As we age, we worry about wrinkles in our skin, the graying and thinning of our hair and the changing curves of our figure. But, what about our bones?

One of the most important things to keeping our youth and independence is healthy, strong bones. Maybe we want to travel after we retire, hold our grandchildren in our arms and dance with our spouses under a starlit sky. To do this, we need a solid bone structure -- it is our framework for a quality life.

Healthy bones support our muscles and protect our vital organs, enabling us to perform everyday tasks and enjoy other activities. Gone should be the fears of becoming hunched over from weakened or fragile bones. Yet, the National Institute of Health reports that 44 million Americans are at risk for osteoporosis, 68 percent of those are women.

"It is unfortunate to see someone suffering from osteoporosis, because it is preventable," says Judith Dibble, MD, internal medicine.

Vitamin D and Calcium Are Crucial
"Women lose the most bone mass in the first five years after menopause due to estrogen loss," says Dr. Dibble. Men have less bone loss due to later age-related testosterone decline.

So, how can you increase your chances of standing strong and tall as you age? Nutrition throughout life is key to building and maintaining a strong skeleton.

"So many people are undernourished today when it comes to calcium and vitamin D, the two most important nutrients our bodies need to develop and maintain bone density," says Dr. Dibble. To absorb calcium into our bones, we need vitamin D. The average woman should take about 1,200 to 1,500 mg of calcium daily and between 400 and 1,000 international units of vitamin D. The average man should take 1,000 mg calcium daily and the same vitamin D.

"In the past, people used to get more of their vitamin D from sun exposure.  Now with the use of sunscreens to protect against skin cancer and as people spend less time outdoors, we must rely more on our food intake and supplements," says Dr. Dibble.

"I've seen women with low bone density make major improvements by increasing their intake of vitamin D and calcium, along with exercising and avoiding the need to take osteoporosis medications."

It's So Easy to Track Your Intake
Since strong bones are so critical to good health, Dr. Dibble recommends taking calcium and vitamin D every day. An easy way to do this is

• Take a multivitamin -- for women, one that is specific to women and contains at least 800 mg of vitamin D, and usually 450 mg calcium -- in the morning
• Eat a couple of dairy portions, or fatty fish during the day -- most dairy servings, such as cheese, yogurt and milk, contain about 200 mg of calcium
• Take a calcium supplement at night

"If you know how much calcium is in the vitamins, then you know how much dairy to ingest through food sources. The calcium supplement at night has the added benefit of aiding sleep."

While women need more calcium than men, men also should consider the adequacy of their diet and risk factors for early bone loss. Dr. Dibble recommends spreading the intake of supplements out over the course of the day, and drinking lots of water.

Exercise and Other Healthy Habits for Bones
Beyond good nutrition, there are other ways to improve bone health. Cigarette smoking, caffeine and excessive alcohol intake worsen bone health. Interestingly, many medications are being studied for their secondary effects on our bones. Some preliminary evidence indicates that statins used for lowering cholesterol may aid in bone strength.

Weight-bearing and weight resistance exercises also enhance bone health. "Remember to exercise your arms as well as your legs," says Dr. Dibble.

Osteoporosis Is the Silent Disease.
Osteoporosis is a 'silent disease,' because no symptoms are evident until the bones have already become weakened. It is often not diagnosed until someone has experienced an unusual or non-traumatic fracture.

Who should get tested for low bone density? "I like to see all women within one year of menopause, regardless of age, have a baseline bone density test. Younger women with poor calcium intake, anorexia or a history of hyperthyroidism should be considered for testing. Men and women with other less common endocrine disorders or malabsorption syndromes also should be tested.

For those who have been diagnosed with osteopenia (lower than normal bone density) or osteoporosis: while you may have missed the best opportunity to build bones (before age 30), there are increasing options for medication and supplement treatments, to help prevent fracture risk. These, as well as vitamin supplements, should be discussed with your physician.

Dr. Judith Nations Dibble is a board-certified internal medicine physician on staff at Missouri Baptist Medical Center. She received her medical degree from Washington University School of Medicine and completed her internship and residency at Jewish Hospital in St. Louis.