Strong foundations: building better bones

In a previous post I wrote about why healthy bones are important for overall health, not only to reduce osteoporosis and fractures, so here is a bit more information to help you keep your bones health. 

Knowing your risk factors, or contributors to poor bone health

If we look at what can lead to osteoporosis and poor bone health, then we know what to try to avoid or minimise. This list isn't everything and some of these you can't change (like genetics), but knowing that you might be at a higher risk is a good motivator to pay a bit more attention to your bone.

Genes, age and sex

• Family history: Of osteoporosis or fractures might be genetics or it might be environmental where no-one had access to a healthy diet and healthcare.
• Low peak bone mass: If peak bone mass (usually reached by age 30) was low, bones are more vulnerable later in life. This might be due to poverty and poor access to food and healthcare or other reasons for a suboptimal diet in childhood, prolonged illness and not much running, skipping and jumping and some medical treatments. 
• Small body frame: People with smaller frames have less bone mass to draw from as they age.
• Age: Bone density naturally decreases with age, particularly after 50. 

Hormonal factors

• Low oestrogen: Low oestrogen levels increase the rate of bone loss as we age. the most common cause of low oestrogen is menopause but it can also occur in eating disorders, hypothalamic amenorrhoea and conditions or treatments that stop ovulation (e.g. chemotherapy)
• Low testosterone: In both men and women, low testosterone can weaken bones. As women, testosterone declines gradually from our late 20s and doesn't have a big drop like oestrogen.
• Thyroid and parathyroid disorders: Overactive thyroid (hyperthyroidism) or high levels of thyroid hormone replacement therapy can increase bone turnover leading to bone loss, and overactive parathyroid glands can cause excessive calcium loss from bones.

Nutritional Factors

• Low calcium Intake: Inadequate calcium reduces bone density.
• Vitamin D deficiency: Vitamin D is essential for calcium absorption and bone health, and low levels are surprisingly common.
• Low protein and collagen: These are necessary for bone matrix strength.
• Excessive sodium: High salt intake can increase calcium loss through urine.
• Excessive caffeine or alcohol: Both can interfere with calcium absorption and bone metabolism.

Lifestyle Factors

• Physical inactivity: Even if you have excellent calcium and protein intake, without weight-bearing or resistance exercises it makes no difference.  
• Low sunlight exposure: Reduces vitamin D synthesis. Even with sun, some people may not absorb vitamin D well.
• Smoking: Smoking impairs calcium absorption and reduces bone mass.
• Excessive alcohol intake: Alcohol disrupts bone remodeling and increases fracture risk.
• Chronic stress: High cortisol levels associated with chronic stress can weaken bones.

Medical Conditions and treatments

• A bunch of different conditions can affect bone health, including: some auto-immune conditions like rheumatoid arthritis, GUT issues such as Coeliac disease and Crohn's disease, diabetes, and kidney disease.
• Frequent falls, poor balance, muscle weakness, or environmental hazards increase the risk of doing less exercise, weakening bones and getting fractures.
• Medications and treatments that can affect bone health include long-term use of oral steroids (e.g., prednisone), some chemotherapies an radiation therapy, some epilepsy medications and proton-pump inhibitors used for GORD/GERD and reflux if they are taken long-term as they can decrease calcium absorption. 

What you can do for healthy bones

Get active

Activities like walking, hiking, or resistance training stimulate bone growth and improve density. You might have seen weighted vests on social media - you can use these but they're not essential and if you want to add weight you can save money and wear a backpack with some books or a couple cans of lentils, or carry a small child

Nutrition for strong and healthy bones

Nutrition is a cornerstone of strong, healthy bones. While calcium often takes center stage, maintaining bone health requires a range of nutrients working together to support bone density, structure, and repair. You don't need anything fancy or ridiculously expensive - some protein, loads of veges, some legumes, a bit of yoghurt (and avoid excess salt)!

• Calcium, include dairy products, green leafy vegetables, fortified plant milks, soy milk, tofu and edamame, nuts and seeds and tinned sardines, salmon, mackerel and anchovies, and legumes.
• Vitamin D, apart from sunshine, vitamin D is in fatty fish, eggs, and fortified foods.
• Protein and collagen, aim to include lean meats, fish, legumes, tofu, cottage cheese, ricotta, yoghurt in your meals, protein powders can be helpful if struggling to get enough protein.
• Magnesium helps convert vitamin d into its active form and is found in nuts, seeds, whole grains, and green vegetables.
• Vitamin K works with calcium to strengthen bones and prevent fractures, find it in leafy greens like spinach and kale. 

** Did you notice how many times leafy greens were mentioned?

 Eating a balanced diet with a variety of whole, nutrient-dense foods not only strengthens your bones but also supports overall health. when paired with regular weight-bearing exercise and a healthy lifestyle, proper nutrition can keep your bones healthy and strong and help reduce the risk of fractures and osteoporosis.

Supplements

I do not recommend self-prescribing supplements, or taking something based on online information. It's best to see a health professional who understands nutrition, can recommend appropriate testing if indicated and who can then make any recommendations. That said, key nutrients that may be recommended include calcium, vitamin D, protein, collagen, and vitamin K.

Medical condition and medication review

Talk to your healthcare provider about medications or supplements that may be appropriate, or that may be increasing your risk for osteoporosis, especially if your bone density is declining rapidly. 

In Australia bone mineral density scans are covered by Medicare if you meet the criteria (age over 70, early menopause, multiple fractures, some medical conditions and medications - speak with your GP to check if eligible). You can still have a bone density scan if you don't meet the criteria but you'll need to pay the radiology clinic.

Avoid the obvious

Keep alcohol at a minimum, or go without, quit smoking. I get it, easier said than done, so speak with your health professional about what support is available (for instance there are some great women's programs to change your relationship with alcohol, even if you don't fully quit).