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The Health Risk Most Women Ignore

Here, six surprising truths about osteoporosis.

Wendy Mikola has a lifestyle any physician would praise. The 36-year-old accountant from Ohio exercises regularly, doesn't smoke, and fills her plate with fresh fruits and vegetables, lean protein, and whole grains. But there's one glaring lapse: She doesn't give much thought to protecting her bones. "I figure that's something I can worry about later," says Wendy. "Osteoporosis usually affects older women."

She's not the only one who feels this way: A survey by the National Osteoporosis Foundation found that 85 percent of women assume they're not at risk for osteoporosis, a disease that makes bones porous and brittle and leads to debilitating fractures. While it's true that women usually don’t develop the condition until their 50s or beyond, "the measures you take as a 20-, 30-, and even 40-something play an enormous role in determining your bone health later in life," says Miriam Nelson, Ph.D., an associate professor at the Friedman School of Nutrition Science and Policy at Tufts University and the author of Strong Women, Strong Bones.

Yet only 4 percent of young women are taking the necessary precautions to stave off osteoporosis, finds a recent study in the journal Arthritis & Rheumatism. "Many make the mistake of thinking that their daily cup of yogurt or glass of milk is enough to protect them," says Nelson. “But tha's not the case." To prevent bone loss before it starts, we gathered the facts you need to know.

1 It's not too late to build bone

Just like skin cells turning over, bone is constantly being made and broken down throughout your life. When you’re young, bone grows much faster than it degenerates. That rate slows as you age; by 18, most women have formed up to 90 percent of their bone mass, and by 30, they’ve reached their peak.

During the next two decades, hormones get into the act. Levels of bone-protecting estrogen begin to fall, so you start to lose bone mass more quickly than you can replace it. "Five to seven years after reaching menopause, most women have already lost about 20 percent of their bone density," says David Hamerman, M.D., director emeritus of the Comprehensive Bone Center at Montefiore Medical Center in New York City. But all is not lost. Consider your frame an account to invest in: With certain diet and exercise tweaks, it's possible for a woman in her 20s or 30s to add to her reserves or simply preserve what she's got.

2 You may have to ask for a bone density check

Although current recommendations call for your first osteoporosis screening at age 65, you might need one decades earlier: Some experts estimate that one in six college-age women have osteopenia, a precursor to osteoporosis. “"Don't depend on your physician to alert you if there's something wrong—you have to be proactive and ask her to assess your odds," says Nelson. It's especially important to speak up if you have any risk factors (see list here). Your doctor may recommend a DXA scan (formerly DEXA, or dual X-ray absorptiometry) to measure your bone density. If your results reveal that it's low, she may recommend several lifestyle changes, such as taking calcium and vitamin D supplements.

3 Not every type of exercise protects your bones

Swimming, cycling, and Pilates all tone your muscles, but you need more force to bulk up your infrastructure. "Any weight-bearing activity, like strength training, aerobics, or running, has been shown to stimulate bone formation," says Nelson. During this type of exercise, your skeleton adapts to the pressure of gravity by building more bone cells.

The American College of Sports Medicine recommends doing weightbearing workouts three to five times a week, as well as plyometrics, or explosive leaping moves, for 10 to 20 minutes three days a week. Try jumping rope or doing squat jumps (starting in the squat position, jump vertically into the air, landing on flat feet).

But these lower-body exercises only serve the bones in your legs and hips. Bridge the gap with activities like weight lifting, which will shore up those bones in your arms and back.

4 Bone-strengthening foods can be found in the produce aisle

When it comes to warding off osteoporosis, lowfat dairy gets most of the credit for its high calcium content. But your skeleton requires a supporting cast of nutrients to stay strong: A study published in the Journal of Bone and Mineral Research found that women who consumed the most vitamin C had higher bone densities than those who got the least. So the next time you head to the supermarket, stock up on foods rich in the vitamin, such as citrus fruits, broccoli, and red peppers.

While you're at it, toss some kale, spinach, or Swiss chard in your shopping cart. These vegetables are all high in vitamin K, which boosts production of osteocalcin, a protein that binds calcium to bone tissue. And don’t skip the seafood aisle. Yellowfin tuna is rich in magnesium, another must for strong bones; nearly 50 percent of your body’s store of this mineral is found in your skeleton. Each day, aim for 320 milligrams of magnesium, which is also found in brown rice and peanut butter.

5 Calcium is co-D-pendent

All the milk, yogurt, and supplements in the world won't do a body a bit of good unless you’re getting vitamin D along with your calcium. "Calcium is reliant on vitamin D," says Susan E. Brown, Ph.D., director of the Osteoporosis Education Project in East Syracuse, New York. "Without sufficient vitamin D levels, very little of the calcium you consume will actually be absorbed and useful to the body."

You need 1,000 to 1,200 milligrams of calcium a day—the amount in three to four servings of lowfat dairy—and at least 400 to 800 international units of vitamin D, according to the National Osteoporosis Foundation guidelines. Find the vitamin in salmon, shrimp, and fortified milk or orange juice. While 15 minutes of unprotected sun exposure is another good source of vitamin D, you also run the risk it will damage your skin and lead to cancer.

Because the average American falls short on vitamin D, experts recommend taking a pill daily. There are two forms of the supplement, D2 and D3. "Opt for the D3 version, which is more effective," says Robert P. Heaney, M.D., an osteoporosis researcher and professor of medicine at Creighton University.

6 Some foods are calcium thieves

You poured nonfat milk over your raisin bran at breakfast this morning, then sprinkled cheese on your spinach salad at lunch, so you're well on your way to meeting your calcium quota, right? Maybe not. Certain chemicals, such as oxalates (found in spinach and rhubarb) and phytates (in wheat bran and beans), bind to calcium, blocking its absorption. So don't factor all of the calcium you consume with these foods into your daily total. Having a diet high in processed foods can also set you up for calcium loss. "They're usually sky-high in sodium," says Felicia Cosman, M.D., clinical director for the National Osteoporosis Foundation. "And when your kidneys excrete excess sodium, some calcium is swept along with it." She recommends limiting your intake to less than 2,000 milligrams a day by choosing low-sodium foods and cutting back on packaged goods. A cup of soup, for example, can pack in nearly 900 milligrams of sodium, while two tablespoons of French dressing contains 250 milligrams.