Bone Health for Women Across the Lifespan

Women face a unique set of challenges when it comes to keeping a strong, healthy skeleton as they age. Compared to men, women on average tend to have smaller bone mass, live longer, and experience major hormonal changes (like menopause) that impact bone health. These factors increase the risk of osteoporosis, which weakens bones and increases the chance of fractures (broken bones). Since osteoporosis usually develops quietly with no warning signs until a fracture occurs, awareness and prevention are especially important.

Childhood: Building the Foundation for Lifetime Bone Strength

Childhood builds the foundation for a life with strong bones. Bone mass increases quickly as kids grow, so this is a vital time for bone development.

During these years, nutrition plays a key role. Getting enough calcium and vitamin D during childhood supports the formation of strong bones. In fact, the American Academy of Pediatrics recommends that all children take vitamin D supplements.

Regular physical activity is just as important: weight-bearing play like walking, running, and most sports help strengthen growing bones. (Exercises where the body is not supporting its own weight, like swimming or biking, don’t count as weight-bearing.) To help children reach their highest possible (peak) bone mass, the National Institutes of Health (NIH) stresses the importance of staying active and consuming bone-building nutrients from an early age.

Adolescence/Teenage Years: Reaching Peak Bone-Building Efficiency

Most women reach their peak bone density in their twenties, which means the teen years are a crucial time for bone-building– not just for rapid growth like puberty, but for lifelong bone health, too. During adolescence, certain risk factors can reduce a person’s bone-building potential (how much bone someone can build over time). These include poor nutrition, lack of exercise, over-exercise, restrictive dieting, and drinking a lot of soda.

Intense exercise/sports or not eating enough can reduce the amount of estrogen in the body, which weakens bones and causes irregular or absent periods. Female athletes who struggle with disordered eating are especially at risk of something called the “female athlete triad”, which is three connected health conditions stemming from overexertion and under-fueling: low energy, menstrual irregularities, and low bone mineral density. Having a regular period is important because it signifies that the body is producing enough estrogen. Athletic women who are not having a period may also be at risk for poorer bone health.

Young Adulthood: Solidifying Peak Bone Mass

By early adulthood, your bones reach their peak mass. At this stage in life, bone building and bone breakdown are about equal, so it is important to maintain healthy habits to protect the bone you have built.

Weight-bearing exercise and strength training should be part of your routine, as these activities help maintain bone density. Getting enough calcium (about 1,000 mg a day) and vitamin D (around 600-800 IU a day, depending on your age) helps keep bones strong and supports long-term bone health. Calcium is found in dairy products, leafy greens, and legumes. Vitamin D is not found in many foods, but you can get some from dairy, fatty fish, egg yolks, and sunlight.

Certain habits can weaken bones over time. Smoking, drinking too much alcohol, and sitting for extended periods all increase the risk of bone loss, but these risks can be reduced by making lifestyle changes.

Reproductive-Age Adulthood: Supporting Bone Health During Hormonal Fluctuations

During the reproductive years, estrogen helps protect bones and maintain bone density. This is one of the reasons why tracking your cycle is so important: irregular periods may be a sign of an underlying issue.

According to ACOG and the NIH, getting the recommended amounts of calcium and vitamin D is incredibly important if you are pregnant or breastfeeding. Since growing babies need calcium, too, a woman’s body may use some of its own calcium stored in her bones to “donate” calcium to a growing baby. This can cause temporary bone density changes, though bone mass recovers after pregnancy and breastfeeding in most cases.

In this stage of adulthood, some health conditions, such as thyroid disease, autoimmune disorders, and long-term steroid use, may weaken bones. Women with these conditions may need extra monitoring or support from a healthcare provider.

Perimenopause: Beginning of Accelerated Bone Loss

In the years leading up to menopause, estrogen levels begin to drop. This hormonal change causes bone breakdown to happen faster than bone formation, which accelerates the rate of bone loss.

Women in perimenopause can protect their bones by engaging in regular resistance and weight-bearing exercise, getting enough calcium and vitamin D, and avoiding smoking and excessive drinking. Women with additional risk factors may need bone density screening earlier (before age 65).

Postmenopause: The Most Rapid Period of Bone Loss

After menopause, estrogen levels fall to low levels. This drop causes significant bone loss and dramatically increases a person’s risk of osteoporosis. All women age 65 and older should receive routine bone density testing (DXA) to determine if they have osteoporosis or osteopenia (low bone density). Postmenopausal women under 65 with risk factors such as family history, poor diet, and smoking should undergo screening earlier.

For those diagnosed with osteopenia (mild bone density loss) or osteoporosis (significant bone density loss), treatment may include medications that slow down bone loss or help rebuild bone, and lifestyle changes like quitting alcohol and getting enough calcium and vitamin D.

Key Bone-Healthy Habits for All Ages

Regardless of age, weight-bearing and resistance exercises are important for strong, healthy bones. Weight-bearing exercises include things like walking, running, lunges, squats, dancing, or any exercise where you are carrying your own body weight. Resistance exercise is any workout that forces your muscles to work against a force or weight, such as resistance bands, free weights, or reformer pilates.

Having a diet rich in calcium and vitamin D is always beneficial for bone health. Avoiding smoking and limiting alcohol protects bone tissue and improves overall wellness. Talk to your healthcare provider about medical conditions or medications that may affect your bone health.

Bone health is a lifelong journey. The habits formed in youth and adolescence build the foundation, and the choices made in adulthood and beyond help maintain bone health to prevent fractures and preserve overall wellbeing. Women should check in with their healthcare team about risks, prevention, and recommended screenings for bone health across all life stages.

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