Cara's Personal Bone-Building Plan

I first wrote this in 2013. I’ve updated it for 2026

When I first wrote this blog, I had just received my DEXA scan results. Mild osteopenia — age-appropriate and not worrisome, but enough to make me take action. This blog post became one of my most popular, and I've been living this plan ever since.

Now there's new research worth sharing, so I'm revisiting it with fresh eyes and updated information.

For those who are new here: DEXA stands for Dual X-ray Absorptiometry, and it's currently the gold standard for measuring bone density. It's still the only reliable way to know whether you have osteoporosis or are at risk. If you're a postmenopausal woman and you haven't had one, ask your doctor. Fewer than half of women receive the bone density scan they should at age 65 — meaning most people don't even know where they stand.[1] That's a problem we can fix.

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The DEXA Tells You What Already Happened. This Test Tells You What's Happening Now.

A DEXA scan is a snapshot — it shows you where your bone density stands today. But there's a urine test called the NTx (N-telopeptide of type I collagen) that tells you something different and frankly more actionable: how fast your bones are currently breaking down. When bone tissue is resorbed, it releases collagen fragments into the bloodstream, which are then excreted in the urine. The NTx test measures those fragments. High levels mean your bones are actively losing ground right now — even if your DEXA looks okay. It's the difference between a photograph and a movie. Most doctors don't test for this. But you can request it.

These two tests are partners. The DEXA tells you what has already happened. The NTx tells you what's happening in real time — and whether the food, herbs, and exercise you're doing are actually working. You can retest in three to six months and see movement.[2] That's much more satisfying than waiting two years for your next DEXA scan.

Ask your doctor about it, or ask us — we can help you get it ordered.

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What's New in Bone Research?

The field has been busy. A few things worth knowing:

Osteopenia is now being taken more seriously.

For a long time, osteopenia was watched but not treated aggressively. That's changing. Researchers and clinicians are increasingly recognizing that treating people at high risk — particularly younger postmenopausal women with osteopenia — is an important window for preventing fractures before they happen.[3] If that's you, don't wait.

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Move: And I Mean Really Move

Sitting is a problem — even if you exercise.

I've always told my patients to exercise for their bones. But recent research added a nuance I wasn't expecting: it's not just about adding movement — it's about reducing the time you spend sitting. A major review by the International Osteoporosis Foundation found that prolonged sitting may harm bone health, even among people who exercise regularly.[4] In a study of nearly 200,000 participants, those who sat for more than 8 hours a day during leisure time had a 38% higher risk of osteoporosis than those who sat for fewer than 5 hours.[5]

It makes sense when you think about it — bones respond to being used. Hours in a chair is the opposite of that. But you don't have to run a marathon to fix it. Getting up every hour, walking to the kitchen, doing calf raises on the phone — it all adds up.

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The Calcium Supplement Problem

I don't eat much dairy — it's inflammatory for me and makes my joints ache. But I'm also not reaching for calcium supplements. Recent studies suggest that for postmenopausal women, supplemental calcium may increase cardiovascular risk without reliably preventing fractures.[6] In our practice, when a supplement is recommended, we prefer calcium with ipriflavone — an isoflavone that inhibits bone breakdown and has been shown to help reverse osteoporosis.[7]

Instead, I made a game of eating more non-dairy, calcium-rich foods I actually enjoy. As I always say, dairy is just vegetables that went through a cow. Plant sources also have a better calcium-to-magnesium ratio. While calcium builds strong bones, magnesium builds flexible bones, which are less likely to break.

Plus — it had to be food I love and will actually eat.

Greens

Especially my favorites: watercress and dandelion. Watercress has 41 mgs of calcium per cup, and dandelion has 103 mgs. And yum! Other good sources: collards, kale, and most cooked cruciferous vegetables.

Nuts and Seeds

Did you know that tahini — made from sesame seeds — contains 63 mgs of calcium in one tablespoon? If you haven't made the tahini sauce from the Zahav cookbook, please stop everything and do that today. It's delicious on everything. Almonds contain 74 mgs per ounce. And chia seeds are the surprise powerhouse with 177 mgs in just one ounce — about 2 tablespoons.

Seaweed

My longtime favorite hijiki is a winner: 1/3 of an ounce contains 100 mgs of calcium. Check out my blog on seaweeds and the Pinterest board I created with recipes to inspire you.

Tinned Fish

Not only are they full of healthy fats — a can of sardines with the bone-in contains 382 mgs of calcium. That's a third of your daily requirement. I've been eating them for breakfast. Canned salmon with the bone in contains about 200 mgs for 3 oz. Great on a salad or whole grain bread for lunch.

Beans

White beans have 132 mgs per cup. Other beans, especially chickpeas, are reliable sources too.

Beets

Beets don't contain calcium, but they're rich in silica — a trace mineral found in bones, teeth, skin, and organs. It's also a constituent of collagen, which helps keep skin elastic. The herb horsetail is rich in silica, too. And oddly, so is iceberg lettuce — so now you can eat it guilt-free.

Maple Syrup

Oh — this is perhaps my favorite nutritional tip of all time. One tablespoon has 20 mgs of calcium — slightly more than milk. That practically makes it a health food.

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I'm Drinking My Calcium Too

But not milk. I'm drinking oat straw and nettle tea, steeped long and strong. A good oat straw infusion can contain up to 300 mgs of calcium per cup, plus B vitamins and trace minerals. Nettles can yield up to 200 mgs. These numbers are for long infusions — put a generous handful in a pot, let it steep for hours, and drink it as part of your daily water intake. The flavor is grassy and pleasant.

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Natural Progesterone

We've long known that estrogen helps prevent bone loss — a process called osteoclastosis. What's less well known is that progesterone can stimulate bone growth, which is called osteoblastosis. I use a natural wild yam cream on my skin at night.

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Lift Heavy

For years, the standard advice for people with osteoporosis was: be careful, don't overdo it, stick to gentle exercise. Then along came the LIFTMOR trial and flipped that on its head.

LIFTMOR stands for Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation. Postmenopausal women with osteopenia and osteoporosis did supervised heavy lifting — squats, deadlifts, overhead presses, and jumping — twice a week for 8 months. The results: roughly 4% better lumbar spine bone mineral density and about 2% better femoral neck bone mineral density compared to women doing light home exercise. And the program was safe.[8]

Here's what's interesting for those of us who don't have a spotter: the key isn't a specific exercise or even a specific weight. The research shows that bones respond to effort, not just to load. Whether you're doing 5 heavy reps or 10 moderate ones, what matters is that you're working hard enough that you couldn't do many more — what exercise scientists call going close to failure.[9] The NY Times recently covered this, highlighting an approach that works especially well without a trainer: use a weight heavy enough that you can only do 8 to 10 slow, controlled repetitions. The slower you move, the more your muscles have to work without relying on momentum — which means more stimulus to the bone with less injury risk. It's hard. That's the point.

The women in the LIFTMOR study were supervised by professionals, and form absolutely matters. But it does not mean you need a trainer forever. It means start conservatively, learn the movements well, increase weight gradually, and take the slow rep approach seriously. Your bones aren't fragile — they need to be reminded they're not.

I've been lifting for most of my adult life, and this research is a very good reason to keep going.

What About Vibration Plates?

They've become popular, and people ask me about them regularly. Here's what I actually think about them.

A meta-analysis of studies in postmenopausal women with osteoporosis found statistically significant increases in bone mineral density at the lumbar spine and femoral neck following whole-body vibration therapy.[10] The gains are real but small, and they don't replace weight-bearing exercise.

A very recent 2026 study compared three groups of women aged 60–79 with osteopenia: exercise only, vibration platform, and exercise with a weighted vest. The weighted vest group showed greater T-score improvement than both other groups, and leg bone density actually increased. The vibration group? Little change. The exercise-only group actually lost bone mass.[11]

That said, vibration plates aren't useless. For people who can't do traditional weight-bearing exercise due to frailty, joint problems, or mobility limitations, a vibration platform is far better than nothing. The plates also improve balance and leg muscle strength, which reduces fall risk. For someone with osteoporosis, preventing a fall can be just as important as building bone.

One important caution: a 2024 review concluded that low-amplitude vibration is safe and beneficial — but this means high-intensity vibration plates at the gym may actually be too aggressive for fragile bones.[12] If you're interested in trying vibration therapy, talk to your provider about appropriate settings first.

Weighted Vests

The research here is promising but nuanced. Weighted vests appear most effective when combined with movement — particularly walking and resistance exercise. In the 2026 study above, the women wearing weighted vests during exercise outperformed both other groups.[11]

However, a 2025 randomized clinical trial found that in older adults who lost weight through caloric restriction, daily use of a weighted vest didn't prevent hip bone loss and performed about the same as traditional resistance exercise.[13] In other words: useful, not magic. Best as an addition to strength training, not a replacement for it.

The bottom line on all three: heavy resistance training has the strongest evidence for building bone. Weighted vests are a good complement. Vibration plates have a role, especially for people with limited mobility. None of them replaces getting strong.

A Note on HRT and Bones

For years, many women were frightened away from hormone replacement therapy by the Women's Health Initiative study, published in 2002, which reported increased risks of breast cancer and cardiovascular disease. HRT use dropped by nearly half, almost overnight. What got lost in the panic was that the same study also showed HRT reduced hip fractures — and that most of the women in the study were in their 60s and 70s, well past the window when estrogen therapy is most relevant and most protective.

In the years since, researchers have carefully reanalyzed that data. The Nurses' Health Study had already shown that women who used estrogen in early menopause had significantly lower rates of cardiovascular events — findings that directly contradicted the WHI narrative. What emerged from all of this is what's now called the "timing hypothesis": estrogen is most beneficial — and safest — when initiated within ten years of menopause, not decades later. The WHI study largely focused on the wrong window.

When the relative breast cancer risk reported in the WHI was examined more closely, the absolute risk turned out to be very small — about 8 additional cases per 10,000 women per year, a 0.08% increase — and estrogen-only therapy was actually associated with lower breast cancer rates than placebo. MenoHealthNurse Those nuances were buried in the original headlines.

In November 2025, the FDA announced it would remove or revise the boxed warnings on estrogen products that had been in place since 2003, updating label language to remove references to cardiovascular disease and breast cancer risks — a significant regulatory reversal reflecting two decades of accumulating evidence. Patient Care Online

And just this year, the largest real-world study to date — involving over 137,000 postmenopausal women — found that those who started HRT within one year of their menopause diagnosis had a significantly lower risk of osteoporosis over the following five years, and a 13% reduction in fracture risk compared to those who never used it. Aaos-annualmeeting-presskit

This doesn't mean HRT is right for everyone — women with a history of hormone-sensitive cancers should have a careful conversation with their doctor. But for many women in early menopause with bone loss concerns, the picture looks very different from what it did in 2002. Worth knowing. Worth asking about.

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Vitamin D

Without vitamin D, the body can't effectively absorb calcium. Technically, it's a hormone, not a vitamin, because our bodies can synthesize it from sunlight. It also regulates immunity, which is why supplementing matters — especially in our area where winter sun isn't strong enough to do the job.[14] I take between 2,000 and 5,000 IUs daily.

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A Word About Osteoporosis Drugs

Many of my patients come to me after being prescribed bisphosphonates — medications like Fosamax, Boniva, Actonel, and Reclast — and want to understand what they're taking. I think patients deserve to know the full picture.

Bisphosphonates work by slowing the rate at which bone is broken down. They've been prescribed since the mid-1990s and do have solid evidence for reducing fracture risk. I'm not here to tell anyone to stop taking a medication their doctor prescribed. But it's worth knowing what you're signing up for.

Side effects can include bone, joint, or muscle pain, and the oral tablets specifically may cause nausea, difficulty swallowing, heartburn, esophageal irritation, and gastric ulcers.[15] Those GI issues are significant — they're one of the main reasons people stop taking the medication.

The longer-term picture is more complicated. There have been reports of osteonecrosis of the jaw — a condition where the jawbone loses its blood supply and fails to heal, often triggered by dental procedures. There have also been reports of atypical femoral fractures — unusual breaks in the thigh bone that occur after longer-term treatment, typically beyond five years.[15]

And here's the twist that most patients don't hear: in 2026, the FDA updated the labels of bisphosphonate medications to warn that atypical fractures can also occur in bones beyond the femur — including the ulna and tibia — and can sometimes affect the same bones on both sides of the body.[16] The drug meant to prevent fractures can, in some cases, contribute to unusual ones with extended use.

Oral bisphosphonates also have strict, inconvenient dosing requirements: taken first thing in the morning, on an empty stomach, with a full glass of water, while staying upright for at least 30 minutes. Absorption is further reduced in older adults, particularly those taking proton pump inhibitors.[17]

For denosumab (Prolia), another commonly prescribed option, there's a high risk of spinal fractures if you stop taking it — which means once you start, stopping requires a careful transition to another medication under medical supervision.[18]

None of this is meant to frighten anyone. For people with severe osteoporosis and high fracture risk, these drugs can be genuinely life-changing. But for someone with mild osteopenia, no fracture history, and plenty of lifestyle levers to pull — the risk-benefit calculation looks very different. Worth knowing. Worth talking to your doctor about. Worth asking questions.

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What Does Chinese Medicine Say About Bones?

In Chinese medicine, the bones are ruled by the kidneys. The kidneys also govern the back and knees, which is why we draw on kidney tonics when patients have weakness or pain in those areas.

Many traditional herbs are used to support bone health, including licorice root, fresh ginger, dandelion root, oyster shell, white peony root, and cinnamon bark. A review of randomized trials found that Chinese herbal medicine demonstrated pharmacological effects comparable to those of standard anti-osteoporotic drugs in regulating bone turnover.[19]

Certain acupuncture points also support the production of calcitonin — the hormone responsible for directing calcium into bone. Research from Chengdu University has demonstrated the positive effects of acupuncture on bone metabolism.[20]

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And there you have it — my personal bone preservation plan, updated. I hope it gives you a useful starting point. The bottom line hasn't changed: your bones are alive, they respond to how you feed and move your body, and it's never too late to start.

For recipe ideas and inspiration for calcium-rich foods, check out my Pinterest board.

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Citations

[1] Bouxsein ML, et al. FDA qualifies bone mineral density as surrogate endpoint for fractures in osteoporosis trials. Beth Israel Deaconess Medical Center. December 2025. https://bidmc.org/news-stories/all-news-stories/news/2025/12/bidmc-investigator-contributes-fda-approval-new-better-way-test-osteoporosis-treatments

[2] Brown S. Bone testing — assessing bone breakdown and bone loss. Better Bones. https://betterbones.com/bone-health-basics/bone-testing-assessing-bone-breakdown-bone-loss/

[3] Leder B, et al. Osteopenia: a key target for fracture prevention. The Lancet Diabetes & Endocrinology. September 2024. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(26)00011-2/fulltext

[4] Bruyère O, Scott D, Papaioannou A, et al. The impact of sedentary behavior and physical activity on bone health. International Osteoporosis Foundation Rehabilitation Working Group. Calcif Tissue Int. 2025;116(1):109. https://www.osteoporosis.foundation/news/new-research-highlights-critical-role-movement-lifelong-bone-health-20250908-1540

[5] Replacement of leisure-time sedentary behavior with various physical activities and the risk of osteopenia and osteoporosis: evidence from the UK Biobank. ScienceDirect. September 2025. https://www.sciencedirect.com/science/article/pii/S1728869X2500067X

[6] Calcium supplements and cardiovascular risk in postmenopausal women. NIH/NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572690/

[7] Agnusdei D, Bufalino L. Efficacy of ipriflavone in established osteoporosis and long-term safety. Calcif Tissue Int. 1997. https://www.ncbi.nlm.nih.gov/pubmed/9263613

[8] Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211–220. https://onlinelibrary.wiley.com/doi/abs/10.1002/jbmr.3284

[9] Souza D, Barbalho M, Ramirez-Campillo R, et al. High and low-load resistance training produce similar effects on bone mineral density of middle-aged and older people: A systematic review with meta-analysis. Exp Gerontol. 2020;138:110973. https://www.fkbphysio.com/do-i-really-need-to-lift-heavy-weights-to-improve-my-bone-density

[10] Massini DA, et al. Effect of whole-body vibration training on bone mineral density in older adults: a systematic review and meta-analysis. PeerJ. 2025;13:e19230. https://peerj.com/articles/19230/

[11] Comparative effects of weighted vest and whole-body vibration training on bone and muscle health in osteopenia. Life (MDPI). February 2026. https://www.mdpi.com/2075-1729/16/2/229

[12] Simon AB, et al. The clinical utility of whole body vibration: a review of the different types and dosing for application in metabolic diseases. 2024. https://www.healthline.com/health/vibration-plate-for-osteoporosis

[13] Beavers KM, et al. Weighted vest use or resistance exercise to offset weight loss–associated bone loss in older adults: a randomized clinical trial. JAMA Netw Open. 2025;8(6):e2516772. https://pmc.ncbi.nlm.nih.gov/articles/PMC12181796/

[14] Vitamin D and calcium absorption. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

[15] Side effects of bisphosphonates. Bone Health & Osteoporosis Foundation. https://www.bonehealthandosteoporosis.org/patients/treatment/medicationadherence/side-effects-of-bisphosphonates-alendronate-ibandronate-risedronate-and-zoledronic-acid/

[16] FDA side effects update: osteoporosis drugs and new bone fracture risks. MedShadow Foundation. February 2026. https://medshadow.org/drug-updates-recalls/fda-side-effect-updates/osteoporosis-drugs-and-new-bone-fracture-risks/

[17] Adami G, et al. How, when, and why to potentially stop antiresorptive drugs in osteoporosis. Arthritis & Rheumatology. 2025. https://acrjournals.onlinelibrary.wiley.com/doi/full/10.1002/art.43179

[18] Mayo Clinic. Osteoporosis treatment: medications can help. December 2025. https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis-treatment/art-20046869

[19] Chinese herbal medicine and osteoporosis: review of randomized controlled trials. NIH/NCBI PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572690/

[20] Acupuncture and bone metabolism research. Chengdu University of Traditional Chinese Medicine. 

[21] Barsi J, et al. Early hormone replacement therapy and long-term bone health in postmenopausal women: a real-world propensity-matched study. Presented at the American Academy of Orthopaedic Surgeons Annual Meeting. New Orleans, March 2026. https://aaos-annualmeeting-presskit.org/2026/research-news/new-study-finds-early-hormone-replacement-therapy-reduces-risk-of-osteoporosis-and-fractures-for-older-women/

[22] Patient Care Online. Hormone replacement therapy after the WHI: clinician's evidence timeline 2002–2025. https://www.patientcareonline.com/view/hormone-replacement-therapy-after-the-whi-clinician-s-evidence-timeline-2002-2025-

[23] What the Women's Health Initiative has taught us about menopausal hormone therapy. PMC/NIH. https://pmc.ncbi.nlm.nih.gov/articles/PMC6490107/

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