By Sally Lehrman

In a recent phone conversation, my mother nonchalantly mentioned that the technician who’d given her a bone density test had told her not to let anyone hug her: Her weak bones might break from the pressure.

But Mom said she’d ignored the advice. “I’m just not going to live in fear all the time!” she declared. I was quiet, afraid to imagine what it would be like not to be able to hug her anymore. Or worse yet, to feel her skeleton crack between my arms.

Mom’s structural health got me to thinking about my own—and I realized I need to start taking it a lot more seriously. The process of skeletal weakening often gets under way when a woman is in her forties, right where I am now, and speeds up after menopause, when estrogen levels plummet. And while many women in Mom’s generation relied on hormone replacement therapy (HRT) to protect their bones, recent research linking HRT to cancer and heart disease has made that a questionable route.

Everywhere I look, dairy products are touted as the way to keep my skeleton strong. But like millions of other women, I happen to be lactose intolerant; all it takes is one bite of cheese to saddle me with an ache in my stomach for the rest of the day. Clearly, it’s time for me to step up my efforts on the bone-preserving front, but I can’t rely on the mainstream strategy of boosting dairy intake.

Luckily, there’s a lot I can do to make sure I won’t have to pull back from
the outstretched arms of my loved ones. Here’s the latest thinking on the best ways for the dairy-averse to support the bones that support us—along with some surprising news about what’s not worth doing. Food Dos and Don’ts

Sidle up to soy
Kenneth Setchell, a professor of pediatrics at Children’s Hospital Medical Center in Cincinnati, recommends that people who are lactose intolerant substitute soy milk for cow’s milk on their morning cereal. He and other researchers are convinced that certain estrogenlike chemicals in soy, called isoflavones, can keep bones strong. In one two-year study, Setchell asked 54 postmenopausal women to drink two glasses of soy milk containing 85 grams of isoflavones a day; another 54 drank soy with the isoflavones removed. At the end of the study, the isoflavone drinkers had retained their bone mass, while the others had lost 4.5 percent of theirs. “The findings are quite encouraging,” he says. Flaxseed, nuts, and whole grains are good sources of other types of plant-based estrogens.

What’s more, many soy milks come with added calcium, as does some tofu. (You won’t find the bean curd advertised as “fortified.” But check the label; products in which calcium salt has been used to “set” the tofu contain about 430 mg per half-cup.)

Try a different kind of dairy
Goat and sheep’s milks, cheeses, and yogurts, which are rapidly becoming more available, are also worth a try for people like me: Although they contain lactose, some lactose-intolerant people can tolerate them, and they’re just as rich in calcium as dairy products from cow’s milk.

Eat fortified foods
Supermarket shelves are ever more crowded these days with calcium-enriched foods. Check the labels on cereals and orange juice; you can often add several hundred milligrams to your daily total this way.

Don’t fret about eating meat
While meat has gotten a bad rap for leaching calcium from the skeleton (because of its high protein content), recent research suggests the reputation is undeserved. True, the process of metabolizing protein does prompt bones to give up some of their calcium—but it doesn’t seem to make much of a difference in overall bone density. “For a long time, we thought this process was important, but newer studies are showing it might not be,” says Connie Weaver, who heads Purdue University’s department of foods and nutrition. In fact, at least ten studies have found that diets high in protein are linked with high, not low, bone density.

Do visit the vegetable kingdom
Despite their lackluster reputation in this area, a few vegetables do contain significant amounts of calcium. The ones that rival a glass of the white stuff are Chinese cabbage flower leaves and Chinese mustard greens, which offer 95 mg and 85 mg of calcium per serving, respectively. A couple of servings of bok choy will also do the trick, delivering 42.5 mg of calcium each.

The Skinny on Supplements

Calcium: The cornerstone
However diligent you are about your diet, the fact is, anyone who’s not a dairy fanatic will probably need a daily supplement of around 600 mg, advises Linda Massey, a nutritionist at Washington State University in Spokane.

Standard calcium carbonate, the form in many antacids, and calcium citrate are both good choices. (Carbonate is cheaper, though.) For optimal absorption, it’s best to take doses of no more than 500 mg at once, at or near mealtimes.

Coral calcium, which is calcium carbonate (or limestone) ground from remnants of coral, has gotten a lot of attention lately. But beware: It may contain lead and could trigger a reaction in people allergic to shellfish.

Vitamin D: Nobody’s getting enough
In order to use all that calcium, vitamin D is essential. Until recently, most nutritionists assumed sunshine contributed all we need, since we store the vitamin for winter use. But researchers in Australia and Canada recently reported surprisingly high levels of deficiency in local populations. It turns out that hardly anyone gets enough D from sun—unless they live in south Florida and never wear sunscreen, Massey says.

If you’re under age 50, make sure to get 400 IU a day. Older folks should increase the dose to 600 IU per day. You’ll find D in certain fortified cereals (check the labels) as well as in some rice and soy milks. Sardines, salmon, and mackerel are good sources, too.

Still, since one of the best sources is fortified milk and cheese, we lactose-intolerant types probably do need to get our daily quota out of a jar, Massey says, especially in the fall and winter. Look for supplements that contain vitamin D-3, also known as cholecalciferol, which is more potent than other forms. You can take it any time of day, with food or without.

Magnesium: Oh, never mind
Weaver and Massey dashed another truism about calcium for me: that the supplement must be taken in combination with magnesium for proper absorption. Many nutritionists have lost their enthusiasm about this mineral’s reputed helper role because results from animal studies of magnesium haven’t held up in research involving people. It’s potentially useful for controlling high blood pressure, among other things, but isn’t so essential for calcium absorption.

Vitamin K: Think bone-knitter
Here’s one I hadn’t thought about: Researchers are just learning that vitamin K, which contributes to the collagen in the core of our bones, is essential for a strong skeleton. There’s lots of it in leafy green vegetables, so eat up!

One more thing: Get moving
It’s not just what you put into your bones that counts: One of the best things you can do for your skeleton is to work it. There’s no doubt among researchers that weight-lifting and high-impact activities (running, tennis) improve bone density. To strengthen the hips—the site of far too many debilitating fractures in older women—high-impact exercises are essential.

“You have to surprise the bone,” says Christine Snow, director of the Bone Research Laboratory at Oregon State University in Corvallis. Snow suggests an unusual way to do this: Jumping in place and landing flat-footed, with knees bent, 300 times a week. (Jumping rope won’t do the trick because there’s not enough of a pause between the jumps.) If your knees are creaky, start small and work up.

Eventually, she says, you can graduate to jumping off a 6-inch box, and finally a 12-inch one. In a yearlong study among 50 women ages 30 to 45, those who followed Snow’s jumping plan (along with lower-body strengthening exercises) increased the bone density in their hips by 2 percent.

As for me and my bones, I’ve learned to see them as a living part of me that require their own care and feeding. And now I know that good intentions, lots of leafy greens, and the occasional slice of goat cheese won’t be enough to preserve my skeleton’s integrity. Since I’ve been skimping on calcium and vitamins, it’s off to the health food store for me—jumping as I go.

How much calcium do you need?
Both men and women under the age of 50 need to get 1,000 milligrams of calcium a day in all. If you’re over 50, aim for 1,500 mg. (Here again, the advice goes for men as well as for women; one-third of men over 75 have osteoporosis.) Experts agree that food is the best source of this mineral, but it’s not easy to get all you need from dietary sources. So most people will need to supplement to avoid a shortfall.