for a spine fracture. By 200% for a hip. Bone density scans don’t always catch this. But your history does.

What You’re Probably Doing Wrong (And How to Fix It)

Most people think osteoporosis prevention means popping calcium pills. It’s not that simple.

Calcium isn’t enough. You need 1,000-1,200 mg a day. But taking 1,200 mg all at once? Your body can only absorb about 500-600 mg at a time. Split it. Take 500 mg with breakfast, another 500 mg with dinner. And don’t take it with coffee or tea - they block absorption.

Vitamin D is the missing link. If your blood level is below 20 ng/mL (which affects 42% of adults), your fracture risk jumps 33%. You need 800-1,000 IU daily. If you’re deficient, you might need 2,000 IU for a few months to catch up. Sunlight helps, but in Perth, even in summer, many people still fall short. Testing your levels is the only way to know for sure.

Smoking and alcohol? Smoking cuts calcium absorption and lowers estrogen. One pack a day? Your fracture risk goes up 55%. More than two drinks a day? Hip fracture risk jumps 41%. Cutting back isn’t just good for your liver - it’s critical for your skeleton.

And sedentary life? That’s a silent killer. If you sit most of the day, your bones get the message: ‘We don’t need to be strong.’ Weight-bearing exercise tells them the opposite. Walking, dancing, stair climbing, lifting weights - these aren’t just for fitness. They’re bone medicine.

The Only Exercise That Actually Builds Bone

Not all exercise is equal when it comes to bones. Swimming is great for your heart, but it won’t help your spine. Cycling? Same thing.

You need impact. You need resistance.

• Weight-bearing: Brisk walking, hiking, stair climbing, dancing. Aim for 30-45 minutes, 5 days a week.
• Resistance training: Lifting weights, using resistance bands, bodyweight exercises like squats and push-ups. Do this 2 days a week. Start light. Focus on form. Progress slowly.

Studies show people who stick with this for 6-12 months see measurable bone density gains. Even better - they fall less. Balance training (standing on one foot, heel-to-toe walks) cuts fall risk by 45%. That’s not just about strength. It’s about your brain telling your body where it is in space.

And if you’re nervous about falling? Join a class. Tai chi, yoga for seniors, or a supervised bone health program. You don’t have to do it alone.

When You Need a Bone Scan - And What the Numbers Really Mean

DXA scans are the gold standard. They’re quick - 15-20 minutes. Radiation? Less than a day of natural background exposure. And they’re covered by Medicare for women over 65 and high-risk men and women over 50.

The result? A T-score.

• Normal: -1.0 or higher
• Osteopenia: Between -1.0 and -2.5 - low bone mass, but not osteoporosis yet
• Osteoporosis: -2.5 or lower

But here’s the catch: 50% of people who break bones have T-scores in the osteopenia range. That’s why doctors now use FRAX - a tool that calculates your 10-year fracture risk using your age, sex, weight, history of fractures, steroid use, smoking, alcohol, and more. It doesn’t just look at density. It looks at your life.

If your FRAX score says you have a 20% or higher chance of a major fracture in 10 years, treatment is usually recommended - even if your T-score is only osteopenia.

Medications: When They Help - And When They Don’t

Not everyone needs pills. But if you’ve had a fracture, or your FRAX score is high, or you’re on long-term steroids, medication can be life-changing.

Bisphosphonates (like alendronate or risedronate) are common. They slow bone loss. But 38% of people stop taking them within a year because of stomach upset or jaw pain. If that’s you, talk to your doctor. There are other options - monthly pills, yearly infusions, or newer drugs like romosozumab that actually build new bone.

And yes, there are risks. Rarely, these drugs can cause jawbone problems or atypical thigh fractures. But the risk of breaking a hip or spine without treatment is far higher. Talk to your doctor about your personal risk - not just the numbers on a screen.

What You Can Do Right Now

You don’t need a diagnosis to start protecting your bones. Here’s your 7-day action plan:

1. Day 1: Drink a glass of milk or eat a cup of yogurt with breakfast. Add a serving of leafy greens like kale or bok choy to lunch.
2. Day 2: Take a 20-minute walk after dinner. No phone. Just your feet on the ground.
3. Day 3: Call your doctor. Ask: ‘Should I get a bone density scan?’ Especially if you’re over 50 and have risk factors.
4. Day 4: Check your vitamin D supplement. If you’re not taking one, start 1,000 IU daily. If you are, check the label - make sure it’s D3.
5. Day 5: Remove one tripping hazard from your home - a loose rug, a cord across the floor, dim lighting in the hallway.
6. Day 6: Do two minutes of balance exercises: stand on one foot while brushing your teeth. Switch sides.
7. Day 7: Tell someone - your partner, a friend - what you’re doing. Accountability works.

This isn’t about perfection. It’s about progress. One step. One change. One day at a time.

It’s Not Too Late - But It Might Be Soon

Some people think, ‘I’m 70. What’s the point?’ But here’s what the data says: even at 70, starting weight-bearing exercise and getting enough calcium and vitamin D can reduce fracture risk by 30%. You don’t need perfect bones. You just need strong enough bones to keep standing - to keep walking, gardening, playing with your grandkids, living your life.

Osteoporosis isn’t a death sentence. It’s a wake-up call. And the best time to act was 20 years ago. The second best time? Today.