Strong bones are important for all of us, especially as we age. Osteoporosis is a condition of significantly low bone mineral density, with an increased risk of fracture. Osteopaenia is a condition of lower than normal bone mineral density, which may or may not progress to osteoporosis; a diagnosis of osteopaenia is an opportunity for you to take a good look at how you are looking after your bones. Bone strength is dependent on the density of the bone, and also on the quality of the bone.
Healthy bones are a potential concern for all women, as women have a higher incidence of osteoporosis than men, which can lead to increased risk of bone fracture and the complications that accompany this. Oestrogen is protective for bone health, and the decline in oestrogen in menopausal years does increase the risk of osteoporosis, which is why the incidence is greater in women than in men.
Bones: more than just calcium, more than just minerals
Bone is a living, changing, dynamic tissue. Minerals are very important for bone health but so is the collagen matrix in which they are deposited. Calcium is what we all think of for bone health, and it is important to have adequate calcium intake. However, it is also important that calcium is balanced with magnesium intake, and also other minerals that allow the calcium to be utilised for bone formation, such as zinc, boron, phosphorus, potassium, silica, chromium and others. Vitamins such as C, D, K, and some of the B group, are also important.
- Calcium is best from dietary sources, but if these are insufficient, supplements should be carefully selected for the form of calcium used and the presence of other co-factors (such as the nutrients mentioned above). Calcium carbonate is not well-absorbed, whereas Calcium citrate, lactate, and orotate are beneficial forms of calcium, as is calcium hydroxyapetite. As we have discussed however, its not all about calcium! Calcium supplementation shows only a modest and limited increase in bone mineral density, even when its a good quality supplement. It is worth noting however, that studies showing the supposed increased risk of cardiovascular events from calcium supplementation are also limited.
- Magnesium is just as important as calcium, and low magnesium is associated with increased rates of osteoporosis.
- Those with osteoporosis are often deficient in Vitamin D, and all people should get their Vitamin D levels checked by their doctor, regardless of age, as deficiency is common in all ages. Vitamin D3 is the preferred form of supplemental Vitamin D and is available in both liquid and capsule form.
- Vitamin K is essential to increase bone strength and reduce the incidence of fracture, especially in post-menopausal women. This makes high dose Vitamins K a valuable supplemental tool in those with osteopaenia or osteoporosis. Vitamin K2 (not K1) is the preferred form for bone health, as it is involved in several proteins which both encourage the mineralisation of bone and also reduce the build-up of calcium in blood vessels. Some call it the ‘calcium director’, telling calcium where to go and keeping it in the right place!
- Vitamin C is protective, helping to stimulate growth and mineralisation of bone as well as supporting collagen. It also reduced oxidative stress and inflammation.
- Collagen is another key component of bone, responsible for its flexibility and resilience. Vitamin C is a component of collagen, and dietary or supplemental collagen may also be of benefit. A whole article on collagen is in the pipeline!
General Nutritional and Lifestyle Tips for Strong Bones
- Reduce sugar, salt, alcohol, fizzy drinks and caffeine, as all of these increase the loss of minerals through urinary excretion. Very high-protein diets also increase calcium loss, however getting enough protein is essential for mass, strength and microarchitecture of bones. Alkalising the body also helps reduce mineral loss.
- Dietary and herbal phyto-oestrogens can increase bone mineral density; Increasing tofu & soy products may be of benefit. Supplements or herbal extracts such as soy isoflavones, Black Cohosh or Red Clover can be discussed with your practitioner.
- Good sources of calcium in the diet are not exclusive to dairy foods; almonds, brazil nuts, sesame seeds, unhulled tahini, fish, salmon, green vegetables, figs and soy foods are all also good sources of calcium. For more on calcium foods, click here.
- Smoking significantly reduces bone strength by interfering with mineral absorption and oestrogen metabolsim.
- Some medical conditions and drugs can also have detrimental effects on bone density.
- Certain medications increase your risk of osteoporosis, while others increase your risk of fracture directly.
- A healthy body weight is essential for bone health; women who are thin have increased risk of bone fractures and osteoporosis.
- Poor intestinal absorption of nutrients also contributes to lower bone density, conditions such as chronic diarrhoea will obviously reduce nutrient uptake, but also poor stomach acid production impairs mineral uptake form the diet. Improve digestion by taking herbal bitters or eating bitter or sour foods before a meal to encourage the production of stomach acid.
- An emphasis on lots of fresh vegetables in the diet is a great way to boost your vitamin and mineral intake naturally. Increased dietary Vitamin C has been linked to a reduced incidence of osteoporosis.
- Homemade stocks, made with bones or seafood shells and vegetable scraps, are excellent sources of minerals. Adding a small amount of vinegar or wine while making the stock helps extract minerals from the bones.
- Incorporating seaweeds into the diet is another way to boost mineral intake.
- Eating the softened bones of small fish is great for mineral intake; especially sardines, salmon, whitebait.
- The stress hormone cortisol breaks down bone, so reducing or managing stress is also important.
- Inflammation has a negative impact on bone health, and opting for an anti=inflammatory diet is of benefit.
- Green leafy vegetables provide calcium and good levels of vitamin K, essential for healthy bones. Homemade parsley pesto, and similar weedy concoctions, are all easy ways to boost greens in your diet. Nettle teas, steeped overnight, provide excellent minerals, while Oatstraw decoctions are a wonderful natural source of silica.
Exercise & Movement
Lack of exercise increases mineral loss from bone.
Weight-bearing exercise and movement encourages the growth and strength of bones, and is essential for all women. Young women also need to exercise to maintain bone health, as our bone health in later years is partially determined by our peak bone mass which is established in our youth.
Weight-bearing exercise includes: Walking, jogging, dancing, gardening, weight-training, sports, stair-climbing and skiing. (Swimming and bicycling are lower impact and not as significantly weight-bearing).
Falls Prevention: Whatever your bone strength, the real problem with osteoporosis lies in the increased risk of fracture. 90% of hip fractures occur after falls. Because of this, all strategies to reduce the risk of falls are to be employed. Other than the exercise measures discussed above, specific forms of exercise and movement that encourage good balance and body awareness such as Tai Chi have been shown to be useful for preventing falls. In addition to this, assessing the use of medications which may increase the risk of falls is also important.
Healthy Bones Are In Your Hands…
…and your feet and legs and well, you get it! No matter your age, now is the time to think about building strong, resilient healthy bones to carry you through a good long life. Remember that bone is a living tissue, responding to its environment, using the resources available to it, so make that environment a healthy one- mineral rich and full of goodness. With the right encouragement – weight and movement – your little bone building cells will know just what to do!