Strong Foundations: A Complete Guide to Bone Health
- robyn3051
- 5 days ago
- 9 min read
If you’ve followed us for a while, you know we’re big advocates for building muscle for healthy aging. But there’s another essential foundation of healthy aging we would like to talk about today - bone health. And it deserves just as much attention!
We are going to discuss
challenges with bone health and how it is diagnosed
lifestyle factors you can control to promote bone health
nutrition and supplementation to support bone health
bone health across different life stages and genders
We hope you find this helpful to provide awareness of what you can control with your bone health and why this topic is so important!!
Why Bone Health Matters
Unfortunately, most people are unaware of their bone health status until it becomes a problem. Screening for this in Canada is not recommended until later in life, and symptoms dont start until your bone health is compromised. Because of this it is really important to do what you can to promote bone health, so you can prevent issues as you age.
Osteopenia is defined as lower than normal bone density, placing the individual at risk for osteoporosis
Osteoporosis is a more advanced state of bone loss that significantly increases bone fracture risk.
DEXA scan (Dual-Energy X-ray absorptiometry) measures bone mass density, giving an indicator of bone health status
The recommendation for screening bone mineral density in Canada:
Age 70 if no risk factors
Age 65-69 yrs with 1 risk factor
Age 50-64 yrs with prior fracture or ≥ 2 risk factors
Risk factors include:
previous fractures
falls >2 per year
parent having a fractured hip
BMI <20
smoking
alcohol use >3drinks/day (10)
However, some experts are suggesting earlier screening would be more beneficial in order to gain earlier detection of bone health status.
Osteoporosis is often known as the “silent thief” because the disease progresses without symptoms. (11)
Here are some statistics regarding osteoporosis and hip fractures:
Fractures from osteoporosis are more common than heart attack, stroke, and breast cancer combined.(11)
At least one in three women and one in five men will suffer an osteoporotic fracture during their lifetime. (11)
Every year in Canada, about 150 people per 100,000 suffer a hip fracture, which leads to increased morbidity, excess mortality, decreased quality of life and loss of autonomy. (10)
The reason we are so concerned with low bone health and the correlation with hip fractures is the fact that this can lead to a permanent loss of independence and function as we age, and even death.
Therefore, PREVENTION is KEY in order to safeguard your precious bone mass!
Lifestyle Strategies for Lifelong Bone Health
In order to promote bone health and optimize bone mineral density, the following are ESSENTIAL (note we didn't say optional).
Strength Training and Jumping Exercises
One of the single best things you can do for your bones is to prioritize LIFTING weights and jumping exercises across your lifespan!
When bone cells sense any strain (for example, the impact of striking your foot on pavement as you skip rope, or bearing the load of a barbell), the body sends signals to increase bone formation. (11) (14)
Bone adapts to mechanical loading. If you don’t load your bones, they weaken. Even just six weeks of non-weight-bearing activity can result in disuse osteopenia, a measurable decline in bone mass. (2)
We recommend strength training 3-4 times per week at a RPE of 7-9 for your sessions.
If you are just starting out with strength training, you can build up to this frequency and intensity. You want to be lifting “heavy” for YOU, where the last couple reps of the exercise are challenging for you. Following your sessions with some jumping type exercises like box jumps, broad jumps, or simply jumping in place is a great practice to implement as well.
Don’t Undereat
Low energy availability—caused by excessive exercise or restrictive eating (essentially undernourishing your body for the amount of training you are doing)—interferes with hormones like estrogen and leptin, impairing bone formation (11) (14). This state of energy deficiency can have far-reaching consequences, particularly for women, whose hormonal systems are highly sensitive to energy intake and stress.
One sign for women of insufficient energy availability is hypothalamic amenorrhea (HA)—a condition where the menstrual cycle becomes irregular or stops altogether due to disruptions in the hypothalamic-pituitary-ovarian (HPO) axis. This often results from low calorie intake, high physical stress, or a combination of both (15)
Missing or irregular periods are not just a reproductive concern—they can be a major indicator of compromised bone health. Estrogen plays a critical role in maintaining bone density, and when estrogen levels drop due to HA, bone turnover increases and bone formation slows. Over time, this can lead to osteopenia or even osteoporosis, significantly increasing the risk of stress fractures and long-term skeletal issues (15).
A missing period is not “normal” for active women. It is a signal that your body is under stress and not functioning optimally. If you’ve lost your cycle or are experiencing irregularity, especially paired with other signs such as reduced recovery, low energy, brittle hair and nails, increased injuries etc, it is essential to work toward restoring energy balance which can be achieved by increasing caloric intake, potentially reducing training intensity or frequency, and prioritizing recovery - all of these factors are individual and we highly recommend working with a qualified coach to support you during this!.
To optimize bone health, ensure you are eating at maintenance calories most of the year, keep diet periods focused and as short as possible, and avoid chronic dieting—especially if body fat percentage is low. A healthy body fat percentage for females is between 18-28% for women and 10-20% for men.
Prioritizing adequate nutrition is not just about energy for workouts; it is about long-term hormonal and skeletal health.
Ensure Adequate Calcium, Vitamin D, and Magnesium through Diet and/or Supplementation
CALCIUM
Calcium is the cornerstone of bone structure—99% of the body’s calcium is stored in your bones(11) Aim to get 1,000–1,200 mg per day, ideally from food with dairy products, the richest source(7). Keep in mind: certain plant foods (like spinach or nuts) contain compounds (phylates and oxalates) that can interfere with calcium absorption. (11)
VITAMIN D3/K2
Vitamin D3 is super important for calcium absorption!
Sunlight is the most powerful way to get your vitamin D!
Almost one out of four people have vitamin D blood levels that are too low or inadequate for bone and overall health —especially in northern climates where sunlight exposure is limited. (11)
If sunlight exposure and dietary sources are limited, consider supplementation.
A blood test (25-hydroxyvitamin D) can guide the dosage of your supplementation:
Levels greater than 50 nmol/L (20 ng/mL) are usually in line with bone health
Levels below 30 nmol/L (12 ng/mL) are too low and might weaken your bones.(9)
Vitamin K2 helps direct calcium into bones instead of soft tissue(9)(10). Many supplements contain both vitamin D3 and K2 combined as they work together synergistically
MAGNESIUM
Magnesium is involved in the structural development of bone, and plays a role in the regulation of calcium balance and is required for the conversion of vitamin D into its active form. (12)
A study involving 52 postmenopausal women aged between 44–76 years found that daily treatment with 500 mg of magnesium resulted in significantly increased vitamin D levels. (12)
Individuals under high stress or with intense activity levels may require supplementation as they tend to use up magnesium stores more quickly.
Consider Additional Supplementation
CREATINE
While primarily known for muscle benefits, creatine may also support bone health indirectly by increasing lean mass and improving functional strength.(3)
Benefits for bone health typically require higher creatine doses—around 8 g per day—whereas the lower 5 g daily dose supports muscle, but may be insufficient for optimizing bone integrity over time.(6)
HYDROLYZED COLLAGEN (TYPE 1 and TYPE 2)
Type 1 collagen is the main structural protein in bone. Hydrolyzed type 1 collagen has been shown to improve bone density in postmenopausal women with osteopenia in the Florida Bone study. (4)(5)
Type 2 collagen, on the other hand, supports joint health by targeting cartilage integrity and may help reduce joint discomfort.(5)
Ensure Adequate Protein Intake
Protein makes up 20-30% of bone mass and influences growth hormones in the body, which helps support bone health. Adequate protein intake also supports muscle development, which supports bone health. (11)
We recommend 0.8-1.2g/lb “ideal” body weight, which is above the recommended RDA for dietary protein (at 0.8 g/kg/day) in order to optimize both muscle and bone health.
Avoid Smoking
Smoking disrupts bone remodelling by reducing calcium absorption and estrogen levels. Long-term smoking is strongly linked to lower bone density and higher fracture risk. (10)
Start Young: Building Bone in Childhood and Adolescence
“Osteoporosis is a childhood disease.”
-Dr. Belinda Beck (2)
By around 18 or 19 years old, we’ve reached about 95% of our peak bone mass. We can continue to build some bone in our 20s, but by age 30, we stop. This is why childhood and early adulthood are critical windows for maximizing bone health. (11)
All of the interventions we explained above are KEY to start in childhood and adolescence
Calcium from food - dairy being the best source.
Sunlight exposure (approximately 1hour per day) for Vitamin D
Avoiding undereating
Participate in a variety of high-impact activities like jumping and running, as well as activities that place strain on bone, such as resistance training. (2)
The Menopause Factor: Estrogen and Bone Loss
Menopause is a major turning point for bone health. Estrogen plays a vital role in regulating bone turnover and maintaining muscle mass. After menopause, bone loss accelerates to 2% per year, compared to about 1% pre-menopause due to the drastic drop in estrogen during this phase of life. (2)(5)
Estrogen receptors are present on both bone and muscle tissue, which helps explain why its loss contributes not only to weaker bones but also reduced muscle repair and strength(5) This dual effect increases fall risk and fracture likelihood in aging women.
70% of midlife women will experience the musculoskeletal syndrome of menopause. This is a term used to describe the typical symptoms women experience as a result of the large drop of estrogen surrounding the menopause transition in relation to the musculoskeletal system. These symptoms include musculoskeletal pain, arthralgia, loss of lean muscle mass, loss of bone density with increased risk of fracture, increased tendon and ligament injury, adhesive capsulitis and cartilage matrix fragility with the progression of osteoarthritis(12)
The good news is that you can still support your bone health at any stage of life, with resistance training and jumping-type exercises being some of the most impactful things you can do. A study called the LIFTMOR trial showed that supervised high-intensity resistance and impact training performed over 8 months increased spine and hip bone mineral density and improved strength and function in postmenopausal women with low bone mass. (12)
It is important to note that if you are postmenopausal, at risk for or have osteoporosis, and new to strength training, it is important to start a strength training program under the supervision of a qualified professional.
Hormone Replacement Therapy (HRT) and Bone Health
Hormone Replacement Therapy (HRT)—especially estrogen-based therapy—can significantly reduce the rate of postmenopausal bone loss and lower fracture risk.(5)
Estrogen helps suppress bone resorption, reduce inflammation, maintain lean body mass, all of which contribute to a stronger musculoskeletal system.(5)
Estrogen therapy may help prevent bone loss and reduce fracture risk by 20-40% with most benefit shown if it starts within the first ten years of menopause. (13)
If you’re in perimenopause or recently postmenopausal, consider talking to your healthcare provider about whether HRT is right for you. Starting estrogen therapy earlier in the menopausal transition will be more effective in protecting both bone and muscle, and must be continued in order to receive the ongoing benefits.(12)
What About Men? Bone Loss Happens Differently
While osteoporosis is more common in women, men are not immune. Men typically start with higher peak bone mass, and they don’t experience the sharp estrogen-related decline women do after menopause. Instead, bone loss in men tends to occur more gradually with age, often tied to lower physical activity and declining testosterone.(1)
Final Thoughts
Bone health is about protecting your mobility, strength, and independence as you age.
Start early, train wisely, nourish your body, and screen appropriately to support your precious bone mass!
Author Robyn Stewart
REFERENCES
1-Attia, P. (Host). (n.d.). AMA #37: Bone health, screening, supplements, and strength training [Audio podcast episode]. The Peter Attia Drive. Retrieved from https://peterattiamd.com/ama37/
2-Attia, P., & Beck, B. (n.d.). Bone health, resistance training, menopause [Audio podcast episode]. The Peter Attia Drive. Retrieved from https://peterattiamd.com/belindabeck/
3-Chilibeck, P. D., Kaviani, M., Candow, D. G., & Zello, G. A. (2017). Effect of creatine supplementation during resistance training on bone health in older adults: A systematic review. Open Access Journal of Sports Medicine, 8, 67–76. https://doi.org/10.2147/OAJSM.S123529
4-Elam, M. L., Johnson, S. A., Hooshmand, S., Feresin, R. G., Payton, M. E., Gu, J., & Arjmandi, B. H. (2015). A calcium-collagen chelate dietary supplement attenuates bone loss in postmenopausal women with osteopenia: A randomized controlled trial. Journal of Medicinal Food, 18(3), 324–331. https://doi.org/10.1089/jmf.2014.0100
5-Lyon, G. (Host). (2025, April 8). The science of joint health: How to keep your bones strong for life (with Dr. Jocelyn Wittstein) [Audio podcast episode]. The Dr. Gabrielle Lyon Show. https://podcasts.apple.com/ca/podcast/the-dr-gabrielle-lyon-show/id1622316426?i=1000702701914
6-Lyon, G. (Host). (2024, April 2). How to get the most out of creatine (with Darren Candow, PhD) [Audio podcast episode]. The Dr. Gabrielle Lyon Show. https://podcasts.apple.com/ca/podcast/the-dr-gabrielle-lyon-show/id1622316426?i=1000651178959
7-National Institutes of Health, Office of Dietary Supplements. (n.d.). Calcium: Fact sheet for consumers. https://ods.od.nih.gov/factsheets/Calcium-Consumer/
8-National Institutes of Health, Office of Dietary Supplements. (n.d.). Magnesium: Fact sheet for consumers. https://ods.od.nih.gov/factsheets/Magnesium-Consumer/
9-National Institutes of Health, Office of Dietary Supplements. (n.d.). Vitamin D: Fact sheet for consumers. https://ods.od.nih.gov/factsheets/VitaminD-Consumer/
10-Osteoporosis Canada. (n.d.). Quick reference guide to the 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. https://osteoporosis.ca/quick-reference-guide-clinical-practice-guideline/?utm_source=chatgpt.com
11-Precision Nutrition. (n.d.). All about bone health. https://www.precisionnutrition.com/all-about-bone-health
12-Wright, V. J., Schwartzman, J. D., Itinoche, R., & Wittstein, J. (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466–472. https://doi.org/10.1080/13697137.2024.2380363
13-Haver, M. C. (2024). The new menopause: Navigating your path through hormonal change with purpose, power, and facts (1st ed.). Rodale Books.
14-Sims, S. T., & Yeager, S. (2022). Next level: Your guide to kicking ass, feeling great, and crushing goals through menopause and beyond (1st ed.). Rodale.
15-Gordon, C. M., & Ackerman, K. E. (2015). Hypothalamic amenorrhea: Diagnosis and treatment. Fertility and Sterility, 104(3), 611–617. https://doi.org/10.1016/j.fertnstert.2015.06.014