he doctors and nurses at the emergency room in Jacksonville, Florida, were “perplexed,” as Dia Thomas remembers it. They believed her when she said she was in pain—imaging had revealed fractures in multiple areas of both her left hip and her left femur—but her story, or, rather, the absence of one that could have explained the kinds of fractures they were seeing, didn’t make sense.
Social workers arrived to talk to the then 28-year-old in private. Had someone hurt her? Had she been in an accident? Was everything okay at home? They relented when Thomas insisted: One minute she’d been standing at her parents’ kitchen counter; the next, she could barely walk. “We didn’t even start talking about osteoporosis until after my emergency surgery” to cobble her hip and leg back together after she’d sustained the complex fracture, Thomas says.
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Osteoporosis—a condition in which the minerals filling and strengthening your bones like cement dissipate, leaving your body’s scaffolding seriously fragile—had completely sneaked up on her.
Young women’s bones don’t shatter spontaneously. But in situations like Thomas’s, a sudden snap can be the first sign of quiet, gradual changes that have already happened in the skeleton. (For Thomas, that “already happened” part was the result of teenage years marked by inadequate nutritional intake and overexercising.) Sometimes a step, a bump, or, as in Thomas’s case, a simple shifting of body weight that strains a bone in just the right way is all it takes to fracture a piece of what should be the body’s sturdiest structure.
Bone density has long been relegated to the realm of the silver-haired and retired, a health metric rarely measured or researched in younger women before they hit menopause. Now, women like Thomas—who has shared her story on podcasts and social media in hopes of raising awareness—are inserting bone health into new, younger circles of discourse. The oldest millennials are aging (and watching their parents age) in a way that’s encouraging broader perspectives on health across the lifespan.
“Our parents are starting to fracture,” says Taylor Wallace, PhD, an adjunct clinical associate professor at George Washington University’s medical school who studies healthy aging. “Those of us who are 40 are looking at our parents’ mistakes and saying, ‘Okay, what can I do to be preventative?’ ”
In other words, bone health is hip-ish. (And not one that’s broken.) Perhaps that newfound awareness is why bone health is a growing fixation online and in the longevity world, where Google searches for terms like bone health and bone density have climbed steadily over the past five years and where workout programs (such as Onero) featuring the load-bearing exercises (or lifting) favored by bone health experts proliferate. Forty-year-olds are getting informational DEXA scans (the X-ray standard for measuring bone density), and new age skeletal-strengthening health centers like OsteoStrong have popped up from New York to London.
For Hannah A., a 34-year-old social worker in Melbourne, Australia, bone health has been a key fitness goal for the past few years. It’s one of many factors that helped her reconfigure her outlook on movement and weight lifting. Initially, she was focused only on losing weight, but gradually, she began to also turn to strength training for relieving stress, gaining actual strength, and improving overall health. “I probably would have tried lifting sooner if I had known bone health was such an important part of my central mobility goal,” she says.
Hannah has a concrete reason for her twice-weekly lifting and aerobic sessions: A vision impairment prevents her from driving, so the ability to walk long distances, she says, is something she can’t risk losing as she gets older.
“I’ve also seen how my mother prioritized absolutely everything else—not frivolous things, but really important things, like career and caring responsibilities—over her own health, including fitness and strength,” Hannah says. “Now, as she’s aging, it scares me to see how badly that’s affecting her.”
Research on bone health is also booming as holistic, future-focused health practices (and supplement sales) grow, creating the perfect conditions for conversations, curiosity, and calcium in all its forms. “We’ve really come around to recognize that younger adulthood is an important time in health,” says Wallace. “You can think of your bones like a Roth IRA, or a retirement account.” If you build up bone health when you’re young, you’ll get a bigger payout later on (i.e., a better chance of skirting the challenges compromised bone health can present).
Your Bones’ Foundation
You may think of bones as steady, strong, unchanging. But that’s not the reality. “Bone is constantly remodeling: breaking down and building up,” says Wallace.
Think of your skeleton as the scaffolding of your body, but each piece of that scaffolding also serves as a physiological safe-deposit box. Within each bone’s outer shell, which is made of firm yet flexible collagen, is a spongier inner tissue packed full of essential minerals. These deposits of calcium, magnesium, phosphorus, and more keep your bones sturdy and are used in processes throughout the body.
As we move, our bones experience wear and tear that stimulates a mineral turnover process called remodeling. The minerals are gradually exported from the bone and replaced with stronger, fresher deposits that come from the food we eat. This bone metabolism is powered by nutrition and regulated by estrogen.
As we grow, the mineral deposits going into those bone bank boxes outpace the withdrawals, increasing the density of minerals stored away until sometime between ages 19 and 30 (usually on the younger side in women), Wallace says, when the input and output equalize. Changes in the body, which are mostly chalked up to hormonal fluctuations, eventually cause mineral breakdown to occur more quickly than its buildup—a decrease in density that can result in osteoporosis.
A Young Person’s Problem
The reality is that the rates of osteoporosis and its precursor, osteopenia, are currently rising among older adults—and roughly half of all women over the age of 50 will break a bone due to osteoporosis. But endocrinologists and other health experts believe that the numbers trend will continue down the age scale, and we’ll start to see more and more cases in younger women too.
We already know that menopause can be a major bone-weakening time; yet other critical periods of change tip the bone health scales much earlier, like adolescence. When you’re staying active and looking after your health in a general sense, “you’re not going to know that there’s an issue until something drastic happens,” says Thomas, now 35 and living with five fractured vertebrae. It’s unlikely she’ll ever be able to fully undo the damage caused by those nutritional deficiencies in her teenage years. “When you’re young, why would you think that bone health is going to be an issue?”
Adolescence is all about opportunity, and the bones are no exception. Women can reach 90 percent of their peak bone mass—meaning their mineral stores are as good as they’ll ever get—by age 18. (To be clear, you can and should still work to stave off bone loss throughout your life in various ways—keep reading! It’s just harder to build new reserves.)
So you can see why proper nutrient intake during this developmental period can make or break lifelong bone health. This bone-mass peak unfortunately hits during the time frame when young women are most likely to develop restrictive eating disorders, which have an average age of onset of about 18 years old. “The group that is most likely not to have adequate calcium and vitamin D intakes are 14- to 18-year-old girls,” says Wallace. “By ensuring that teenagers’ diets contain what they need to easily build bone, doctors and parents are setting them up for success.”
