Our bones can feel like the most inert part of our bodies: structures that provide our foundation, seemingly fixed and easy to take for granted. The reality is that our bones are always changing, and as we begin to enter middle age—not only when we’re well into our 60s—bone loss begins to accelerate. This is a universal process true for both sexes, which is why our skeleton deserves more attention than we typically give it.

“Bone loss starts much earlier than people think—often in the mid to late 40s, not the 60s,” says Dr. Elizabeth Poynor, a top women’s health expert and Chair of Women’s Health & Gynecology at the Atria Health Institute. “By the time screening happens at 65, significant loss may already have occurred. People should ask their health care team if screening earlier is warranted.”

The good news: osteoporosis—a chronic bone disease where bone breakdown happens more quickly than the development of new bone mass formation—is largely preventable and treatable. The key is to start prioritizing your bone health now, whatever your sex. Doing so allows you to either catch it early and treat it most effectively or prevent the disease entirely.

The hormonal story

Declines in key hormones are a primary driver of bone loss in midlife

In women, estrogen plays a critical role in slowing bone resorption—the process by which bone tissue breaks down. When estrogen begins to fluctuate during perimenopause and then drop during menopause, bone loss accelerates sharply, with women losing up to 2.5% of bone mineral density per year during this period, especially in the spine and hip. The steepest losses typically occur in the years just before and after menopause. About half of postmenopausal women will experience a fragility fracture in their lifetime.

Men are not exempt. Estrogen matters for male bone health too, and low testosterone levels can lead to decreased bone mass in both sexes. Male bone loss tends to develop later and more gradually than women’s, but one in four men over age 50 will also break a bone due to osteoporosis, and the window for prevention is similar: earlier is better.

How to support your skeleton at every stage of life

Late teens, 20s, and 30s: This is when you’re building peak bone mass—the ceiling of bone strength you’ll draw on for the rest of your life. Lifestyle choices matter more than most young adults realize: up to 40% of bone strength is influenced by factors within our control, including getting enough calcium, doing weight-bearing exercise, getting adequate vitamin D, avoiding smoking, and limiting alcohol.

40s and 50s: This is the critical intervention window. Strength training and impact activities (like walking regularly, jogging, or dancing) become especially important. It’s also a key time to discuss screening with your doctor: while current guidelines recommend bone-density scans starting at age 65 for women, Dr. Poynor notes earlier screening is warranted for people with risk factors including family history of osteoporosis, low body weight, smoking, excessive alcohol use, early menopause, prior fractures, or chronic use of  medications like glucocorticoids (steroids). A 2025 study in JAMA Internal Medicine found that when men over 65 with at least one risk factor were screened, more than half had low bone density.

Hormone therapy is also worth discussing with your doctor. Estrogen is FDA-approved for preventing postmenopausal osteoporosis.

60s and beyond: Bone health plans should be customized to individual fracture risk. All postmenopausal women should aim for about 1,200 mg of calcium and 800 IU of vitamin D daily, ideally from food. For men, adults should aim for 1,000 mg of calcium per day, and after age 70, they should aim for 1,200 mg. Continuing strength training, weight-bearing activity, and balance exercises to prevent falls remains essential for everyone.

Surprising things that actually move the needle

Exercise matters as much as calcium—and not just any exercise. Walking is helpful, but strength training and impact activities like resistance training or light jumping are what truly stimulate bone formation. Muscle strength and balance also matter for preventing falls, which is what leads to most fractures. “Calcium without muscle loading has limited benefit,” Dr. Poynor says. 

There are several other lifestyle factors that meaningfully impact bones: alcohol, smoking, low body weight, and prolonged dieting can all accelerate bone loss significantly. 

The bone health field has also seen advances in recent years, according to Dr. Rachel Arakawa, a metabolic bone health specialist at Atria Health Institute. Newer anabolic “bone-building” medications show better fracture prevention than older treatments, and doctors can target treatments to your individual fracture risk level. Clinical trials are also underway for oral alternatives to injectable osteoporosis treatments, monoclonal antibodies to enhance bone formation, and new technology to enhance local delivery of injectable meds. 

The bottom line

Bone health is not a problem for you tomorrow. Your biology is working quietly, in both sexes, which makes the decisions you make in your 30s, 40s, and 50s among the most consequential you can take for your long-term health and movement.

For more, see our complete guide to supporting your bone density here.