Lifelong Bone Health: A Functional Approach from Youth to Healthy Aging

By Anna Gunderson, PA-C, IFMCP Candidate

Most people think about bone health only after they’re diagnosed with osteopenia or osteoporosis. In reality, strong bones are built over a lifetime, beginning before birth and continuing through every stage of aging. The strength of your skeleton at age 70 is influenced by factors that begin before birth and continue throughout every stage of life. From nutrition and hormones to exercise and blood flow, maintaining healthy bones requires a comprehensive approach.

Building Strong Bones Early

Approximately 80% of peak bone mass is developed before age 18, making childhood and adolescence the most important years for skeletal development.

Bone health begins in the womb. Research suggests that adequate maternal vitamin D levels during pregnancy support healthy fetal bone development and may improve neonatal bone mineral content.

Teenage Bone Saboteurs

The teenage years are a critical period for building lifelong bone strength, but several common “bone saboteurs” can prevent teens from reaching their full bone-building potential.

Smoking and vaping are particularly harmful. Nicotine can suppress the activity of bone-building cells and may lower the body’s protective estrogen levels—a hormone that plays an important role in maintaining strong bones in both males and females. Other bone saboteurs include sedentary lifestyles, excessive consumption of carbonated sodas, poor nutrition, and eating disorders, all of which can impair healthy bone development during these important years.

Some studies have linked stimulant medications used for ADHD with lower bone mineral density in children and adolescents. While these medications may be necessary and beneficial for many individuals, awareness of their potential impact allows families and healthcare providers to take proactive steps to support bone health.

Because peak bone mass serves as a reserve for later life, minimizing these bone saboteurs during adolescence may help reduce the risk of osteoporosis and fractures decades later.

A Functional Medicine Approach to Osteoporosis

When bone loss has already occurred, treatment should go beyond simply recommending calcium and vitamin D.

The Gut-Bone Connection

Healthy bones depend on healthy digestion. Conditions such as H. pylori infection, dysbiosis, low stomach acid, celiac disease, and inflammatory bowel disease can impair nutrient absorption and contribute to bone loss.

Clues that an underlying digestive issue may be present include chronic bloating, reflux, abdominal discomfort, unexplained nutrient deficiencies, anemia, or a history of digestive symptoms. These conditions can often be identified through a combination of medical history, laboratory testing, stool testing, and, when appropriate, additional gastrointestinal evaluation.

Addressing the root cause—whether that means treating an infection, restoring a healthy gut microbiome, improving digestive function, or managing an underlying inflammatory condition—can help ensure the body absorbs the nutrients needed for healthy bone remodeling and long-term skeletal health.

Beyond Calcium

• Vitamin K2 – Helps direct calcium into bones and away from soft tissues.
• Magnesium – Plays an essential role in bone structure and metabolism.
• Boron – Supports bone metabolism and hormone balance.
• Zinc and Manganese – Important for collagen formation and bone remodeling.
• Collagen – Provides much of the protein framework that gives bone its strength and flexibility.
• Silicon – Supports collagen production and healthy bone mineralization.

Together, these nutrients help support the structure and function of healthy bone tissue.

Hormone Optimization

Hormones play a central role in bone remodeling.

Estrogen helps slow bone breakdown by limiting osteoclast activity, while progesterone supports osteoblasts, the cells responsible for building new bone. Although these hormones are often discussed in the context of menopause, they are important for bone health in both women and men.

Hormone optimization begins with identifying imbalances through appropriate testing and addressing potential contributors such as chronic stress, poor sleep, nutrient deficiencies, excess alcohol intake, certain medications, and underlying thyroid dysfunction. For some individuals, lifestyle changes may be sufficient, while others may benefit from targeted therapies under the guidance of a healthcare professional.

In women, supporting healthy estrogen and progesterone levels during perimenopause and menopause can play an important role in preserving bone density. In men, maintaining healthy testosterone levels—which can be converted into estrogen in small amounts—is also essential for long-term musculoskeletal health. Optimizing thyroid function and DHEA levels may further support healthy bone remodeling and maintenance in both sexes.

Bones Need Stress to Stay Strong

Weight-bearing exercise remains one of the most effective ways to preserve bone density. Fast walking, resistance training, and other weight-bearing activities stimulate bone growth and remodeling.

Whole-body vibration (WBV) therapy has also shown promise for improving lumbar spine bone mineral density in postmenopausal women.

Blood Flow: An Emerging Piece of the Puzzle

Bone is living tissue that depends on an adequate blood supply for growth, repair, and remodeling. Emerging research highlights the role of nitric oxide (NO) and nitrates in supporting bone health by promoting circulation and helping deliver oxygen and nutrients to the bone matrix.

Supporting nitric oxide production naturally may therefore be another important piece of a comprehensive bone health strategy. Plant-based nitrates found in beets, spinach, arugula, and other leafy greens help promote nitric oxide production and healthy blood flow.

Products such as Nutriex Proteins+ which contain betaine nitrate derived from beetroot extract, can complement a nutrient-rich diet and help support nitric oxide pathways involved in circulation and nutrient delivery to bone tissue.

The Bottom Line

Strong bones require more than calcium alone. Lifelong skeletal resilience depends on nutrition, digestive health, hormone balance, physical activity, and adequate circulation.

Whether the goal is building peak bone mass during youth or managing osteoporosis later in life, addressing these interconnected systems can help support stronger bones, better mobility, and long-term skeletal health.