It is important to build strong and healthy bones during childhood and adolescence. Steps can be taken to protect bone health in adulthood too. Bones are continuously changing – new bone is made and old bone broken down . Most people have peak bone health at the age of 30 years and after that remodelling continues but most people will lose slightly more bone mass than gained.
Calcium is required to maintain healthy bones , teeth and muscles. Good sources are milk, cheese and other dairy , green leafy vegetables, soya with added calcium , bread (and anything made with fortified flour) and fish (sardines, pilchards).
Vitamin D is required to help regulate calcium and phosphate in the body . These nutrients are required to help keep bones , teeth and muscles healthy. A lack of Vitamin D can leads to rickets in children and bone pain caused by osteomalacia in adults. It is advised that everyone should consider taking a vitamin D supplement during the autumn and winter months. Good sources are oily fish, red meat , liver , egg yolks, fortified foods such as fat spreads and cereals. In the UK cow’s milk is not a good source of Vit D (but it is good for calcium) because it is not fortified as it is in other countries . If people choose to take Vit D supplements, 10 micrograms daily will be enough for most people.
It is important to load bones – being inactive makes muscles and bones lose strength and therefore increases the risk of sustaining low energy fractures. Classic sites for this are the wrist, the hip and the spine. Brisk walking , dancing , running , swiming, sports are good examples of loading bones. Some strength work (weights) and working on balance (yoga , pilates) and flexibility are also important for strong bones.
Smoking and Alcohol
Research suggests that smoking may contribute to weaker bones and similarly drinking too much alcohol may also increase the risk of osteoporosis.
Sex
Women are at greater risk of osteoporosis especially after the menopause as oestrogen levels drop. Prolonged absence of menstruation (amenorrhea) before the menopause also increases the risk of osteoporosis. In men, low testosterone levels can cause loss of bone mass.
Our maximum bone size and strength is called the peak bone mass (PBM). Genes play an important role but the peak bone mass can be affected significantly by diet and exercise. There is a limited time that we can influence our PBM. The best time to build bone density is during childhood and adolescence. Most people will reach their PBM by age 30 years. The higher the PBM , the better protected we are from osteoporosis in later life. Bones become less dense as one ages. After the age of 50 years bone breakdown (resorption) outpaces bone formation and bone loss accelerates, particularly at the time of menopause.
People of Asian and White descent are at greater risk of osteoporosis, as are people with a positive family history.
Eating disorders and other conditions
Severe restriction of food intake and being underweight will weaken bones in both men and women . In addition weight loss surgery as well as those with conditions such as Coeliac’s disease need to compensate for the body’s reduced ability to absorb calcium.
Vegan Diet
People on a vegan can lead a perfectly healthy life. Good sources of calcium & vitamin D are green leafy vegetables (broccol etc) , fortified soya , rice and oat drinks, calcium set tofu, sesame seeds and tahini, pulses , brown & white bread (in UK calcium is added to flour by law). A healthy vegan diet would comprise
-at least 5 portions of fruit & vegetable daily
-meals based on potatoes, bread , pasta or other starchy carbohydrates (wholegrain where possible)
-dairy alternative such as soya drinks and yoghurts (lower fat , lower sugar options)
-beans , pulses other proteins
-unsaturated oils and spreads
-consider nutrient supplements such as calcium , vitamin D, Vit B12 and Iron. Good sources of vitamin D for vegans are exposure to sunlight (especially from March to the end of September), fortified spreads, cereals & soya drinks (with vitamin D added).
Long term use of oral steroids (prednisolone , cortisone , dexamethasone) is damaging for bone health. Some of the drugs used as chemotherapy for breast cancer (aromatase inhibitors) , methotrexate (use in rheumatoid arthritis)and anti-epileptic medication. (eg phenytoin) can also negatively impact on bone health so it is important that they are discussed with your prescribing doctor and whether vitamin D and calcium supplements are required .
