In midlife, the focus turns from building bone to preserving what we have.
During midlife, the focus shifts from building bone to preserving it. In the third installment of our special series "Stronger Bones at Every Age," we explain how nutrition, physical activity, and lifestyle habits in your 30s to 60s can help maintain bone density, prevent loss, and support long-term skeletal health.
"Stronger Bones at Every Age" is a special limited series made possible in part by the National Cattlemen's Beef Association, a contractor to the Beef Checkoff. This series is dedicated to providing the same evidence-based, unbiased information you've come to expect from the Nutrition Diva, reflecting the editorial integrity and professional expertise of our host.
For more information on the topics discussed in this episode, visit https://www.quickanddirtytips.com/bones.
You can also find citations for the entire series at https://www.quickanddirtytips.com/bones#citations.
Welcome back to our special series on building healthy bones throughout the lifespan. I’m Monica Reinagel, host of the Nutrition Diva podcast and we are offering these bonus episodes in observation of Osteoporosis Awareness month, in addition to our usual Nutrition Diva episodes that publish every Wednesday. The entire series, once complete, will also be available on our website at https://quickanddirtytips.com/bones.
Once again, we are grateful to the National Cattlemen’s Beef Association for helping to make this special series possible. The NCBA is a contractor to the beef checkoff, a program overseen by the USDA that funds research into human nutrition, food safety, environmental impacts, and other topics, and also support efforts (such as this one) to make that information more widely available. Rest assured, however, that the information I’m sharing in this series reflects my own independent assessment of the evidence, professional experience and judgment.
For any of you who listening who may be registered dietitians, just a reminder this entire podcast series has been approved by the Commission on Dietetic Registration for 1.5 hours of continuing education credits! At the end of the series, you will be able to access those credits (as well as the episodes themselves) by going to the Beef Nutrition Education Hub at https://beefnutritioneducation.org.
In the first episode, we focused on the unique opportunities and challenges to building healthy bones during childhood. Our second episode focused on teens and young adults and the unique challenges and opportunities that this time of life presents in terms of bone health. And in this episode, we are looking at the period between ages 30 and 60–both in terms of what’s happening with bone metabolism as well as our overall health and wellness.
By the time we reach our 30s, our bones have finished growing and most of us have achieved peak bone mass. But that doesn’t mean our work is done. In fact, midlife is when the equation begins to shift—and the focus turns from building bone to preserving what we have.
Throughout our 30s and 40s, bone remodeling—the ongoing process of breaking down and rebuilding bone—begins to slow down. That slowdown means that bone resorption (or, breakdown) gradually starts to outpace bone formation, resulting in a net loss of bone mass over time. It’s a subtle shift at first, but it can set the stage for more pronounced losses later if not addressed.
For women, this process accelerates significantly during the perimenopausal and menopausal transition. Estrogen plays a key role in maintaining bone density, and as estrogen levels decline, bone resorption speeds up. That’s why this life stage is associated with an increased risk of osteopenia (thinning bones), which is often the first step toward full-blown osteoporosis.
But men aren’t off the hook. While they don’t experience the same abrupt hormonal shift, age-related declines in testosterone and other anabolic hormones can also contribute to gradual bone loss over time.
The good news? The dietary and lifestyle choices we make during our 30s, 40s, and 50s can still have a significant impact on how well we maintain bone mass—and how well we set ourselves up for the decades ahead.
Of course, there are some key nutritional factors that we’ll want to discuss in more detail, but first, let me quickly touch on some of the other lifestyle factors that play a role in protecting bone health during midlife.
One of the most effective things you can do to preserve bone density is to stay physically active—specifically with weight-bearing and resistance exercises. Activities like walking, hiking, dancing, and strength training place stress on the bones in a good way, signaling the body to maintain or even build bone tissue. The key is consistency, not intensity. You don’t have to run marathons—regular, moderate activity can make a meaningful difference.
In fact, we tend to think of “exercise” as something that happens at the gym or during a dedicated workout—but some of the best opportunities to support bone health happen in the in-between spaces of our day.
This is where NEAT, or non-exercise activity thermogenesis, comes into play. NEAT includes all the movement we do outside of structured exercise: walking the dog, gardening, taking the stairs, doing housework, or choosing to bike or walk instead of drive–in other words, the activities of daily living . These smaller, more frequent bouts of activity can accumulate into a meaningful load on the bones—especially when they involve weight-bearing movement or varied terrain.
The more we can integrate physical activity into our daily routines, the more consistent stimulus we give to our bones and muscles. And this kind of movement often feels more accessible and sustainable than fitting in a formal workout every day. So in addition to strength training or yoga or dance class, look for ways to move more throughout the day. Every bit counts.
Being more active can also help us maintain a healthy body weight–which is another important factor in bone health. As we touched on in the previous episode, intense dieting to lose weight, or being significantly underweight is associated with lower bone density and higher fracture risk. At the same time, excess body fat—especially visceral fat—may have inflammatory effects that also impact bone metabolism. The goal isn’t a specific number on the scale, but rather a body weight that supports overall health, mobility, and bone preservation.
Another often-overlooked factor in bone health is how we sleep—and how we cope with stress.
Chronic stress has been shown to negatively affect bone health through a variety of biological pathways. Persistently high levels of cortisol, the body’s main stress hormone, can interfere with the formation of new bone and even accelerate the breakdown of existing bone. Stress also activates the sympathetic nervous system and increases inflammation—two additional factors that can disrupt the delicate balance of bone remodeling.
And this isn’t just theoretical. In a large 6-year study of more than 11,000 postmenopausal women, those who reported high levels of social stress experienced accelerated bone density loss, even after controlling for factors like age and smoking status.
Sleep quality can also influence bone health. While the mechanisms are still being fully unraveled, it’s thought that sleep supports the regulation of hormones involved in bone remodeling, including growth hormone and melatonin. Poor or insufficient sleep may disrupt these rhythms and contribute to imbalances in bone turnover over time.
So while sleep and stress may not be the first things we think of when it comes to bone health, they’re absolutely worth our attention—especially in midlife, when sleep quality can decline, and life stressors often accumulate. Supporting better sleep and managing stress isn’t just good for your mental and emotional well-being—it may help preserve your skeleton, too.
While we’re talking lifestyle, a couple of other lifestyle-related choices—like smoking and excessive alcohol consumption–have been linked to lower bone density and increased fracture risk. Bone loss can be silent for years before showing up as a fracture or diagnosis, so protecting your long-term bone health is one more reason to minimize these risks.
And while it’s not a “lifestyle” factor in the traditional sense, this is also a good time to mention that some women may choose to use hormone replacement therapy (HRT) to help manage menopausal symptoms—and in doing so, may also help reduce their risk of osteoporosis. HRT can slow bone loss and preserve bone mineral density during and after menopause. It’s not right for everyone, and the decision should always be made in consultation with a healthcare provider—but for some women, it’s a meaningful part of the bone health conversation.
Let’s turn now to the nutritional factors that can support bone health during midlife. And we’ll start by clearing up a few misconceptions.
You may have heard that things like caffeine, sodium, or the phosphates in soda are harmful to bones because they increase calcium losses in the urine. And that’s true—these compounds do increase the amount of calcium that you excrete in your urine. But what’s often left out of that conversation is that the body adapts to this by increasing the absorption of calcium from the diet. So these aren’t necessarily threats to your bone health—unless your calcium intake is low to begin with. That’s why, when it comes to bone health, ensuring adequate calcium intake is ultimately a lot more important than trying to avoid caffeine, sodium, or phosphates.
But how much calcium do we actually need? For most adults aged 30 to 50, the recommendation is 1,000 mg per day. For women over 50 and men over 70, that increases to 1,200 mg. But it’s not a case of “more is better.” In fact, getting too much calcium—particularly from supplements—can carry risks. High-dose calcium supplementation has been linked to an increased risk of kidney stones and, in some studies, a higher risk of cardiovascular events in postmenopausal women. For that reason, supplements should really only be used to bridge the gap between what you’re getting from your diet and the recommended amount.
If you’re playing your cards right, that gap should be relatively modest—no more than 250 to 500 milligrams per day. The typical American diet contains about 250 mg of calcium from foods like grains, vegetables, legumes–and even coffee, all of which provide small amounts of calcium that add up.
To meet the rest of your needs, include a few servings a day of calcium-rich foods such as:
You don’t have to get exactly the recommended amount of calcium each and every day. A couple hundred milligrams more or less from day to day is not a problem, as long as your average intake is close to the target.
Let’s turn now to protein, another nutrient that’s often misunderstood in the context of bone health. Some people worry that higher protein intake might harm bones because it also leads to increased urinary calcium losses. And that’s true. But just like with caffeine and sodium, the body compensates for this by increasing its absorption of calcium from the foods that you’re eating.
Higher-protein diets result in increased intestinal calcium absorption. And a growing body of research suggests that higher protein diets may actually help protect bone health, especially in the lumbar spine. In fact, a systematic review and meta-analysis from the National Osteoporosis Foundation found no adverse effects of higher protein intake and even noted some positive effects on bone mineral density.
Here once again is Dr. Taylor Wallace, who was one of the authors of that systematic review. I asked him to share some thoughts on what we most need to keep in mind during this phase of life.
Dr, Wallace: Bones are like a 401k plan. You get heavily penalized if you start withdrawing bone mineral too soon during middle adulthood. Our preliminary work actually suggests that the period just prior to the menopause transition may be a nutrition sensitive time point during which bone health can be more greatly impacted through the diet. Older data have previously suggested that dietary protein intake could potentially be of detriment to bone density during middle to older adulthood. But we know now through metabolic tracer studies and advanced imaging technologies that this just isn't the case. In fact, higher levels of protein in the diet preserve bone density, particularly during the menopause transition in women.
On average, women in the U.S. take in between 60-70 grams of protein a day, which works out to about 15% of their calories from protein. That’s more than enough to prevent protein deficiency but arguably not enough to support optimal bone and muscle health. (And as we get older, those intake levels tend to decline even more..) Meanwhile, there’s plenty of room to increase protein intake while still remaining well within the recommended range for protein, which is up to 35% of daily calories.
Personally I shoot for about 20% of calories from protein. For a 150-pound person, that works out to around 100 grams per day. Although it takes a bit of focus, I find this doable and it allows me to get the benefits of a higher protein diet while still leaving plenty of room for other foods I enjoy.
Eating a bit more protein not only helps preserve bone and muscle, it can also help with satiety–helping you feel fuller for longer. This may help counteract the so-called “midlife spread”—that slow, steady weight gain that many people experience in their 40s and 50s.
So let’s talk about where we’re going to get this protein from. A systematic review commissioned by the National Osteoporosis Foundation found no significant differences in bone outcomes between animal and plant-protein sources in peri- and post-menopausal women. But there are some differences worth noting.
Animal proteins—especially lean beef, fish, and poultry—are particularly rich in the amino acid leucine, which is not only a trigger for muscle synthesis, but may also play a unique role in the the satiety effect that we get from protein. Animal sources of protein also tend to be a lot more protein-dense, meaning they deliver more protein per calorie. That can be helpful if you're trying to increase protein without increasing total calorie intake too much.
(For more on protein density, please check out episode #483: How to get more protein for fewer calories)
Plant-based proteins—like beans, lentils, tofu, nuts, seeds, and whole grains come packaged with other valuable nutrients, such as fiber and various antioxidants. But you generally have to eat larger volumes of these foods to get the same amount of protein. Personally, I think I’d find it a lot harder to meet my protein goals—without overeating—if I were relying exclusively on plant sources. I aim for a roughly 50/50 balance between plant and animal protein, including lean beef, fish, poultry, and eggs, along with tofu, lentils, peanut butter, and whey protein powder.
If you’re eating 100% plant-based, you’ll want to make sure you’re getting your protein from a variety of sources to ensure a complete profile of essential amino acids. Some of the plant-based foods highest in leucine include soy products like tofu and tempeh, legumes like lentils and chickpeas, and peanuts or peanut butter.
Even for those who include animal protein in their diets, plant-based sources of protein have some unique benefits. For one, they are usually higher in fiber and research is beginning to show that fiber may play a supportive role in bone health as well. We know that the fermentable fibers in foods like beans and lentils promote the growth of beneficial gut bacteria. These microbes may improve the body’s absorption of calcium and other minerals, as well as reduce inflammation—both of which could positively affect bone density over time.
In short, getting enough protein and calcium—ideally from a variety of nutrient-dense foods—can go a long way toward preserving your skeletal health during midlife. With that, let’s sum up everything we talked about today into some key steps for preserving our hard-won bone density during this critical midlife period.
Thanks again to the National Cattlemen’s Beef Association, a contractor to the beef checkoff, for making this special series possible. I hope you’ll tune in next week for the final installment of our special series, where we will be focusing on strategies to maintain strong and healthy bones as we enter our senior years.
If you’re interested in exploring some of the research that I cited today, there is a complete list of scientific references for this series. You can find that at https://quickanddirtytips.com/bones
If you’re a new listener who has joined us for this special series, I hope you’ll also subscribe to our regular weekly podcast, where we take a closer look at the latest nutrition news, research, and trends, sort fact from fiction, and answer your food and nutrition questions!
Nutrition Diva is a Quick and Dirty Tips podcast. Steve Riekeberg is our audio engineer, Brannan Goetschius provides script editing. Holly Hutchings is the Digital Operations Specialist and Morgan Christianson heads up Podcast Operations & Advertising. We get also get indispensable support from Nat Hoopes. Thanks to all of them and thanks to you for listening!