This is the second in our 2025 “Health Matters” series focused on health topics in South Snohomish County and sponsored by the Verdant Health Commission. Read past articles in this series here.

Edmonds resident Beth Sanger thought she was doing everything right when it came to bone health. She exercised regularly, including frequent hikes.

But, as she returned to her car after a challenging 10-mile hike to Mailbox Peak, Sanger stumbled over a rock.

“I felt like I cartwheeled through the air,” she said. “I knew as soon as I fell that something was broken.”

Indeed, the tumble had fractured her tibial plateau, or the top of the shin bone, an injury that is more common in people with low bone density. Sure enough, a scan revealed that Sanger, then 49, had osteoporosis, a disease that weakens bones and makes them more likely to break.

“It was kind of crazy to think the structure that held me up was failing,” she said.

In the U.S., osteoporosis affects more than 10 million Americans ages 50 and older, with the majority women, according to the U.S. Department of Health and Human Services. In addition, more than 43 million people have low bone mass, which makes them more likely to develop the disease.

During May, Osteoporosis Awareness and Prevention month, bone health advocates are spreading knowledge of what is often referred to as a silent disease. That’s because people often don’t recognize the loss until they break something. There are multiple steps people can take to improve bone health before it gets to that point, health experts say.

“Bone health is part of greater overall health,” said Dr. Sarah Gruber, a family medicine doctor with the Community Health Center of Snohomish County. “If you can focus on eating a well-balanced, healthy diet and getting exercise and continue that throughout your life, you’ll get benefits that will go beyond bone health, to all aspects of your life.”

Building healthy bones is a lifelong pursuit

Bones are living tissue, which are in a constant flux of building and being broken down. When the bone is broken down faster than it’s being built, loss occurs. Osteoporosis can lead to bones breaking more easily, with a seemingly small fall or misstep having traumatic results. For example, Gruber had a patient who fractured her knee after stepping awkwardly off a bus.

Dr. Katherine Bumstead, a family medicine physician at Providence Medical Group, uses a construction metaphor to describe the key components of health bones: “Calcium is the brick, Vitamin D is the mortar and exercise puts it all together.”

While bone health typically becomes a concern as people age, it’s never too soon to think about those factors, she said.

“If you start with your glass full, you will have a little more wiggle room later,” she said. “Many people who have good bone health start when they are young. Being sure our children and adolescents have good habits with calcium, vitamin D and exercise is so important to grow strong bones.”

While absorbing vitamins and minerals in their natural state through food and sunlight is ideal, some people might need a supplement – especially for Vitamin D in the sun-starved Pacific Northwest.

Exercise is helpful not only for strengthening bones, but also for preventing falls and fractures. The intensity of exercise and weight training efforts depends on the individual. While weight-bearing activities help strengthen bones, exercise doesn’t have to be “heavy and hard” to support bone health, she added. In some cases, providers may also prescribe medication to treat osteoporosis and reduce fracture risk.

Women experience higher risk  

While osteoporosis can affect all people, women who are post-menopausal are at the highest risk. About 27% of women over age 65 in the U.S. experience osteoporosis, compared to nearly 7% of men in that same age group, according to the Centers for Disease Control and Prevention.

When estrogen levels decrease during menopause, bone loss accelerates, explained Dr. Susan Ott,  a University of Washington Medicine physician who specializes in research and clinical treatments for bone disease, such as osteoporosis. Hormone replacement therapy, which replaces the estrogen that the body no longer makes, has been historically controversial for its link with increased cancer risk, Ott said. Now, with changed formulas intended to reduce those cancer risks, more providers are recommending estrogen therapy as a woman experiences menopause, she said. (It’s important to consult with a health provider for individual recommendations for steps like hormone therapy).

Along with addressing menopausal symptoms, that additional estrogen can also help protect the heart and ward off bone loss, she said. Estrogen treatment must start before age 60 because if women start taking it later than that, they have a risk of heart disease, she added.

But even if someone is well past menopause and facing bone loss, there are numerous options to improve bone density, from improving diet and adding exercise to medication use. In fact, many of Ott’s patients have improved their bone density through these strategies.

What you eat can affect your bones

Being aware of those steps is critical, especially as people age, said Michael Lynch, a registered dietician nutritionist with Edmonds-based Nutrition with Heart.

“An incorrect narrative we have is that bones are stagnant and strong and forever strong,” he said. “But we know that’s not the case.”’

Even though bones are dynamic, it can be harder to build back bone loss as the body ages. That’s why paying attention to bone health when you’re young can impact your bone health decades later. Thinking preventatively about bone health employs similar nutrition strategies to improving overall health, such as eating a well-balanced diet low in sodium and sugar.

“This works for your waistline, your overall health, and your bones,” he said. “Whatever the motivator, there’s a lot of crossovers.”

Lynch recommends his clients get bone-building nutrients like calcium naturally through a variety of foods such as dairy, tofu, sardines, canned salmon, beans, almonds, collard greens, figs and edamame. Nondairy fortified milks and cereals are useful, too. Getting enough Vitamin D through foods and even sunlight can be tough in the Pacific Northwest. That’s why he recommends getting Vitamin D levels checked to see if supplementation is necessary.

“You need to have both calcium and Vitamin D – they work in a symphony kind of way,” he said.

That diet combined with bone-strengthening activities is the recipe for a health skeleton.

“The human body was designed and engineered to move,” he said. “The body will put energy into bones if they’re properly challenged.”

Moving for Bone Health

That’s the case for local residents like Janet Pearson of Edmonds, who does Jazzercise in part to boost her bone health. Pearson has osteopenia, or reduced bone density, which she hopes to stop in its tracks before developing the more severe osteoporosis.

“Jazzercise Edmonds ticks all the boxes for me because it’s cardio and weight bearing,” she said.

Similarly, Jane Snyder, 75, has been doing a boot camp with Shoreline-based Outside Up Fitness to boost her bone health. Snyder watched her mom experience a fracture simply from sitting down too hard, and wants a different experience as she ages. Along with medication and Vitamin D to address her weakened bones, Synder heads out to Richmond Beach every week for a mix of cardio, weight-bearing exercises and balance moves. In addition to improving bone health, the exercise has helped her feel more capable on her own. She recently packed her carry-on suitcase for an upcoming trip and felt good when she could lift it up overhead on her own.

The balance and strength that come along with those workouts have other positive side effects, points out Outside Up Fitness coach Bethany Gipson: “All of those healthy muscles hold up your bones, and better balance can keep you from falling,” she said.

Local entrepreneurs focus on advocacy, awareness

In Snohomish County and beyond, entrepreneurs and bone health advocates are working to spread awareness and help people take action.

April Haberman, an Edmonds resident, co-founded a company called MiDOViA, which focuses on menopause education and awareness. Too often, women only learn about bone loss after they fall, break a bone and discover they already have osteoporosis or osteopenia, Haberman said.

After experiencing early menopause and related  bone health concerns herself, Haberman dedicated herself to educating more women. That’s critical information since breaking a bone can really deteriorate someone’s quality of life.

“I think bone health is an afterthought,” she said. “Our goal is to educate early and give women options and education so they can implement good nutrition, strength training and exercise to prevent bone loss,” she said.

When Haberman was younger, she emphasized feeling good and looking fit. Now, that she’s in her 50s, she realizes the importance of having strong bones, preparing her body for aging in the best way possible. Along with cross training and strength-building routines, Haberman also walks around the Edmonds waterfront with a weighted vest. Just the other day, she saw several people doing the same.

“We just smile,” she said. “We’re taking care of our muscles and bones.”

That’s a trend that Seattle entrepreneur Esther Sedgwick is closely following. Sedgwick is creating a weighted vest company that’s especially geared toward women’s bodies. After experiencing perimenopause symptoms, Sedgwick started researching the impact of declining hormones on women’s bone density and skeletal health. She considered her own mom, who broke her leg in two places when Sedgwick was in middle school.

“The time to address this this isn’t when you’re 60 and diagnosed with osteopenia,” she said. “It’s when you’re 30 or 40 and building the bone density to last your lifetime. We say we’re building the next generation of strong grannies.”

Similarly, Linda Goos this month launched a new fitness studio called Studio Bloom in Kirkland dedicated to improving strength, mobility, balance – and stronger bones—as people age. After going through early menopause herself, Goos was inspired to help women maintain their strength and build bone health.

In her work as a certified personal training coach and functional aging specialist, Goos has noticed many postmenopausal women who are interested and aware of bone health after being diagnosed with osteoporosis. She wishes younger women would focus on these needs when bone development is at its height.

That’s a sentiment that resonates with Sanger, the Edmonds resident whose hiking fall led to a realization of her bone loss. Five years later, her osteoporosis is gone. She attributes the change to a combination of factors: medication, adding protein to her diet, supplementing with vitamins and minerals, and engaging in weight-bearing workouts.

Sanger recently returned to Mailbox Peak, the place where she experienced the fracture five years ago.

“Being up there again was so magical,” she said.  “Getting back to my car was even better.”

Resources

Bone Density Scans

A DEXA, or bone density scan, is generally recommended for women 65 and older, as well as younger individuals who have risk factors for osteoporosis or fractures, according to the U.S. Preventative Services Task Force. Current evidence is insufficient to access the benefit/harm for men, the task force notes. Other groups, though, such as the Bone Health and Osteoporosis Foundation recommend the scans for men 70 and older, or younger men who have risk factors or previous broken bones. Since specific guidelines may vary, it’s best to discuss your individual needs with your doctor, notes the American Academy of Family Physicians.

Diet and workout recommendations

For more information on calcium recommendations and how to get calcium in foods, check out Bone Health and Osteoporosis Foundation guidelines. For individual recommendations on diet and strength building, consult a health professional.

Kellie Schmitt is an award-winning health reporter based in Edmonds. She covers health policy, public health and children’s health for a variety of publications including the Johns Hopkins University Public Health Magazine, ParentMap, and USC’s Center for Health Journalism. She has a master’s in science writing from Johns Hopkins University.

This series is supported by funding from the Verdant Health Commission. The My Neighborhood News Network maintains full editorial control over content produced as part of this series.