Bone Health in Women After 40: How to Keep Your Bones Strong for Life

Guest post written by Dalia Abi-khattar, Dietetics Student from the University of Ottawa

I wanted to chat about something that's been on my mind lately—keeping our bones strong and healthy, especially as we age. When was the last time you thought about your bones? Unless you're dealing with pain, a fracture, or osteoporosis, I’d guess it’s not something you think about often. Maybe it’s because we don’t see them (out of sight, out of mind), or maybe it’s because we tend to focus more on muscle tone and body fat.

But here’s the thing—your bones need just as much attention. They literally hold you up, and as we get older, they become more vulnerable to fractures and loss of density. In fact, more than 2.3 million Canadians are living with osteoporosis, according to Osteoporosis Canada. The good news? There’s a lot you can do to keep your bones strong.

In this post, we’ll chat about why bone health matters, the nutrients and habits that support strong bones, and how weight loss—especially rapid weight loss—can impact your bone density. If you’ve been hearing about GLP-1 medications like Ozempic and Wegovy and wondering about their effect on bone health, you’ll want to keep reading.

Why Women Over 40 Need to Prioritize Bone Health

Bones naturally lose density as we age, especially after menopause when estrogen levels drop. But before we get to the stage of bone loss, it’s important to understand how bones develop. Typically, we build most of our bone mass during childhood and adolescence, reaching peak bone density in our early 20s. After that, the process shifts from growing new bone to maintaining and preserving what we already have. This means that rather than focusing on creating new bone, the goal as we age is to slow bone loss as much as possible and maintain strength for overall health and mobility.

We talk more about how menopause affects bone health in our blog: Thriving Through Perimenopause: Simple Nutrition and Lifestyle Changes for Symptom Relief. Check it out!

Fractures later in life not only take longer to heal but can also severely impact mobility, independence, and overall quality of life. Osteoporosis Canada highlights that one in three women and one in five men will experience an osteoporosis-related fracture, emphasizing how widespread and important this issue is. For women in particular, the reduction in estrogen that occurs in menopause accelerates bone loss significantly, making women over 40 particularly vulnerable. Unfortunately, when it comes to bone health, after your early 20s, it really is all downhill from here, which is why we need to focus on food and behaviours to preserve as much bone mass as possible.

Comparing Normal Bone Tissue to Osteoporosis

Essential Nutrients for Strong Bones

Your bones are constantly regenerating, and they need the right building blocks to stay strong. Here’s what should be on your radar:

1. Calcium: The #1 Mineral for Bone Strength

Calcium is essential for maintaining strong bones and preventing bone loss. Health Canada recommends 1,000 mg daily for adults aged 19-50 and increases this recommendation to 1,200 mg daily for those over 50, as bone density declines more rapidly after this age.

Great sources of calcium include dairy products like milk, cheese, and yogurt. If dairy isn't your thing, you can also get calcium from leafy greens (like kale or collard greens), fortified almond or soy milk, and calcium-fortified orange juice. Be aware that while fortified beverages are often fortified to similar levels to dairy, not every version may be fortified (I'll never forget the time I bought a whole case of oat milk from Costco only to discover that it wasn't fortified with calcium). Also, while leafy greens do contain calcium, you often need to eat a lot of them in order to get a similar amount to what you would find in a cup of milk.

Quick Tip: Boost your calcium intake by swapping water for milk in your morning oatmeal.

2. Vitamin D: The Key to Better Calcium Absorption

Vitamin D is a fat-soluble vitamin critical to bone health because it helps your body effectively absorb calcium. While our body can produce vitamin D when we are exposed to sunlight, unfortunately, living in Canada, especially during the winter months with limited sunlight exposure, makes it harder to produce sufficient vitamin D naturally. Osteoporosis Canada suggests a daily vitamin D supplement of 400-800 IU (10-20 µg) for adults over 50.

In addition to or instead of a supplement, you can also get vitamin D from the foods you eat. Dietary sources include fatty fish like salmon or mackerel, egg yolks, and fortified foods like dairy products and cereals.

Quick Tip: Take your vitamin D supplement with a meal containing healthy fats to boost absorption. Constantly forgetting to take your vitamin D? Opt for a drop or a gel capsule where the vitamin D is suspended in a fat source. Then, place it in a location where you can see it or pair it with another task. I like to keep mine right next to my toothbrush so I take it when I brush my teeth in the morning.

3. Protein’s Role in Bone and Muscle Support

Adequate protein intake is vital for bone health because bones aren't just made of calcium—they’re also made up of protein. In fact, protein not only forms the structure of our bones, but also the structures in our muscles, which help to hold our bones in place. The Canadian Nutrition Society, along with Osteoporosis Canada, emphasizes the importance of eating enough protein. It’s important to note that not eating enough protein can increase fracture risk even when you’re getting enough calcium. Want to increase your protein intake? Including lean meats, poultry, fish, beans, legumes, nuts, and dairy products in your meals supports both muscle and bone strength.

How much protein do you actually need?

While you should aim to get enough protein, you don't have to go crazy. In certain spaces on the internet, I've seen people recommending upwards of 2g of protein per pound of body weight. That is a lot of protein! Health Canada recommends 0.8g of protein per kilogram. Depending on how active you are, you may want to eat more than that (I often recommend 1.2-1.6 g/kg depending on your activity level), but opting for a source of protein at most meals and snacks should be sufficient without having to obsess over the math.

4. Magnesium & Vitamin K: The Overlooked Bone Builders

A few other nutrients to keep on your radar include magnesium and vitamin K. Magnesium helps activate vitamin D, enhancing calcium absorption, while Vitamin K is crucial for bone mineralization, which helps keep your bones strong and rigid and reduces fracture risk. Nuts and seeds are rich sources of magnesium. Leafy greens such as kale, Swiss chard, and spinach are excellent sources of vitamin K. Spinach and broccoli offer a good amount of both magnesium and vitamin K, making them particularly valuable for bone health!

Best Lifestyle Habits for Bone Health

Your daily activities and lifestyle choices play a significant role in maintaining bone health:

1. Why Strength Training Is Essential for Bone Density

Weight-bearing exercises like walking, jogging, tennis, or dancing and resistance training with weights or resistance bands stimulate bone formation and slow bone loss. The Public Health Agency of Canada highlights physical activity as one of the most effective preventive strategies against osteoporosis. Strength training also has the added bonus of building muscle mass. Strong muscles help to keep our bones in place and help with balance and mobility, reducing the risk of falls and fractures.

As women, it’s easy to get caught up in wanting to do a lot of cardio to lose fat mass, especially as we hit menopause and body composition starts to change. However, for the sake of building your old-lady body, if you’re going to start an exercise program, I would urge you to focus on strength training. Building muscle mass is so important for overall health and wellness as we age. 

2. The Importance of Eating Enough to Prevent Bone Loss

Nourishing your body with a well-rounded diet rich in essential nutrients can support bone health at every stage of life. It can be easy to fall into the diet trap, especially as bodies change as we age, however, it's very important to eat enough food and eat consistently. Instead of focusing on calories, prioritize nutrient-dense foods that supply the calcium, vitamin D, protein, and minerals necessary for strong bones. Including a variety of whole foods, such as leafy greens, dairy or fortified plant-based alternatives, nuts, and legumes, ensures that your body gets the fuel it needs to maintain optimal bone strength.

3. How Smoking and Alcohol Weaken Bones

Excessive alcohol intake and smoking have been directly linked to decreased bone density and increased risk of osteoporosis. Reducing alcohol consumption and quitting smoking can significantly improve your bone health over time.

Hormone Replacement Therapy (HRT) and Bone Density

Can HRT Help Prevent Osteoporosis?

Hormone Replacement Therapy (HRT) can be an important consideration for women over 40, particularly around menopause. Estrogen plays a key role in maintaining bone density. As estrogen levels drop during menopause, bone loss accelerates. This can lead to a greater risk of developing osteoporosis and experiencing fractures.

According to Osteoporosis Canada, HRT using estrogen or a combination of estrogen and progesterone has been shown to help prevent bone loss and reduce the risk of spine and hip fractures. By preserving estrogen levels, HRT can effectively maintain bone mass during the menopausal transition.

Understanding the Risks and Benefits of HRT for Bone Health

However, the decision to begin HRT should be made in consultation with a healthcare provider. Health Canada notes that while HRT may be effective in supporting bone health, it can also carry certain risks, such as an increased likelihood of breast cancer, stroke, and cardiovascular disease, especially if used for more than five years. While that may seem scary, talking with your doctor and having regular follow-ups can go a long way in assessing your individual risk.

For women who may not be suitable candidates for HRT, there are alternative treatments such as Selective Estrogen Receptor Modulators (SERMs), which can mimic estrogen's positive effects on bone without some of the associated risks. Regardless of the approach, combining medical options with lifestyle habits like weight-bearing exercise, eating enough food, and getting enough calcium and vitamin D remains essential for preserving bone health as you age.

The Hidden Risks of Weight Loss & Bone Health: A Note on GLP-1 Medications

Semaglutide medications such as Ozempic and Wegovy, known as GLP-1 receptor agonists, are becoming increasingly popular for weight loss. These medications work by influencing insulin regulation and appetite control, which can lead to significant weight loss over time in some people (while they are often marketed as a quick fix, they don't work for everyone). If you are taking or considering taking these medications, it’s important to understand how rapid weight loss affects overall health, especially bone density and muscle mass.

How Rapid Weight Loss Affects Bone Density

When weight is lost quickly, the body does not just lose fat—it also sheds muscle and bone mass. Research suggests that up to 50% of weight lost through these medications may come from lean tissue, including muscle and bone. Loss of bone mass can increase the likelihood of fractures, which can significantly impact mobility and quality of life.

Another factor to consider is that with less muscle mass, there is reduced support for the skeletal system, making falls more dangerous.

The Impact of GLP-1 Medications Like Ozempic and Wegovy on Bones

But why exactly do these medications affect our bones?

This might be happening for a few reasons, and it’s not just about eating less.

One of the main effects of GLP-1 medications is reduced appetite, making it harder to eat enough food overall. When you're not eating enough, you're also less likely to get the key nutrients that support strong bones, like calcium, vitamin D, magnesium, and protein. Over time, that can weaken your bones.

But there’s more to it. Some early research shows that GLP-1 medications might directly affect how our bones rebuild and repair themselves. Our bones are constantly breaking down and rebuilding, and these medications may slow that rebuilding process.

On top of that, when we lose weight quickly, we often lose some muscle mass too. Our bodies are smarter than we give them credit for, so often fat mass is preserved as a failsafe during periods of rapid weight loss. While we do lose fat mass, we also lose muscle and water. When your muscles shrink, they don’t support your bones as well. That can make falls more dangerous and healing more difficult.

So it’s not just about eating less—it’s also about what you’re losing along the way, and how that affects your bones from the inside out.

How to Protect Bone Mass While Losing Weight

For those who decide to take GLP-1 receptor agonists, it is crucial to implement protective measures, including strength training exercises, adequate protein intake, and regular monitoring of bone density. Consulting with a healthcare professional about these concerns can help ensure that weight loss occurs in a way that prioritizes long-term skeletal and muscular health.

It's important that we don't sacrifice long-term bone health for short-term thinness, whether you are using medication or dieting.

To minimize these risks:

• Incorporate regular resistance training to maintain muscle and bone mass. Examples of resistance training include bodyweight exercises (like squats, lunges, and push-ups), resistance band exercises, and weightlifting using dumbbells or machines.

• Ensure adequate protein intake to support muscle and bone health. Depending on your dietary preference:

• Vegan options: Lentils, chickpeas, quinoa, tofu, tempeh, edamame, and plant-based protein powders.

• Vegetarian options: Eggs, Greek yogurt, cottage cheese, and the plant-based sources listed above.

• Omnivore options: Lean meats (chicken, turkey, fish), eggs, dairy, and legumes.

• Eat enough food: Most GLP-1 receptor agonists work by reducing appetite, and in some people, it makes them feel nauseous. This can make it difficult to eat an adequate amount of calories and fit in all the nutrients we need (like calcium, vitamin D, magnesium and vitamin K). Without enough nutrients, we can speed up bone loss.

• Regularly monitor your bone mineral density (BMD) through healthcare consultations to track bone health over time.

If you need help ensuring that you are meeting your nutrient needs, you can always meet with a Registered Dietitian. I offer a free 15-minute discovery call to see if I would be a good fit for you. If I’m not a good fit, I can point you in the right direction of someone who would be.

Protect Your Bones for Life: Key Takeaways

Prioritizing your bone health isn’t just about avoiding fractures—it’s about maintaining your quality of life, mobility, and independence as you age. Focusing on proper nutrition, regular physical activity, and healthy lifestyle choices today can yield significant long-term benefits.

Remember, always consult with your healthcare provider before starting new medications or significantly altering your diet and exercise routines. Let's commit to taking better care of our bones, staying active, and enjoying life to its fullest potential.

Disclaimer: This information is for educational purposes only and should not replace professional medical advice.

References

Health Canada. (2020, October 14). Vitamin D. Government of Canada. https://www.canada.ca/en/health-canada/services/nutrients/vitamin-d.html

Osteoporosis Canada. (2022). 2022 Osteoporosis Canada facts and stats. https://osteoporosis.ca/wp-content/uploads/2022-Osteoporosis-Canada-Facts-and-Stats_Web.pdf

Public Health Agency of Canada. (2023, February 24). Osteoporosis and related fractures in Canada: Report from the Canadian Chronic Disease Surveillance System. Government of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/osteoporosis-related-fractures-canada-2021.html

Health Canada. (2021, August 18). Dietary reference intakes tables: Reference values for vitamins. Government of Canada. https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-vitamins.html

Public Health Agency of Canada. (2021, June 15). Physical activity and bone health. Government of Canada. https://www.canada.ca/en/public-health/services/chronic-diseases/osteoporosis/physical-activity-bone-health.html

Canadian Nutrition Society. (2023). Protein and bone health: The role of dietary protein in bone maintenance. https://cns-scn.ca/resources/nutrition-and-health/protein-and-bone-health

Osteoporosis Canada. (n.d.). Vitamin D. https://osteoporosis.ca/vitamin-d/

Osteoporosis Canada. (n.d.). Calcium. https://osteoporosis.ca/calcium/

Osteoporosis Canada. (n.d.). Hormone therapy. https://osteoporosis.ca/hormone-therapy/

Health Canada. (2005, June 14). Benefits and risks of hormone replacement therapy (estrogen without progestin). Government of Canada. https://www.canada.ca/en/health-canada/services/healthy-living/your-health/medical-information/benefits-risks-hormone-replacement-therapy-estrogen-without-progestin.html

Kim, H., Kim, M. J., Kim, H. J., Park, K. S., Jeong, M. H., & Kim, H. S. (2020). Smoking cessation increases levels of osteocalcin and uncarboxylated osteocalcin in human sera. Scientific Reports, 10, Article 16596. https://doi.org/10.1038/s41598-020-73789-4

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