BONE HEALTH - TIPS TO KEEP YOUR BONES HEALTHY

Bones provide structure, protect organs, anchors muscles, and store calcium and phosphorus, releasing them into the body when we need them for other uses. While it's important to build strong and healthy bones during childhood and adolescence, you can also take steps during adulthood to protect bone health.

More than 3 million people in the UK have osteoporosis, which is a loss of bone mass (1). Osteoporosis increases the risk of fractures and women are at especially high risk of this due to the role that oestrogen plays in maintaining bone mass; oestrogen declines with age and is affected by many factors including diet, exercise, and stress (2).

Osteopenia is a precursor to osteoporosis, and both are diagnosed using bone mineral density scanning using a DEXA machine. It is very important to address osteopenia, as this can help to prevent the development of osteoporosis.

This article will explore the crucial role that nutrition and lifestyle play in keeping our bones healthy.

1. Calcium

Calcium is the most important mineral for bone health, and it's the main mineral found in your bones.

The recommended daily allowance (RDA) of calcium in the UK is 700mg a day for adults and 1000mg for those who have osteoporosis, coeliac disease or inflammatory bowel disease (3).

Foods that are high in calcium include:

• Dairy products such as milk, cheese, and yogurt.

• Dark green vegetables such as a kale, spinach, and broccoli.

• Sweet potatoes.

• White and red beans.

• Sardines.

However, there are a few things to keep in mind about calcium:

• Are you getting enough vitamin D to aid with calcium absorption?

• Is calcium in balance with other nutrients? Recent evidence suggests that we don’t benefit from supplementing more than 1000 mg of calcium daily — and in excess, supplemental calcium can actually be harmful (6).

• Are you eating other foods, or taking other medications, that could interfere with calcium absorption? For example, phytates and oxalates (mainly found in seeds, grains, and legumes) that can hinder calcium absorption.

Calcium supplements can be beneficial in some cases, but you should always get individual advice about this from a healthcare professional as this will depend on your diet, medication, and use of other supplements.

2. Vitamin D

This ‘sunshine vitamin’, Vitamin D, is extremely vital for health — particularly our bones.

As mentioned earlier, we need vitamin D to build bones and absorb calcium.

You may be able to get enough vitamin D through sun exposure and food sources such as fatty fish. However, most people should consider supplementing with vitamin D to ensure that levels are optimal. Vitamin D requirements vary greatly depending on geography, sun exposure, and current blood levels.

3. Protein

Consuming enough protein is important for healthy bones. Several studies point to a positive effect of high protein intake on bone mineral density (4). This fact is associated with a significant reduction in hip fracture incidence, as recorded in a large prospective study carried out in postmenopausal women (4).

However, a study indicated that the positive effects of protein intake on bone health may only be beneficial under conditions of adequate calcium intake (5).

Therefore, the evidence shows that a high-calcium plus a high-protein diet is optimal for bone health. Thus, look for a variety of plant and animal-based protein sources to cover all areas.

4. Vitamins K and C

Vitamin D is not the only crucial vitamin to bone health. Vitamins K (more importantly vitamin K2) and vitamin C also appear to be important.

Vitamin K2 is involved in calcium transport and helps to improve bone density (7, 8). Foods rich in vitamin K2 include dairy, meat, poultry, and natto, a traditional Japanese food made from fermented soybeans.

Vitamin C stimulates the production of bone-forming cells. In addition, some studies suggest that vitamin C's antioxidant effects may protect bone cells from damage (9). Foods rich in vitamin C include vegetables and fruits.

5. Magnesium

Magnesium is another mineral that is essential for bone health. Magnesium is one of the key minerals that make up the structure of the bone matrix, and it will be pulled from the bones if blood magnesium levels drop (10). Magnesium deficiency is a known risk factor for osteoporosis (11).

Foods rich in magnesium include dark leafy greens, beans, seeds, and nuts.

While in theory, we should be able to get enough magnesium from a balanced diet, however, in practice many people (particularly women of reproductive age) are magnesium-deficient and benefit from supplementation.

Speak to your healthcare practitioner before supplementing as higher doses of magnesium may interfere with certain medications and compete for absorption with other minerals like calcium, iron, and zinc.

Lifestyle factor

Weight-bearing and resistance exercises

Exercise is important for supporting and preventing osteoporosis. Not only can exercise improve your bone health, it can also increase muscle strength, coordination, and balance (which reduces the risk of falling) and can lead to better overall health.

Weight-bearing exercises force you to work against gravity. Such as walking, hiking, jogging, climbing stairs, and tennis. Resistance exercises – such as lifting weights – can also strengthen bones (12).

Bottom line:

Bone health is important during all stages of life. We tend to take strong bones for granted, thus do not wait until symptoms of bone loss advances. There are many nutrition and lifestyle habits that can be implemented to help build and maintain strong bones —it's never too early to start!

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References:

1) The NHS Website ‘Osteoporosis’ [available via: https://www.nhs.uk/conditions/osteoporosis/]

2) Rizzoli R1, Bischoff-Ferrari H, Dawson-Hughes B, Weaver C. (2014). Nutrition and bone health in women after the menopause. Womens Health (Lond). 10(6):599-608.

3) The Royal Osteoporosis Society “Calcium” [available via: https://theros.org.uk/information-and-support/looking-after-your-bones/nutrition-for-bones/calcium/]

4) Bonjour JP. (2011). Protein intake and bone health. Int J Vitam Nutr Res. 81(2-3):134-42.

5) Mangano, K. M., Sahni, S., & Kerstetter, J. E. (2014). Dietary protein is beneficial to bone health under conditions of adequate calcium intake: an update on clinical research. Current opinion in clinical nutrition and metabolic care, 17(1), 69–74.

6) Li, K., Wang, X. F., Li, D. Y., Chen, Y. C., Zhao, L. J., Liu, X. G.,Deng, H. W. (2018). The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health. Clinical interventions in aging. 13, 2443–2452.

7) Flore R., Ponziani F. R., Di Rienzo T. A., et al. (2013). Something more to say about calcium homeostasis: the role of vitamin K2 in vascular calcification and osteoporosis. European Review for Medical and Pharmacological Sciences. 17(18):2433–2440.

8) Maresz K. (2015). Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health. Integrative medicine (Encinitas, Calif.), 14(1), 34–39.

9) Aghajanian P, Hall S, Wongworawat MD1,3, Mohan S. (2015). The Roles and Mechanisms of Actions of Vitamin C in Bone: New Developments. J Bone Miner Res. 30(11):1945-55.

10) Castiglioni, S., Cazzaniga, A., Albisetti, W., & Maier, J. A. (2013). Magnesium and osteoporosis: current state of knowledge and future research directions. Nutrients, 5(8), 3022–3033.

11) Orchard, T. S., Larson, J. C., Alghothani, N., Bout-Tabaku, S., Cauley, J. A., Chen, Z.,Jackson, R. D. (2014). Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study. The American journal of clinical nutrition, 99(4), 926–933.

12) Benedetti, M. G., Furlini, G., Zati, A., & Letizia Mauro, G. (2018). The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. BioMed research international.4840531.