Americans of all ages must do more to protect their bones now to protect themselves from fractures and other related problems later in life, U.S. health officials warned on Thursday.

About 10 million Americans ages 50 and older already have the bone-weakening disease osteoporosis, and another 34 million risk developing it. By 2020, 14 million older adults could develop osteoporosis, with another 47 million at risk.

The report also called for bone density testing in women over 65 and anyone who breaks a bone after age 50.

U.S. Surgeon General Richard Carmona stopped short of recommending that all women with a family history of osteoporosis receive bone density tests.

“While osteoporosis manifests itself in our later years, the problem actually begins many years earlier,” Carmona said.

The condition, which is four times more likely in women than in men, causes bones to become porous and brittle. It is often not diagnosed until a patient breaks a bone.

Officials recommended a number of steps to help prevent the loss of bone mass, including consuming leafy green vegetables, dairy products and other foods or drinks rich in calcium and vitamin D. Exercise and maintaining a healthy weight are also important, officials said.

Those at high risk should work with their doctors to see if they need the test, according to the report, which cost $1.3 million and took more than two years to produce.

Risk factors include smoking, heavy drinking, poor diet and early onset of menopause. Steroids, chemotherapy drugs and other medicines can also curb bone mass.

The 400-page report did not make specific new recommendations for patients who already have bone disease.

“There’s enough medication out there now to deal with the clinical issues,” Carmona said. “What we really want to do is make it so that we reduce the dependence on medications, on very costly therapy.”

A number of companies make drugs approved to treat or prevent osteoporosis. They include Merck & Co.‘s Fosamax, Eli Lilly’s Forteo and Evista, and Procter & Gamble Co.‘s Actonel.

Hormone replacement therapy also has been used to help prevent menopause symptoms, including bone loss, but its use dropped after several studies showed increased health risks.

The impact of estrogen and progestin use on women’s bones “is unknown at this point,” Carmona said.