Bone Health at Every Age: Why Your Bones Are Living Tissue and How to Keep Them Strong

39 minutes ago

10 min read

We tend to take our bones for granted or maybe really don't talk about them. They are out of sight, quietly supporting our bodies, allowing us to move and protecting our internal organs. Most of the time, we only think about them when something goes wrong — perhaps after a fracture, or when a doctor mentions osteoporosis as we get older.

But there is something fascinating about our skeleton that deserves much more attention: our bones are not lifeless structures. They are living, active tissue that is constantly changing, adapting and rebuilding itself. And this process continues throughout our entire lives.

Understanding how our bones work helps explain why bone health is not just a concern for older people (especially for women), why our everyday habits matter, and why it is never too early — or too late — to start looking after our skeleton.

Your skeleton is constantly rebuilding itself

Imagine if your house could detect tiny cracks in its walls, remove the damaged material and replace it with new building blocks. That is, in a simplified way, what happens inside your bones every day.

Bone is a dynamic tissue undergoing a continuous process called remodelling.

Specialised cells work together to remove old or damaged bone and replace it with new tissue.

Two types of cells play particularly important roles:

Osteoclasts break down and remove old bone tissue
Osteoblasts build new bone tissue

This may sound counterintuitive. Why would the body deliberately break down something as important as bone? Because this is how it repairs microscopic damage, adapts to the physical demands placed on it and maintains the strength of the skeleton.

In healthy bone, the processes of breakdown and formation are carefully balanced.

Problems arise when bone is removed faster than it can be replaced. Over time, this can lead to a loss of bone mass and deterioration in the internal structure of the bone.

This is one of the processes behind osteoporosis.

There is another interesting detail: bones are not simply a storage structure for minerals. Bone marrow, found inside many bones, produces red blood cells, white blood cells and platelets. Our skeleton also stores most of the body's calcium, which can be released when the body needs it for essential functions such as nerve signalling and muscle contraction.

In other words, bones are involved in far more than movement and structural support. They are an active part of our body's everyday functioning.

We build our bone reserves early in life

Bone health is influenced by our entire life history, beginning in childhood.

During childhood and adolescence, bone formation is greater than bone breakdown. Bones grow in size, become stronger and accumulate mineral content. Even after we stop growing taller, our skeleton continues to develop and gain strength.

Most people reach their peak bone mass — the greatest amount of bone they will have — in early adulthood, generally between their twenties and around the age of 30.

Think of peak bone mass as a reserve. The stronger that reserve is, the more capacity we have to withstand the gradual bone loss that often occurs with ageing.

This is why childhood and teenage years are so important. Adequate nutrition, physical activity and healthy development during these years help build the foundation for bone health later in life.

But reaching adulthood does not mean that the story is over. Bone remodelling continues, and our lifestyle still influences how well we maintain our skeleton.

Why bone loss becomes more common with age

As we get older, the balance between bone formation and breakdown can gradually shift. More bone may be removed than replaced, leading to a decline in bone mass.

This happens in both women and men, although the pattern and timing can differ.

For women, menopause is a particularly important stage. Oestrogen plays a significant role in regulating bone remodelling. When oestrogen levels fall during menopause, the rate of bone breakdown can increase, sometimes quite rapidly. Men also experience age-related bone loss, although it tends to occur more gradually.

The result can be osteoporosis — a condition in which bones become less dense and their internal structure weaker, making fractures more likely.

One of the challenges is that osteoporosis often develops without noticeable symptoms. A person may feel perfectly well and have no idea that their bones have become more fragile until they experience a fracture.

A fracture following a relatively minor fall, or even an everyday movement, should therefore never be dismissed as simply bad luck. It may be an important signal that bone health needs investigating.

Why a Hip Fracture Can Be Life-Changing

Hip fractures are one of the most serious consequences of osteoporosis and become increasingly common with age. Although they can occur in both women and men, women are affected more often. In Europe, the estimated remaining lifetime risk of a hip fracture from the age of 50 is around 15% for women and 6% for men. The risk rises sharply in older age, particularly after 70–75, making hip fractures a major health concern among older adults.

A hip fracture is much more than a broken bone, particularly in older adults. It can have a profound impact on mobility, independence and overall health. Recovery often involves surgery, rehabilitation and a prolonged period of reduced physical activity, which can lead to further complications such as muscle loss, infections and blood clots.

Research has also established a significant association between hip fractures and increased mortality. A large meta-analysis found that older women who experienced a hip fracture had almost six times the risk of dying during the first three months after the injury compared with women of similar age without a fracture. Although this relative risk decreases over time, it does not immediately return to normal. Other large studies have found that the risk of death remains elevated for years following a hip fracture.

These figures do not mean that a hip fracture inevitably shortens someone's life. Age, general health, underlying conditions and access to timely treatment and rehabilitation all influence recovery and survival. However, they highlight why preventing osteoporosis and maintaining strong, healthy bones throughout life are so important.

Strong bones need strong muscles

We often hear about the importance of building muscle, especially as we age. But muscles and bones are closely connected.

When muscles contract, they pull on the bones to which they are attached. The mechanical forces created by movement provide signals that help bones adapt and maintain their strength.

This is one reason why physical activity is so important for bone health!

Not all exercise places the same demands on the skeleton. Activities in which the body works against gravity, as well as exercises that challenge muscles against resistance, are particularly useful.

Examples include:

Brisk walking and hiking.
Dancing and stair climbing.
Jogging or running, if appropriate for your fitness and joint health.
Strength training with weights, resistance bands or body weight.
Activities involving jumping or impact, when suitable.

Swimming and cycling are excellent forms of exercise for cardiovascular fitness, endurance and general health. However, because the water or bicycle supports much of your body weight, they generally provide less bone-loading stimulus than weight-bearing activities.

Balance training also deserves attention, particularly as we get older. Exercises such as tai chi and appropriately adapted yoga can help improve balance, coordination and stability. Preventing falls is an important part of preventing fractures.

The best exercise programme is one that is appropriate for your health, abilities and current bone condition. If you have osteoporosis or a history of fractures, seek professional guidance before beginning high-impact exercise.

Nutrition: more than just calcium

Calcium is probably the nutrient most people associate with healthy bones, and for good reason. It is a major component of bone mineral.

However, bone is not made of calcium alone. Its structure also includes a protein framework, mainly collagen, which gives it some flexibility and helps it resist mechanical stress. This means that a healthy skeleton needs a range of nutrients.

Calcium

Our bodies cannot produce calcium, so we need to obtain it from food. Good sources include dairy products, calcium-fortified plant drinks (soy, almond, oat), calcium-set tofu, almonds, Brazil nuts, sesame seeds, some green vegetables (broccoli, kale, bok choy) and fish eaten with their edible bones, such as sardines.

The amount needed varies with age and life stage. It is generally preferable to meet calcium requirements through a varied diet, using supplements only when dietary intake is insufficient or there is a specific reason to take them. Please consult with your healthcare provider.

Vitamin D

Vitamin D helps the body absorb calcium from the digestive tract. Without enough vitamin D, the body cannot maintain normal bone mineralisation.

In Estonia and other northern countries, vitamin D deserves particular attention because sunlight is insufficient for meaningful vitamin D production during much of the autumn and winter. Dietary sources include for example oily fish, eggs, mushrooms and fortified foods. D- vitamin supplementation is generally advised during autumn, winter and spiring. Please speak to your healthcare provider about the appropriate dose.

Protein

Protein provides the building blocks for the collagen-rich framework of bone. It is also essential for maintaining muscle mass, which supports the skeleton and helps reduce the risk of falls.

You can learn more about the importance of protein consumption from food and how much should we get from our diet in this article.

Other nutrients

Magnesium, phosphorus, vitamin K and vitamin C also contribute to normal bone structure and metabolism. A varied diet containing vegetables, fruit, legumes, whole grains, nuts, seeds, fish and other protein sources helps provide these nutrients.

Rather than focusing on one nutrient or buying a collection of supplements, the bigger picture is a balanced, sufficiently nourishing diet.

A Mediterranean-style dietary pattern, rich in plant foods, fish, nuts, olive oil and other minimally processed foods, has been associated with better bone-health outcomes in research.

You might also find these Vitamins and Minerals one pagers useful as they provide you list of foods that contain all the necessary vitamins and minerals our bodies need to function optimally.

Everyday habits that can work against your bones

Some lifestyle factors can gradually undermine bone health.

Smoking: It is associated with poorer bone health and a higher risk of osteoporosis and fractures.
Excessive alcohol consumption: Heavy drinking can interfere with bone formation and increase the risk of falls. Learn more about the alcohol in this article.
Physical inactivity: A lack of weight-bearing activity and resistance exercise reduces the stimulus bones and muscles need to remain strong.
Inadequate nutrition: Chronic under-eating, restrictive diets and insufficient protein or calcium can compromise bone health.
Poor muscle health: Losing muscle can affect both the forces that help maintain bone and our ability to balance and prevent falls.

Certain medical conditions and medications also deserve attention. For example, coeliac disease and inflammatory bowel disease can affect nutrient absorption and, particularly when the condition is active or poorly controlled, increase the risk of deficiencies that may compromise bone health. Long-term use of oral corticosteroids can accelerate bone loss and increase fracture risk. A history of eating disorders, prolonged undernutrition or significant weight loss may also interfere with the development and maintenance of healthy bone mass.

Bariatric surgery is another important consideration. Depending on the type of procedure, it can reduce food intake and affect the absorption of nutrients essential for bone health, particularly calcium and vitamin D. People who have undergone bariatric surgery should follow their medical team's recommendations for lifelong supplementation and regular nutritional monitoring. This commonly includes calcium, vitamin D and a bariatric-specific multivitamin, with the exact requirements tailored to the type of surgery and individual needs.

If you are taking medication or have a medical condition that may affect your bones, discuss this with your healthcare professional rather than stopping or changing treatment yourself.

Bone health is not just about density

It is tempting to think of bone health as a single number — how dense our bones are. But bone strength is more complex.

It depends on bone density, the internal architecture of the bone, its quality and the way all these features work together.

This is why a person can have no obvious symptoms while bone loss is developing. Bone-density testing, usually performed using a DEXA scan, can help assess bone mineral density and identify osteoporosis.

A healthcare professional can also assess fracture risk using factors such as age, previous fractures, family history, medication use and other medical conditions. Tools such as FRAX help estimate the likelihood of a fracture over the next ten years.

Screening is not necessary for everyone at the same age. It is particularly worth discussing with a doctor if you have risk factors, have experienced a fracture after a minor fall, or are approaching or have passed menopause and have additional reasons for concern.

Osteoporosis is treatable. When medication is indicated, it can reduce fracture risk. Lifestyle measures remain important, but they are not a substitute for medical treatment when treatment is needed.

Looking after your bones is a lifelong investment

The most important message is that bone health should not become a priority only when we are older or when a fracture has already happened.

For children and teenagers, the goal is to build a strong skeleton through good nutrition and regular physical activity.

For adults, it is about maintaining bone mass, supporting muscle strength and avoiding habits that accelerate bone loss.

During and after menopause, it is especially important for women to understand their individual risk and discuss bone health with their healthcare provider.

And in older age, maintaining strength, mobility and balance becomes just as important as maintaining bone density.

Our bones are living tissue. They respond to the way we move, the nutrients we provide and the conditions in which they have to function. We cannot stop the ageing process, but we can influence how well our skeleton serves us throughout life.

Perhaps it is time to give our bones the same attention we give our muscles, heart and brain. After all, they have been quietly supporting us every step of the way.

A few questions worth asking yourself:

Am I doing regular weight-bearing and resistance exercise?
Am I eating enough protein and calcium-rich foods?
Am I getting enough vitamin D, particularly during the darker months of the year?
How is my diet in general, do I get the necessary nutrients?
Do I know whether I have any risk factors for osteoporosis?
Have I discussed bone-density testing with my doctor if I am at increased risk?

Healthy bones are not built in a day. They are supported by the small decisions we make, consistently, throughout our lives.

Are your nutrition and lifestyle choices supporting your bone health? If you would like to find out how to better support your bones through everyday nutrition and lifestyle habits, I invite you to get in touch for personalised nutrition counselling. Contact me at info@katrinpeo.com.