What can I do to build stronger bones?


There are many steps you can take to build strong bones during your teens and to help lower your risk for osteoporosis later in life. The steps to build strong bones include eating a nutrient-rich diet that includes plenty of fruits and vegetables, consuming the recommended amount of calcium from the foods you eat, getting the Vitamin D you need each day, being physically active, avoiding smoking and alcoholic beverages.

Eat a Nutrient-rich Diet Including Plenty of Fruits and Vegetables

It is important that your diet is well balanced in order to meet the needs of your growing body and growing bones. Teens need to eat the right amount of calories to have a healthy body weight and in order for girls to maintain normal menstrual function. It is also important to consume the right amount of protein, carbohydrate, fat, vitamins, and minerals to fuel an active body.

Higher consumption of fruits and vegetables is related to better bones and overall health.  It is wise to fill half of your plate with a variety of colorful fruits and vegetables. For information about how to select a healthy plate, visit ChooseMyPlate

Consume the Recommended Amount of Calcium Each Day

Did you know that 99% of the calcium in your body is stored in your bones and teeth? The remaining small amount of calcium that is found in your blood and tissues plays a critical role in supporting your body’s vital functions; such as controlling your blood pressure and maintaining your heartbeat. If you do not get the recommended amount of calcium in your diet each day, your body takes the calcium it needs to support your body’s vital functions from your bones. Over time, this can result in thinner, weaker bones.

You need to get the recommended amount of calcium in your diet each day in order to reach your peak bone mass. During the teen years (age 13 to 19), the fastest bone building years, you need more calcium than at any other time of life. You need 1300 milligrams of calcium each day. To meet these recommendations, teens need to make sure to include a calcium rich food or beverage at each meal and snack. Calcium-rich foods include low-fat or fat-free dairy products (milk, yogurt and cheese), calcium-rich non-dairy foods (certain green leafy vegetables, almonds, and soy nuts) and calcium-fortified foods (especially cereals, citrus juices, and many others). It is important to learn how to read food labels for calcium content in a serving.

Beverage choices can make a big difference in your calcium intake. Most people who drink too many servings of sodas or coffee, tend to drink less milk and calcium-fortified beverages and are more likely to have a lower calcium intake. It is also a good idea to keep your intake of caffeinated beverages low since caffeine slightly reduces the amount of calcium that your body can use from the beverages that you drink. So, think about what you drink and choose beverages that contain calcium as your first choice.

Here are a few tips to help you get the recommended amount of calcium in your diet even if you are lactose intolerant, allergic to milk, or following a strict vegetarian diet:

  • If you have lactose intolerance, you may feel abdominal discomfort after eating or drinking dairy foods. The inability to breakdown milk sugar (lactose) is due to lack of/or too little of an enzyme called lactase in the intestine. The result is often undigested, fermented lactose in the intestine that can cause symptoms such as bloating, gas, diarrhea, and/or constipation. Though some people cannot handle any lactose at all, many people with lactose intolerance can handle small servings of dairy foods in a mixed meal when spaced throughout the day. If you think you are having symptoms of lactose intolerance, speak to your healthcare provider to find out what diet is recommended for you
  • If you are advised by your healthcare provider to avoid dairy foods, you can get the amount of calcium you need by taking lactase enzyme replacement along with dairy products or by choosing dairy products with lactase enzyme added.
  • If you told by your healthcare provider that you are allergic to milk (protein) or if you are following a strict vegetarian diet, you can get the recommended about of calcium by choosing non-dairy beverages with calcium added such as fortified almond, coconut, rice, or soy beverages and/or fortified juices. Be sure to shake these products before serving to prevent the calcium from settling at the bottom of the container.
  • There are also non-dairy calcium rich foods such as certain green leafy vegetables, almonds, and others.

To get the recommended amount of calcium each day, the best rule of thumb is to include a calcium-rich food at each meal or snack. That is because your body uses calcium best when eaten in small amounts (less than 600 mg at one time) spaced throughout the day. Eating foods with too little calcium can be harmful but on the other hand consuming more calcium than recommended is not better. In fact, too much calcium consumed on a routine basis, especially from supplements may be harmful for overall health. If you think that you are not getting the recommended amount of calcium from the food you eat or that you are consuming too much calcium, it is important to discuss your concerns with your parents/guardians and your healthcare provider.

Get the Recommended Amount of Vitamin D Each Day

It is important to get the recommended amount of vitamin D each day. Vitamin D helps your body use calcium so your bones can become as strong as possible.  To reach your peak mass, you need to get 600 IU of vitamin D in each day. There are only a few foods that are natural sources of vitamin D such as fatty fish, some sushi, sun-dried shiitake mushrooms, and egg yolk. There are foods that are not natural sources of vitamin D but have vitamin D added; they are called fortified foods. Beverages fortified with Vitamin D include all varieties of milk, some almond, rice, coconut, and soy beverages. Most dairy products other than milk are not fortified with vitamin D though recently there are a few brands of yogurt and cheese with vitamin D added. It is important to read food labels for vitamin D content per serving.

Many teenagers need to take a supplement to get the amount of vitamin D recommended each day. It is important to speak to your healthcare provider to find out if a you need vitamin D as a supplement.

Prevent Disordered Eating

Disordered eating behaviors include anorexia nervosa, bulimia, and binge eating disorders, among others. Anorexia Nervosa is a very serious and sometimes life-threatening that many teens face today. People with anorexia often have unrealistic body images related to weight and become obsessed with unhealthy thinness. Individuals with anorexia become preoccupied with self-control by withholding food, sometimes to the point of starvation.

Bulimia is an eating disorder with cycles of binge eating followed by dangerous attempts to purge already eaten food by vomiting, taking laxatives, or exercising too much. Like people with anorexia, teens with bulimia  often have their sense of self-esteem tied to how they look. Unlike those with anorexia, teens with bulimia typically maintain their normal weight though their diet may be poor in many important nutrients.

Binge Eating Disorder is an eating disorder similar to bulimia because the two disorders share a common core of binge eating behavior. Unlike bulimia, behaviors like vomiting, exercise, and taking laxatives do not follow binges in Binge Eating Disorder. Many binge eaters do not eat enough of the nutrients necessary to build bones.

Good nutrition, getting the recommended amount of calcium and vitamin D, and regular physical activity (though not to excess) are essential to build strong bones. Disordered eating deprives the body of essential nutrients and minerals such as calories, protein, calcium, and others. Food restriction and excessive thinness, especially associated with anorexia nervosa, often lead to hormonal imbalance. In females, this can lead to irregular or absent menstrual cycles. Proper hormonal balance is critical for both males and females especially during the bone building years. Teens with eating disorders are at greater risk of not reaching their peak bone mass. In fact, people with eating disorders tend to have bones that are thinner and more fragile than people without eating disorders. Disordered eating, especially anorexia nervosa, will not allow one to reach peak bone mass and may even result in bone loss.

Maintain Normal Menstruation

Getting a regular period is important for overall health and strong bones. The most rapid bone growth usually occurs approximately two years after the first time you get your period. During this time your body needs more calcium. When teenage girls miss periods frequently, they may not absorb the amount of calcium needed to reach peak bone mass.

Lower bone mass may increase your risk of stress fractures and increase your risk for osteoporosis later in life.

Amenorrhea (pronounced: ay-meh-nuh-ree-uh) is when you do not have your menstrual period for three months or more in a year. If you have not had your first period by the age of 16, it is also considered amenorrhea. If you are not having your period, it is important to tell an adult you trust (a parent/guardian, school nurse, or healthcare provider) so they can help you get the medical attention you need. A healthcare provider will know what you can do to get a regular period.  Amenorrhea can occur for many reasons that can be diagnosed and treated by your doctor or healthcare provider.

Beware of the Female Athlete Triad

Exercise and physical activity is recommended as part of a healthy lifestyle for teens and people of all ages. Exercising to excess and overtraining, on the other hand, can hurt performance and may cause medical problems. The female athlete triad, also know as athletic female triad, is a combination of three conditions: disordered eating, amenorrhea and osteoporosis. A female athlete can have one, two, or all three parts of the triad. Poor nutrition and over-exercising disrupt the hormonal balance necessary to build bones. This often results in an increased risk of lower peak bone mass, stress fractures, bone loss, and the potential for increased risk of osteoporosis.  Early recognition and intervention for teens with the female athlete triad is critically important. Be sure to consult with your healthcare provider if you have amenorrhea, stress fractures, are dieting to achieve excessive thinness, or have tendencies toward disordered eating. Intervention can help you to build bone in the bone-building years, prevent stress fractures, and reduce your risk of osteoporosis.

Avoid the Use of Steroids Without a Healthcare Provider’s Prescription

Steroid medications, often called corticosteroids, include medications like prednisone and cortisone. Corticosteroids can be prescribed to be taken in many ways but they are mostly given by mouth or inhaler. Steroid medications are medically necessary to treat many conditions and diseases. The most common diseases requiring steroid treatment are asthma, inflammatory bowel disease, lupus, multiple sclerosis, and rheumatoid arthritis, and multiple sclerosis. It is important to follow the recommendations of your healthcare provider regarding steroid use and to discuss the actions you can take to protect and promote strong bones.

Another type of steroids, anabolic steroids, are manmade substances that are similar to male sex hormones. Anabolic steroids may be taken three ways: orally as a pill, injected into the muscles, or inhaled. Doctors never prescribe anabolic steroids to young, healthy people. The use of anabolic steroids without a prescription is illegal.

Anabolic steroids may make one’s body look deceivingly good on the outside, adding weight, bulking up muscles, and creating six-pack abs. However, it is important to know the risks of what happens on the inside when someone takes steroids. There are many dangerous health hazards connected with the use of steroids, some of which may be permanent. These include acne, facial hair growth, change in voice, cholesterol changes in the blood, liver disease, and possibly heart disease. Dangerous mood swings and impaired mental health status have been associated with the use of anabolic steroids, as well. The major impact of steroid medication on the skeleton is early and sometimes permanent slowing of growth among boys and girls. That means, if you take anabolic steroids during your teens, you take the lifelong risk of being shorter and having weaker bones among other serious medical risks.

Avoid Alcohol

There are many reasons to avoid underage drinking of alcoholic beverages. Among the many dangers of drinking alcohol, it is known to be harmful for your bones. Alcohol can affect bone health because it interferes with the bone building cells known as osteoblasts. In fact, it may decrease the number of osteoblast cells and interfere with their ability to form bone. This can lead to a lower peak bone mass and cause potential bone loss.

Avoid Smoking

Tobacco products are bad for your overall health, and are linked to the development of heart attacks, strokes, many cancers, and lung diseases. Smoking is also harmful for your growing bones! Smoking directly affects the bone building cells and acts to decrease bone formation. This can be particularly bad for bones during youth and young adulthood when smoking can result in reaching a lower peak bone mass than expected. The sooner you quit smoking, the greater the benefit for your bones and your overall health. The good news is there is help to quit and it is free. By calling the New York State Smokers Quitline at 1-866-NY-QUITS (1-866-697-8487) or visiting the New York State Smoker’s Quitsite you can find out how to quit smoking.

For more information for you and your parents about smoking and tobacco control, visit the Centers for Disease Control and Prevention
Youth Tobacco Prevention Program

Take safety precautions for strong bones seriously.

As a teenager, it is up to you to make safe choices. You can protect your bones and overall health by wearing seatbelts in any moving vehicle and by using appropriate protective equipment when participating in sports.