How do I lower my risk of osteoporosis?

Our read is that maintaining bone mineral density is crucial for lowering osteoporosis risk, with interventions potentially increasing peak bone mass before menopause.

Key strategies include managing hormone levels, particularly estrogen in women, engaging in sustained physical activity, and avoiding factors that deplete bone minerals.

Conversely, certain dietary choices and chronic stress can negatively impact bone health, while hormone replacement therapy, though beneficial for many, carries specific contraindications.

For women, maintaining estrogen levels through hormone replacement therapy (HRT) can preserve bone health, and interventions before menopause can increase peak bone mass. Sustained activity levels, as seen in Master's athletes, are linked to maintaining bone mineral density. Avoiding chronic high oxalate exposure, excess sodium, phosphoric acid from soda, and chronic high alcohol intake is also suggested.

• 01Peter Attia states that high exposure to corticosteroids is a significant risk factor for low bone mineral density (5x).
• 02Peter Attia notes that high bone-loading forces during gymnastics stimulate bone growth (1x).
• 03Peter Attia reports that women experience a dramatic loss of bone mass in the 5-8 years following menopause due to the disappearance of estrogen (5x).
• 04Peter Attia indicates that maintaining estrogen levels through hormone replacement therapy (HRT) in women can preserve bone health (2x).
• 05David Sinclair suggests that extended hormone replacement therapy for decades appears to protect against heart disease and bone loss, but is contraindicated for individuals with a history of breast cancer (1x).
• 06Peter Attia observes that the maintenance of bone mineral density in Master's athletes is linked to their sustained activity levels (2x).
• 07Paul Saladino claims that chronic high oxalate exposure can lead to a perpetual donation of electrolytes, particularly calcium, from bones, potentially resulting in osteopenia or osteoporosis (1x).
• 08Andrew Huberman states that chronically elevated cortisol levels can suppress the production of testosterone and other steroid hormones, leading to reduced muscle and bone mass (1x).
• 09Andrew Huberman notes that epidemiological data suggested hormone replacement therapy in women was associated with a lower risk of bone fractures (1x).
• 10Peter Attia reports that bone mass can be increased before menopause by implementing interventions, potentially raising peak bone mass (3x).
• 11Peter Attia highlights that in female endurance athletes, poor nutritional state leading to low BMI, low body fat percentage, and estrogen deficiency is a risk factor for poor bone health (6x).
• 12Andrew Huberman mentions that symptoms of anorexia nervosa include loss of bone density and loss of menstruation in females (2x).

Our sources indicate that modest amounts of prednisone for months or years, or children using steroid inhalers for years, pose a significant concern for bone health (Andrew Huberman, 1x). Paul Saladino cautions that almond milk lacks sufficient calcium, vitamin D, and protein for bone health compared to dairy products (1x), and that ketogenic diets may impair bone health, potentially leading to low-level metabolic acidosis and negative effects on bone remodeling (2x). He also notes that phytic acid in foods like oatmeal can steal minerals from the body, leading to reduced bone density (1x). Bryan Johnson points out that chronic life stress can raise cortisol levels, reduce calcium absorption, and lead to bone loss (1x), and that excess sodium, phosphoric acid from soda, and chronic high alcohol intake can negatively impact calcium absorption and retention (1x). Peter Attia warns that stopping hormone therapy after 10 years can lead to rapid loss of bone density gains (1x), and that a low Z-score in a woman 3-5 years pre-menopause is concerning due to estrogen withdrawal's effect on bone density (1x). Paul Saladino also suggests that a low-protein diet, while potentially extending longevity, increases the risk of bone fractures and osteoporosis (1x). Peter Attia adds that a drug is unlikely to replicate the full benefits of exercise and physical loading on muscle and bone (1x), and that training for events like the Tour de France can lead to negative health outcomes such as osteopenia (1x).

Our verdict would change if new evidence emerged demonstrating that current interventions for increasing peak bone mass or maintaining bone mineral density are ineffective, or if the risks associated with hormone replacement therapy were found to significantly outweigh its bone health benefits for a broader population. Additionally, if studies showed that dietary factors currently believed to be detrimental to bone health have no significant impact, or if novel, highly effective, and universally safe methods for bone density improvement were discovered, our recommendations would be updated.