Chapter 12: Action Plans by Age

12

What you should focus on depends on where you are in life. Here's a practical breakdown.

Your 20s: Build the Bank

This is your last chance to significantly add to peak bone mass. The window closes around 25-30.

Priorities:

• Eat enough (undereating is the biggest threat at this age)
• Get protein at every meal (aim for 1+ g per kg body weight)
• Do impact exercise: jumping, running, sports, weight training
• Don't smoke
• Don't drink excessively

Watch out for:

• Eating disorders or chronic dieting
• Overtraining without adequate nutrition
• Losing your period (women) - this is a red flag, not a badge of fitness
• Very low body fat (both sexes)

Testing:

• Not routinely needed unless problems arise
• Check vitamin D if you don't get much sun
• Get evaluated if you have a fracture from minor trauma

Your 30s: Maintain What You Built

Peak bone mass is reached. Now it's about keeping it.

Priorities:

• Continue weight-bearing exercise and strength training
• Maintain healthy body weight (not too low)
• Ensure adequate vitamin D (supplement if needed)
• Get enough calcium from food (1,000 mg daily)
• Protein remains important (1+ g per kg)

Watch out for:

• Sedentary desk jobs (get up and move)
• Chronic stress (raises cortisol, bad for bones)
• Starting medications that affect bones (steroids, some antidepressants)

Testing:

• Vitamin D level is worth checking
• DXA not needed unless specific concerns or risk factors

Your 40s: Stay Vigilant

Bone loss begins to accelerate, especially as women approach menopause.

Priorities:

• Strength training becomes more important (preserves muscle and bone)
• Maintain or increase protein intake
• Ensure vitamin D is optimized (30-70 ng/mL)
• Women: be aware of perimenopause symptoms

Watch out for:

• Weight gain that leads to less activity
• Assuming bone health is "an old person problem"
• Ignoring early menopause symptoms

Testing:

• Vitamin D annually
• Consider baseline DXA if risk factors present
• Women: discuss timing with doctor as menopause approaches

Your 50s: Critical Transition (Especially for Women)

Menopause hits most women in this decade. This is when rapid bone loss occurs.

Priorities:

• Women: seriously consider HRT discussion with doctor (timing matters!)
• Strength training 2-3x per week minimum
• Protein needs increase—aim for 1.0-1.2 g per kg
• Calcium: 1,200 mg daily for women post-menopause
• Vitamin D: ensure levels are optimal

Watch out for:

• The 5-10 year rapid bone loss phase after menopause
• Dismissing bone health because you "feel fine"
• Doctors who don't take early bone loss seriously

Testing:

• DXA scan recommended for women at menopause, especially with risk factors
• Vitamin D, calcium, and consider bone markers
• Men: consider testosterone check if symptoms present

Your 60s: Active Management

Bone loss continues. Fall prevention becomes increasingly important.

Priorities:

• Continue strength training (critical for muscle mass and balance)
• Add balance exercises (reduces fall risk)
• Review all medications with doctor (some worsen bone loss)
• Discuss treatment if DXA shows osteopenia or osteoporosis
• Stay active—use it or lose it applies strongly here

Watch out for:

• Falls (more dangerous now)
• Polypharmacy (multiple medications interacting)
• Reduced appetite leading to inadequate nutrition
• Social isolation reducing activity levels

Testing:

• DXA scan: all women should have had one by now; men 70+
• Repeat DXA every 1-2 years if on treatment
• Annual vitamin D check
• Consider bone markers to monitor treatment

Your 70s and Beyond: Protection Mode

Focus shifts to preventing falls and fractures.

Priorities:

• Fall prevention is as important as bone density
• Maintain strength training (even light resistance helps)
• Balance exercises daily
• Adequate protein (older adults need more, not less)
• Review home for hazards (rugs, lighting, grab bars)
• Continue or start bone medication if indicated

Watch out for:

• Vision and hearing changes (increase fall risk)
• Medications that cause dizziness
• Dehydration and malnutrition
• Fear of movement (leads to deconditioning)

Testing:

• Regular DXA monitoring if on treatment
• Balance and gait assessment
• Vision and hearing checks
• Medication review for bone and fall effects

Quick Reference: Key Actions by Decade

Age	#1 Priority	Exercise Focus	Testing
20s	Eat enough, build bone	Impact + weights	Only if problems
30s	Maintain, stay active	Weights + cardio	Vitamin D
40s	Don't neglect it	Strength training	Baseline DXA if risks
50s	Address menopause	Strength + balance	DXA at menopause
60s	Active treatment	Strength + balance	Regular monitoring
70s+	Prevent falls	Strength + balance	Ongoing monitoring

Universal Rules (All Ages)

1. Don't smoke. Ever.
2. Limit alcohol. 1-2 drinks max, not daily.
3. Eat enough protein. Every meal.
4. Take vitamin D if you don't get regular sun.
5. Lift weights. The single best exercise for bones at any age.
6. Don't be too thin. Some body fat is protective.

The Bottom Line

The best time to care about bone health was 20 years ago. The second best time is now.

Whatever age you are, you can take action:

• Young? Build as much as possible.
• Middle-aged? Maintain and prevent loss.
• Older? Treat, strengthen, and prevent falls.

It's never too early to start and never too late to benefit.