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Dear Mayo Clinic: My mother had osteoporosis and suffered a devastating fall in her early 60s that she never recovered from.

I am 42, and I want to be proactive about my bone health. What screening do I need, and what, if any, supplements are necessary?

A: Osteoporosis is a condition that causes the bones to thin and lose their strength. When bones become weaker, sudden fractures can occur, even with minimal trauma.

A calcium-rich diet is important to maintain optimal bone health and prevent osteoporosis. So, too, is vitamin D, which helps the body absorb calcium to be deposited into bones. The amount of calcium and vitamin D needed to optimize bone health increases with aging.

Circulating estrogen also is nurturing to bones. Consider the analogy that calcium and vitamin D are the bricks of the bone, and estrogen is like the mortar that holds it all together.

While both men and women are at risk for developing osteoporosis as they age, women have a greater risk because they start to lose bone mass after menopause due to decreasing estrogen levels. Women can rapidly lose bone mass for up to 10 years after menopause begins.

Many factors contribute to bone loss and increase the risk of osteoporosis, including:

• Family history of osteoporosis or fractures related to osteoporosis.
• Nutrition, specifically inadequate calcium and vitamin D consumption.
• Smoking
• Body weight. A smaller, lighter body weight can increase the risk of decreasing bone mass.
• Exercise. A sedentary lifestyle will increase the risk of osteoporosis. Weight-bearing exercises like walking, jogging, tai chi and weightlifting can increase bone strength.
• Medication use. Certain medications can lead to thinning of bones with prolonged use.
• Racial differences. People of Asian and Caucasian descent are at higher risk, but African Americans tend to have more severe bone breaks.

Get regular screening scans

Osteoporosis is typically detected using a bone mineral density test, which is quick and painless. This test is also known as a dual X-ray absorptiometry, or DXA, scan.

This test accurately measures the amount of calcium in bone and determines the density of bones, usually in the hip, spine, wrist or heel.

Your healthcare team can help determine when you would be eligible to start bone mineral density screening and how often screening should occur.

Menopausal hormone therapy also may be recommended for some women to defend their bones against rapid thinning. Also, several medications may be considered to stop ongoing loss or rebuild lost bone mass.

Daily calcium and vitamin D

Regardless of whether you have already been diagnosed with osteoporosis, it is important to remember that a healthy lifestyle, exercise, a well-balanced diet, and optimal calcium and vitamin D levels can help prevent ongoing bone loss.

These are the daily recommended guidelines for calcium and vitamin D:

• Calcium. Those 50 and younger should strive for 1,000 milligrams daily. Those over 50 should aim for 1,200 milligrams daily.
• Vitamin D. Those 50 and younger should strive for 400–800 international units daily. Those over 50 should aim for 800–1,000 international units daily

Daily intake goals for calcium include the total amount of calcium from food or supplements combined.

As far as what to eat or drink to meet daily intake goals, consider these recommendations:

• Traditional dairy products, such as milk, yogurt and cheese. For example, one 8-ounce serving of skim, low-fat or whole milk contains about 300 milligrams of calcium.
• Almond, cashew or oat milk
• Certain vegetables, including broccoli, kale and spinach
• Whole salmon [canned, with bones]
• Certain cereals, juices and breads with added calcium.

Choosing supplements

It can be difficult to consume the daily calcium requirement through diet alone. It’s best to take a supplement that makes up for what you don’t get in the diet.

But be careful not to exceed the daily allotment, as this may result in unwanted side effects.

When shopping for supplements, look for the United States Pharmacopeia (USP) seal or the word “purified” on the label. Most calcium supplements will need to be taken with food for better absorption.

Your gut can only absorb a limited amount of calcium at one time — 500-600 milligrams or less. So it is important to spread your calcium consumption throughout the day.

When exposed to sunlight, your skin can make vitamin D, but amounts vary based on climate, skin pigmentation, age, season and more.

Few foods contain vitamin D, but common sources include wild-caught fish, such as salmon, mackerel and tuna, as well as dairy products, juices and fortified cereals.

It is difficult to meet vitamin D requirements with food and sunlight alone. Most people will need to take a daily vitamin D supplement.

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