There is something profound about our relationship to our bones. We talk about our natural tendencies as being "bred in the bone," and when we are deeply certain of something, we say we feel it "in our bones." Not only do your bones protect your internal organs and hold your body upright, but they also store precious minerals that serve you in innumerable ways.

 
Until recently, many of us took our bones for granted as a reliable and powerful part of our bodies. But within the past several years osteoporosis – the condition of having porous, low-density bones that are capable of spontaneously breaking and crumbling – has become a household word. Now osteoporosis is considered by the National Institutes of Health (NIH) to be a major public health threat. In the United States today, ten million people are estimated to have the disease, of whom eight million are women. The NIH also estimates that 34 million more people may have low bone mass, placing them at increased risk for osteoporosis. With a heightened awareness of this condition, many women are now eager to know what they can do to preserve their bone health.

 
How can you be proactive in creating healthy bones? Taking tests to evaluate your bones is a good place to start. One of the best ways to assess the density of your bones is with a dual energy bone densitometry, or DEXA, test, which uses a special type of X-ray taken of your hip and lower spine. A DEXA test gives you a T-score, which is a measurement of your bone density compared with that of women who are at peak bone density. Results of your DEXA test can help you and your physician make choices on how to best prevent and/or treat osteoporosis.

 
Another excellent test for evaluating your bone health is a Pyrilinks urine test, which measures the fragments of collagen that collect in urine when bone breaks down. This test is especially useful for assessing your amount of bone loss while you are implementing your bone-building program or other therapy.

 
Natural solutions to creating strong bones include exercise, diet, vitamin and mineral supplements, and herbs. It is well known that building your bones begins early in life, but it is never too late to create strong bones with exercise. Any exercise that works against gravity can build bone, but some types are better than others. For instance, weight lifting is an excellent bone building exercise because it literally stresses the bone, in a good way, causing new bone to be laid down or created.

 
Other exercises that are good for building bone include biking, skiing, jogging, and working out on a stationary bike or an elliptical trainer. To create strong bones, work out your entire body. Be sure to work out your arms, chest, abdomen, back, buttocks, and legs at least three times a week. On the whole, your spine gets stronger when you strengthen your abdomen and do upper body exercises. Some exercises, such as squats, involve multiple muscle groups and give you a great overall body workout.

 
One of the great things about eating the Naturally Healthy Diet that I recommend in my book Natural Choices for Women's Health is that, time and again, the foods that are good for one aspect of your health prove to be beneficial to every part of your body. Bone health is no exception. For instance, essential fatty acids – the omega 3 fats found in flax and fish oils, which are known to be good for your heart – turn out to be good for your bones as well. Other bone-building dietary choices include adequate protein, dairy products, fruits, vegetables, and whole soy foods. Bone-depleting dietary choices include too much or too little protein, excessive amounts of sugar or refined carbohydrates, excessive amounts of sodium, too much or too little fiber, caffeinated drinks, alcoholic beverages, and sodas high in phosphoric acid.

 
Many women today who are concerned about their bone health take vitamins and mineral supplements in addition to eating a diet that supports healthy bones. By increasing your intake of certain nutrients, you guarantee that your body has the essential components it needs to build or maintain strong bones. Most of the research on supplements for bone health is centered on calcium and vitamin D, but many other vitamins and minerals are also important for bone health. These include magnesium, vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin K1, boron, folic acid, manganese, zinc, copper, and silicon. These nutrients all work together to ensure that bones are healthy. Some help lower homocysteine, a compound that increases the risk of osteoporosis, while others help your bones by stimulating proteins that play a role in bone remodeling. The good news is that your daily multivitamin will provide you with most of these nutrients.

 
Two other nutritional supplements that have shown promising bone-building effects are vitamin K2 and strontium. Vitamin K2 (menatetranone) may be one reason that Japanese women have a lower incidence of osteoporosis than women in other countries. One of their traditional foods, a fermented soybean product called natto, has been found to contain unusually high amounts of vitamin K2. Research shows that this form of vitamin K may play a major role in bone health by preventing bone loss and reducing fracture risk. According to a March 2000 article in the Journal of Bone and Mineral Research, in women with osteoporosis vitamin K2 may increase bone strength and has been found to prevent the recurrence of new factures.

 
Vitamin K2 is produced in small amounts by your own intestinal bacteria, but as women get older they produce less vitamin K2. You can obtain small amounts of vitamin K2 through your dietary intake of vitamin K1, some of which is naturally converted to vitamin K2 in the intestines. (Vitamin K1 is found in leafy green vegetables and also plays a role in maintaining bone health.) To make vitamin K2 part of your bone-building plan, see if your favorite Japanese restaurant serves natto, or buy natto and try it at home. In Japan, natto is often eaten with chopped green onions, soy sauce, and mustard on rice. Many of my patients tell me they love natto – but it is most definitely an acquired taste! If you prefer, you can also take vitamin K2 as a supplement. The recommended dose is 45 mg a day.

 
Strontium, a naturally occurring mineral, has been found to inhibit the breakdown of bone and stimulate the formation of new bone. An article published in the New England Journal of Medicine in January 2004 reported that two grams of strontium ranelate a day decreased fracture risk and was effective in increasing bone density in postmenopausal women with osteoporosis. Bone density increases were significant; after three years of taking 2 grams of strontium a day, these women's bone mineral density increased by 14.4 percent at the spine and 8.3 percent at the hip. Because strontium ranelate is a semisynthetic patented form of strontium that is currently unavailable, strontium citrate is used instead. Ranelate is different from citrate, and much lower doses of citrate are prescribed to obtain similar effects. The recommended daily dose of strontium citrate is 681 milligrams; for best absorption, avoid taking it with food or mineral supplements.

 
Herbs can also help your bones. Horsetail is especially rich in silica, which can strengthen and regenerate connective tissue and help support your bone health. Oat straw and nettles, which I recommend because of their calming effects on the nervous system, are also very bone-friendly; when you are calm, your body isn't pumping out stress hormones that can ultimately wear down your bones. You can use these herbs on a daily basis, either separately or blended together. To vary the taste, try adding other herbs to the mixture such as peppermint, chamomile, and red raspberry.

 
A number of drugs on the market today help women increase their bone density, but there are many unknowns about their long term side-effects. Many women have been prescribed Fosamax and other biphosphonate drugs for the treatment of osteopenia (thinning of the bones) and osteoporosis. According to Susan Love, M.D., author of Dr. Susan Love's Menopause and Hormone Book, "most experts are no longer recommending biphosphonates for women with osteopenia." This is in part because we lack information about how long a woman can safely take them. Dr. Love recommends that these drugs be considered only for the treatment of osteoporosis or severe osteoporosis. The research shows that women with severe osteoporosis have a decrease in bone fractures within the first two to three years of treatment with Fosamax.

 
While modern medicine continues to search for effective ways to reduce the pain and suffering associated with osteoporosis, it is important that you do everything in your power to maintain your natural bone health. With regular exercise, the Naturally Healthy Diet I recommend, vitamin and mineral supplements, and herbs, you can build healthy bones every day of your life.

 
Dr. Laurie Steelsmith is a naturopathic physician and licensed acupuncturist practicing in Honolulu, Hawaii, and author of the book Natural Choices for Women's Health: How the Secrets of Natural and Chinese Medicine Can Create a Lifetime of Wellness, published by Random House in May. You can visit her website at www.drlauriesteelsmith.com