This Halloween, let’s talk about bone health
In the spirit of World Osteoporosis Day last week (and Halloween, of course), let’s discuss ways to keep your bones healthy and strong. According to the National Osteoporosis Foundation, approximately 10 million Americans suffer from osteoporosis, or clinically low bone mass or bone mineral density. Another 44 million have osteopenia, which is slightly less advanced but still increases risk of fracture and eventual osteoporosis. Stress and bone fractures can severely debilitate mobility, function and overall quality of life. Awareness is key, as people often do not know bone density is low until a bone breaks. It is estimated that osteoporosis is the root cause of about 2 million broken bones per year. While there is a genetic component at play, nutrition and exercise can strengthen bone density and decrease fracture risk.
Before we get to the recommendations, let’s talk bone metabolism. Osteoporosis prevention begins in childhood with regular exercise and a diet high in bone-healthy nutrients like milk, yogurt and foods fortified with calcium. This is a crucial time period to begin accruing bone density and mass, which peaks somewhere between ages 25 and 30. Many clinicians talk about bone mass like a bank – having more bone mass stored in the bank when you turn 30, will decrease osteoporotic risk. The bones you have in your late 20s set the tone for bone health in later decades.
Bones are metabolic tissues in a constant state of turnover and remodeling. Cells called osteoblasts help the body build new bone tissue, while their counterparts, osteoclasts, break down and remove bone tissue. Bone mass is maintained through a balance between these two types of cells. When we are young, the body makes new bone faster than it breaks bone down. After bone mass peaks, we start to lose more bone mass than we build. There are many hormones, vitamins and minerals that play a role in bone metabolism, including estrogen, which is protective for bone. This is why postmenopausal women experience a fast-paced decrease in bone mass after age 50, when estrogen levels significantly decline. One in two women will break a bone due to osteoporosis, which makes nutrition and exercise even more important for women.
While hormones like estrogen help regulate bone metabolism, bone structure is made of various nutrients. As bone is remodeled, minerals and vitamins are lost and must be replaced through the diet. On average, half of bone structure is made of water. The other half primarily consists of calcium, with some phosphorous, protein and fat. This is where nutrition comes in! If you can eat more bone-building nutrients, you can decrease risk and even prevent osteoporosis:
Calcium: Calcium is the main nutritional component of your bone structure and strength. The calcium in your bones serves as a bank to ensure your body has enough calcium in the bloodstream and cells, which enables muscles to contract, blood to clot and the heart to beat. If there is not enough calcium in the bloodstream, the body will pull some from the bone bank, which makes the bones thinner and more fragile. For adults ages 19-50, the recommended daily allowance of calcium is 1,000 mg per day. For women over 50 and men over 71, the RDA increases to 1,200 mg daily. One cup of cow’s milk contains about 300 mg of calcium, while 1 cup of yogurt has about 450 mg. Usually, eating about three servings of dairy daily will help you meet your needs. If you are lactose intolerant, you can always purchase lactosefree milk and yogurt. You can also get calcium from other foods, like 1 cup of dried figs (300 mg), 1 cup of calcium fortified orange juice (300 mg), 4 ounces of tofu (100-400 mg) or 3 ounces of canned sardines (370 mg). Some vegetables and beans are high in calcium, but most contain phytates and oxalates – plant-based compounds that can interfere with calcium absorption. If you’re relying on vegetables like cooked spinach for your calcium intake, you will likely need to eat a larger volume to get a comparable amount of calcium. Soaking beans in water for several hours before cooking can decrease their phytate content and help mitigate this.
Vitamin D: As calcium’s nutrient partner, vitamin D helps the body absorb more calcium in the gut, which then travels to the bloodstream. In addition to helping regulate calcium levels, vitamin D also helps regulate phosphorous, another essential nutrient for bone mineralization. Adults age 19 to 70 need 600 international units (IUs) of vitamin D daily, while adults over 71 need 800 IU to help with bone health. Oily fish, like salmon, and mushrooms are two of the few natural food sources of vitamin D. A 3.5-ounce filet of salmon contains 400-700 IU of vitamin D, while a cup of mushrooms has about 132 IUs. To increase vitamin D intake through food, look for products like milk and cereals or oatmeal that are fortified with vitamin D. Additionally, you can meet your daily vitamin D needs with 15 minutes of sun exposure.
Protein: When we think of bone-building nutrients, we often forget protein. But it’s a major component of the foundation of bone structure. Protein makes up a significant portion of bone mass and volume via a network of fibers that serve as the foundation, or scaffolding for bone. Adequate protein intake helps the body produce hormones that modulate the building of new bone. Muscles, which are also made up of proteins, are attached to bones via tendons and directly contribute to bone strength and stability. Many dairy-based products, such as low fat milk, Greek yogurt and cottage cheese, serve as a two-forone in providing a nice hit of protein along with a hefty serving of calcium.
Exercise: When we exercise regularly, the bone adapts by building more bone and making existing bone denser, which cannot be done without adequate nutrition, especially calcium and vitamin D. It’s crucial to exercise is a variety of ways to challenge your muscles and bones to adapt. This should include strength or resistance exercises, such as weights or resistance bands, as well as higher impact activities, like jogging or jumping rope. The Physical Activity Guidelines for Americans state that we need at least 150 minutes per week of moderate-intensity exercise, including at least two days of muscle strengthening activity. Similar to how we want to ensure we have variety in our diet, we also want to ensure we have variety in our exercise routine.