If you have read some of the sections of this book before getting to this one, you will find familiar topics. If you have browsed your way to this section, it is a sneak preview of what is in store. The condensed, take-home messages in this top ten summary represent a snapshot of broader information. You are encouraged to delve deeper in the earlier sections for more detail.

10. Not just for women

Bone health is important for boys and girls, men and women of all shapes, sizes, races, and ethnicities. Although Caucasian and thin Asian women are at highest risk, anyone can develop osteoporosis. Men account for about 30 percent of all fractures. Even though African American men and women are at lowest risk and Hispanics are intermediate risk, the numbers of non-Caucasians sustaining fractures are projected to markedly increase.

9. Family history

Genes make a difference. If your mother or father or grandparents had a hip fracture or other fractures, your risk of fracture is increased. However, you can change your “bone destiny.” Genes are influenced by your lifestyle. Lower your risk by making healthy choices.

8. Hormones

The goal is to build the skeleton as strong and as sturdy as possible during childhood and young adulthood, then minimize bone loss throughout adulthood to prevent fractures in later life. Estrogen and testosterone are the main hormonal support for growth and maintenance of bone. Peak bone growth occurs around the time of puberty. Any disruption of hormones will result in failure to achieve peak bone mass or, in adults, loss of bone. For women, the loss of estrogen with transition to menopause causes acceleration of bone loss.

7. Fracture risk

If you have factors associated with increased fracture risk, bone density testing is recommended for the perimenopausal and early postmenopausal time frame. Also, adults who have had a fracture after age fifty, all women sixty-five and older, and men over seventy, regardless of risk factors, should have a bone density scan. Results from your bone density, measured by dual energy x-ray absorptiometry (DXA), and your risk factors are used to calculate your personal ten-year probability of major fractures and hip fracture.

6. Common health problems and medicines

Your bone health is part of your overall health. Keep your doctor in the loop. Many common illnesses and medicines used to treat them are associated with harmful effects on your bones. Talk with your doctor about possible bone connections and minimize your risks. If you have a fracture between your office visits, don't forget to report that fact to your primary care doctor. Additional evaluation for contributing causes may be indicated.

5. Bone-healthy diet

Just as your mother said, “Eat your vegetables,” especially green leafy vegetables such as kale and bok choy. Almonds, halibut, wild salmon, tuna fish, cheese, and white beans are other bone-healthy foods for your grocery cart. Eat and drink everything in moderation and maintain a healthy weight.

4. Exercise

Get thirty to sixty minutes of physical activity more days a week than not. A comprehensive workout program, including weight-bearing, cardio, and muscle-strengthening exercises along with balance training, is best. Move more during the day. Try a pedometer to keep track of your steps, and aim for 10,000 steps each day.

3. Calcium

Calcium recommendations for daily intake are based on your age. It is difficult to get enough calcium from your diet each day, but try to choose calcium-rich foods. If not, you may need to add calcium supplements to meet your daily requirements.

2. Vitamin D

Unless you are taking a vitamin D supplement, it is highly likely that you have low vitamin D. Few foods supply natural or added vitamin D and you cannot count on sunlight exposure most months of the year. Vitamin D is needed for efficient absorption of calcium and is required for many other functions in the body. You need to get enough vitamin D to maintain a minimum vitamin D blood level of 30 ng/ml. The amount of supplementation required to reach that target varies from individual to individual, but the usual range is 800 to 2,000 IU a day.

1. It is never too late…

It is never too late to get started on good measures for your bone health. You can prevent fractures, even if you have already had one. For high-risk individuals, the basic bone-healthy measures are very important, but you may need the help of prescription osteoporosis therapies to lower your fracture risk.