Bone quality: what really makes your bones strong

Broken bones can happen even when your bone density looks fine. That’s because bone quality is more than a number on a scan. It’s the mix of bone density, the microscopic structure inside bone, how fast bone is being rebuilt, and how well minerals are stored. Knowing this helps you prevent fractures, not just spot low numbers.

Simple checks and tests that matter

Your doctor will usually start with a DEXA scan. DEXA measures bone density, which is useful, but it doesn’t tell the whole story about quality. Doctors also look at clinical risk factors — age, family history, past fractures, long-term steroid use, and some meds that can weaken bone. For people on long-term prednisone or similar drugs, it’s worth reading our Prednisone Alternatives guide and talking with your prescriber about bone-sparing options.

Other tools: fracture-risk calculators (like FRAX) combine scan results with personal risk to estimate fracture chances. Blood tests for calcium, vitamin D, and markers of bone turnover help in some cases. If you’re over 65 (women) or 70 (men), or younger with risk factors, ask your doctor about testing sooner.

Everyday steps to improve bone quality

Diet and supplements — Aim for about 1,000–1,200 mg of calcium a day from food first: milk, yogurt, leafy greens, and fortified products. If you don’t get enough from food, talk about calcium supplements and take them with food to reduce stomach upset. Vitamin D matters for absorption; many adults benefit from 800–2,000 IU daily depending on blood levels — check with your doctor before you start high doses.

Move your body — Weight-bearing and resistance exercises build bone and improve balance. Walk briskly, climb stairs, lift light weights, or try body-weight moves like squats and lunges. Aim for two or three sessions of strength work per week plus daily walking. If balance is a concern, add tai chi or targeted balance drills to cut fall risk.

Medications and risks — Some drugs weaken bone over time: corticosteroids (prednisone), certain anticonvulsants, and long-term proton-pump inhibitors among them. If you take these, ask about bone-protection strategies. For people at high fracture risk, doctors may recommend medications like bisphosphonates or other prescription options — those require a doctor’s decision and follow-up testing.

Small but important fixes — Stop smoking, cut back on alcohol, and make your home safer (good lighting, remove trip hazards, add grab bars if needed). Get your vision checked and review meds that cause dizziness with your clinician.

Take action now: get a risk check, talk to your doctor about testing, prioritize protein, calcium and vitamin D, and add strength work to your week. If you’re on long-term steroids or other risky meds, ask about alternatives and bone protection. For more practical guides on meds and safer choices, check our Prednisone Alternatives and related articles on BuyBestMeds.com.