The short answer. Osteoporosis prevention starts in childhood, because most people reach their peak bone mass by their mid to late 20s, and that peak helps set bone health for life1. Calcium and physical activity have the strongest evidence for building it2. Adults protect what they built by staying active, not smoking and limiting alcohol, and women 65 and older, plus younger postmenopausal women at increased risk, should be screened3,4.
Osteoporosis is a bone disease that develops when bone density and bone mass decrease, or when the structure and strength of bone change, which raises the risk of fractures3. It is often called a silent disease because there are usually no symptoms until a bone breaks3. Fractures can happen in any bone but are most common in the hip, spine and wrist3.
It is common. Among US adults 50 and older, the age-adjusted prevalence is 12.6%, and among those 65 and older it is 27.1% in women and 5.7% in men4. Hip fractures are especially serious: only 40% to 60% of people who break a hip recover their previous mobility and ability to manage daily activities4.
For the day-to-day habits that keep adult bones strong, such as how much calcium and vitamin D you need and which exercises help, see our companion post, Bone Up on Bone Health. This post follows bone across the lifespan: how it is built, when it is lost, and when to be screened.
Peak bone mass is the point at which your bones reach their maximum strength and density, and in most people it arrives by the mid to late 20s1. In a study that followed young people from age 8 to 30, peak bone mass arrived by the end of the teens or the early 20s, depending on the part of the skeleton5.
The teenage years do much of the work:
Why does the peak matter so much? A computer model of bone remodeling predicted that a 10% higher peak bone density would delay the onset of osteoporosis by 13 years. By comparison, a 10% change in the age at menopause or in the rate of later bone loss delayed it by about 2 years7. That is a model, not a trial, but it shows why building bone early counts.
Genes determine the timing of peak bone mass1. A National Osteoporosis Foundation review estimated that lifestyle choices influence 20% to 40% of adult peak bone mass2. That share is the part families can work on.
The National Osteoporosis Foundation graded the evidence on each factor. The strongest evidence (grade A) was for calcium intake and physical activity, especially in late childhood and the years around puberty2. The evidence was also good for vitamin D and dairy, and for a harmful effect of the injectable contraceptive DMPA2.
Calcium. Children 9 to 13 and teens 14 to 18 need 1,300 mg of calcium a day, more than most adults8. One 8-ounce glass of milk provides about 300 mg1. Children and teens 4 to 18 are among the groups most likely to get less calcium than recommended8.
Vitamin D. Vitamin D helps the body absorb calcium from food1. Many teens do not get enough, probably because they eat and drink fewer dairy products than younger children1.
Exercise. Children and teens 6 to 17 should get at least an hour of activity every day, including bone-strengthening activity at least 3 days a week9. Good choices include hopping, skipping and jumping rope, running, dancing, gymnastics, and team sports like soccer or basketball1. Physically active children gain more bone mass than less active children, and their bone mass typically stays higher into adulthood1.
A healthy weight. Dieting, fasting or exercising too much to lose weight during adolescence can lead to bone loss1. Before menopause, missed periods caused by hormone problems or extreme levels of exercise lower estrogen and raise the risk of osteoporosis3.
After about age 30, bones slowly lose calcium, and the loss speeds up in middle age8. For many women, osteoporosis begins to develop a year or two before menopause3.
The Study of Women's Health Across the Nation tracked bone density in 862 women through menopause10. Bone loss began about a year before the final menstrual period and slowed, without stopping, about 2 years after it10. Over the 10 years studied, women lost 10.6% of their spine bone density, and 7.38% of that was lost in those 3 years around the final period10.
Men are at risk too, especially after age 703. Women have lower peak bone mass and smaller bones than men, which is one reason more women develop osteoporosis3.
The habits that build bone in youth also protect it later. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) recommends weight-bearing exercise, a diet rich in calcium and vitamin D, drinking alcohol only in moderation and not smoking3. Our bone health post covers amounts and exercise types in detail.
Smoking. In a meta-analysis of 59,232 men and women, current smokers had a 25% higher risk of any fracture and an 84% higher risk of hip fracture than nonsmokers11. A 2026 analysis of about 1.7 million people confirmed the link, and found that past smokers had a lower fracture risk than current smokers12, which suggests quitting helps.
Alcohol. NIAMS calls chronic heavy drinking a significant risk factor for osteoporosis3.
Medicines. Long-term use of some medicines can raise the risk of bone loss, including glucocorticoid steroids, some seizure medicines, hormone-based breast and prostate cancer drugs, proton pump inhibitors for stomach acid, selective serotonin reuptake inhibitors (SSRIs) for depression and anxiety, and thiazolidinediones for type 2 diabetes3. Do not stop a prescribed medicine on your own; ask your doctor whether your bones need attention.
Screening means a bone density test, usually a DXA scan, with or without a fracture risk assessment4. The US Preventive Services Task Force (USPSTF) updated its recommendations in January 20254:
| Group | USPSTF recommendation |
|---|---|
| Women 65 and older | Screen (grade B) [4] |
| Postmenopausal women under 65 at increased risk | Screen after a clinical risk assessment (grade B) [4] |
| Men | Evidence insufficient to recommend for or against; clinicians use their judgment [4] |
For women under 65, the USPSTF suggests first checking for risk factors such as low body weight, a parent who broke a hip, smoking and excess alcohol, then using a risk tool to decide whether a DXA scan is needed4. These recommendations do not apply to people who already have osteoporosis or a fragility fracture, or who take long-term glucocorticoids4. The evidence on how often to repeat the test is limited4.
Your result is reported as a T-score or a Z-score. A T-score of -2.5 or lower may mean osteoporosis, and fracture risk rises 1.5 to 2 times with each 1-point drop13.
Ask about your bones if you have broken a bone in a minor fall, lost height, or have a parent who had osteoporosis or a hip fracture3. Fractures from osteoporosis can happen after a fall from standing height or even from bending, lifting or coughing3.
If you are in the Santa Barbara area and have a painful joint or a bone injury, Dr. Scheinberg can examine you, review any imaging and talk through the options. See our treatments or call (805) 682-1394.
Short answers to the questions patients ask most.
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Call (805) 682-1394Reviewed by Dr. Richard Scheinberg, MD, a board-certified orthopedic surgeon in Santa Barbara with 40 years of surgical experience.
