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  • Writer's pictureDr. Emma Lee ND


Updated: Mar 11, 2023

A common concern as women age is the loss of bone density and the potential development of osteoporosis. Bone health is impacted by a multitude of factors, and primary amongst them is a woman’s level of estrogen and progesterone. As these hormones start to fluctuate and dip in our perimenopausal years, which typically start in our 40s, total bone mass can start to decrease. This can be worrisome, but bone is a living tissue and there are various other determinants of bone health that can be addressed –

Dietary Factors

Although there is no one-size-fits-all when it comes diet, there are certain key nutrients that need to be optimized in order to preserve and build bone density.

Calcium, vitamin D3, and other vitamins and minerals

Calcium tends to be synonymous with osteoporosis prevention and treatment; depending on your age, the recommendations for total calcium intake ranges from 1,000 to 1,500 mg per day. But focusing on calcium alone is insufficient. In addition to adequate calcium intake, vitamin D3 regulates calcium metabolism while vitamin K2 promotes the use of calcium in bone mineralization. Magnesium and certain trace minerals such as manganese, copper, and boron also play crucial roles in promoting bone density and quality as well. For example, magnesium impacts the type of calcium crystals present in bones, and its deficiency is associated with abnormal calcification that can lead to an increased risk for fractures.

Omega 3s

Essential fatty acids enhance calcium absorption and increase osseous utilization of the calcium. Omega 3s are especially effective, when compared to longer chain fatty acids, for decreasing kidney stone formation and for preventing the deposition of calcium in other tissues like blood vessels.


It (almost) always comes back to the gut! There is research showing that certain short chain fatty acids made by our microbiome play a role in downregulating genes that promote bone breakdown. ¹

Lifestyle Factors in Determining Bone Health

In addition to adequate dietary intake, certain lifestyle factors also play an important role in determining bone health.

Exercise is important, but what kind?

It has been shown that a combination of aerobic and resistance training helps to achieve optimal results when it comes to preventing the loss of lean body mass and bone density.², ³ It doesn’t have to be complicated! Aerobic activity can be as simple as walking and strength training can be done with body weight exercises. The key to sustainability is to focus on choosing activities that you enjoy.

How does alcohol or smoking affect your bones?

Excessive alcohol consumption, which when it comes to your bones is anything above 2-3 ounces per day, interferes with calcium and vitamin D3 absorption. Some studies suggest that alcohol also decreases estrogen levels ⁴, one of the hormones critical for maintaining bone mass, while at the same time increasing hormones that increase bone breakdown, such as cortisol ⁵.

Similarly to alcohol use, tobacco smoking is a significant risk factor for the development of osteoporosis. Although it’s not completely clear what mechanisms are at play, there is evidence suggesting that smoking also alters calcium absorption ⁶ and lowers estrogen levels ⁷. It appears that women who smoke tend to lose bone at an accelerated rate compared to non-smokers and may reach menopause earlier as well ⁸.

Finally, Your Personal Health History

The presence of certain medical conditions can affect bone health. These include, but are not limited to:

  • Endocrine conditions such as thyroid conditions and Type 1 Diabetes

  • Gastrointestinal conditions such as IBD and Celiac disease

  • Autoimmune conditions such as Rheumatoid Arthritis and Lupus

  • Bone diseases

  • Kidney disease

When should you start caring about osteoporosis prevention?

It is never too early to discuss prevention. However, if you are in your 30s or 40s, this might be the optimal time to work on a plan to maintain and even increase your bone density into your golden years. Start a conversation with your naturopathic doctor to determine what your personal needs are and which solutions best fit your unique demands.


¹ Lucas S, Omata Y, Hofmann J, Böttcher M, Iljazovic A, Sarter K, Albrecht O, Schulz O, Krishnacoumar B, Krönke G, Herrmann M, Mougiakakos D, Strowig T, Schett G, Zaiss MM. Short-chain fatty acids regulate systemic bone mass and protect from pathological bone loss. Nat Commun. 2018 Jan 4;9(1):55. doi: 10.1038/s41467-017-02490-4. PMID: 29302038; PMCID: PMC5754356.

² Villareal DT, Aguirre L, Gurney AB, Waters DL, Sinacore DR, Colombo E, Armamento-Villareal R, Qualls C. Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults. N Engl J Med. 2017 May 18;376(20):1943-1955. doi: 10.1056/NEJMoa1616338. PMID: 28514618; PMCID: PMC5552187.

³ Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. Biomed Res Int. 2018 Dec 23;2018:4840531. doi: 10.1155/2018/4840531. PMID: 30671455; PMCID: PMC6323511.

Kimble RB. Alcohol, cytokines, and estrogen in the control of bone remodeling. Alcohol Clin Exp Res. 1997 May;21(3):385-91. doi: 10.1111/j.1530-0277.1997.tb03780.x. PMID: 9161595.

Adinoff B, Ruether K, Krebaum S, Iranmanesh A, Williams MJ. Increased salivary cortisol concentrations during chronic alcohol intoxication in a naturalistic clinical sample of men. Alcohol Clin Exp Res. 2003 Sep;27(9):1420-7. doi: 10.1097/01.ALC.0000087581.13912.64. PMID: 14506402.

Rapuri P, Gallagher J, Balhorn K, Ryschon K. “Smoking and bone metabolism in elderly women.” Bone 2000; 27:


Jensen J, Christiansen C, Rodbro P. “Cigarette smoking, serum estrogens and bone loss during hormone replacement therapy early after menopause.” N Engl J Med 1985; 313:973–75

Kato I, Toniolo P, Akhmedkhanov A, et al. “Prospective study of factors influencing the onset of natural menopause.” J Clin Epidemiol 1998; 51:1271–76.


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