OSpeoporosis Ten million people in the United States have osteoporosis and 80 percent of them are women. The problem is, you may not even know you have the disease until your bones become so weak that a bump or minor fall causes a fracture. In fact, one out of every two women will have an osteoporosis related fracture in their lifetime, according to the National Osteoporosis Foundation. Women are more prone to developing osteoporosis because the steep drop in estrogen at menopause speeds up bone loss. Even so, doctors are sending the message to women that this is not really an illness of aging. "It has been said that osteoporosis is not a geriatric disease, but a pediatric disease and that's largely the truth," says Stanley Wallach, M.D., clinical professor of medicine at New York University School of Medicine, codirector of the Osteoporosis Center at the Hospital for Joint Diseases, and director of the American College of Nutrition, all in New York City. That's because behaviors that lead to osteoporosis such as not getting enough calcium often begin in childhood. Still, doctors agree it's never too late to bone up on bone. Just be aware that the older you are, the lower your baseline bone mass will be when you start. Even if you're no teenager, experts say these five strategies can help strengthen your skeleton. Nibble the right nutrients. Eating a calcium rich diet from the time you're a little girl is the best way to build and maintain strong bones, says Dr. Sherrer, who is also author of A Woman Doctors Guide to 0steoporosis. But for many teens and young women, milk, cheese, and other sources of calcium are off limits. That's because these foods are typically high in fat, and girls in our culture are concerned about their weight at a very young age, Dr. Sherrer says. As a result, they're not building adequate bone during their peak developmental years and end up putting themselves at risk for osteoporosis later in life. Even women way past their teen years can benefit from getting enough calcium. You may not be able to add bone, but you can maintain what you have, Dr. Wallach says. The bottom line is that premenopausal women need 1,000 milligrams of calcium a day through diet and supplements plus 400 IU of vitamin D, which helps your body absorb calcium. Postmenopausal women need even more: 1,500 milligrams of calcium and between 600 and 800 IU of vitamin D. Get active. Physical activity is another key preventive measure that should be started at an early age and continued throughout life. Regular exercise both aerobic, like fast walking, and lifting light weights not only strengthens and maintains the bone you have but can also increase your bone mass. As you build and strengthen muscle which is attached to your bones you build bone as well, Dr. Sherrer explains. Try to work in at least 30 minutes of weight bearing activity like brisk walking at least three times a week. Other weight bearing activities, which simply means that they require you to bear your own body weight, include running, dancing, tennis, even bowling. Swimming and cycling, on the other hand, are not weightbearing. Measure your bone mass. Women should get a baseline bone density test somewhere around the onset of menopause followed by a screening about one year after the start of menopause, says Dr. Wallach. Doctors can compare the numbers then to see if you've lost (or have failed to acquire enough) bone. If you have a family history of osteoporosis, you should be tested even earlier. The typical test is called the DEXA, which is a quick and painless x ray that measures the density of the hip and spine. Consider using hormone replacement therapy. Giving women synthetic estrogen once their bodies have stopped producing their own can greatly reduce the risk of osteoporosis. That's because women who aren't taking estrogen can lose up to 20 percent of their bone mass in the 5 to 7 years following menopause, making them more susceptible to osteoporosis. Hormone replacement therapy helps by preserving the bone you have, and in some cases it can add bone, Dr. Sherrer says. As with taking any prescription drug, hormone replacement therapy is not without risks certain kinds of estrogen, if taken inappropriately, may cause a small increase in your risk for breast cancer. So talk to your doctor about whether hormone replacement therapy is right for you. Avoid the big three. Another way to prevent further bone loss is to participate in the social graces as little as possible, Dr. Wallach says. "What I mean by that is smoking, alcohol use, and excessive caffeine use," he says. "All of these promote bone loss at any age." How much is too much? Any amount of smoking is detrimental not only to your bones but to your cardiovascular system as well, Dr. Wallach says. One alcoholic drink a day is okay, but drinking more than one a day may weaken your bones. And when it comes to caffeine, more than three cups of coffee a day or the equivalent in cola drinks can cause bone loss. 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