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Strong bones are important for all ages. While bone health is critical for healthy ageing, it’s the bones you bank today that can protect you from osteoporosis later. Article first published in Nourish Magazine.

Your bone bank account

When it comes to bone health, we often associate it with ageing, although we should be paying attention to our bones much earlier than this. The more bone mass we ‘bank’ in our younger years, the better protected we are from osteoporosis and fractures later in life.

Puberty is often correlated with growing taller, but what isn’t as obvious is the rapid increase in bone mass, reaching its maximum when we are around 25 to 30 years of age. By the time we are in our forties and fifties, we slowly begin to lose bone mass as a normal part of aging. We can, however, take steps to optimise bone health at any age to avoid osteopaenia or osteoporosis later in life.

Osteoporosis is a condition that results in loss of bone strength, making bones more fragile and prone to fractures. Osteopaenia, often referred to as ‘pre-osteoporosis’, is where bone mass is abnormally low, but not to the same extent as osteoporosis.

As a general rule of thumb, bone formation tends to slightly exceed bone breakdown in the first half of our life, contributing to an increase in bone mass during our younger years. In the second half of our life, bone breakdown exceeds bone formation, tipping the balance towards a gradual decrease in bone mass over time. Osteopaenia and osteoporosis occur when bone mass decreases more than what would typically be expected as part of ageing.

Osteoporosis is a common condition in both men and women, although it is more common in women. For women, the drop in oestrogen levels that occurs around menopause upsets the balance of bone remodelling, resulting in increased bone loss. An initial rapid decrease is often experienced, which tends to slow over time. For men, the rapid bone loss phase tends to be delayed, typically commencing in their mid to late sixties. For most of us, bone loss can be significantly slowed through proper nutrition and regular exercise.

         For most of us, bone loss can be significantly slowed through proper nutrition and regular exercise.

The best nutrition for strong bones

Let’s get one thing out of the way first. ‘Milk builds strong bones’ is a reductionist way of approaching this important part of human health. Bone health is much more complex than consuming adequate calcium. First, achieving and maintaining excellent bone health is multifactorial: it is a combination of excellent nutrition, regular physical activity, sunlight exposure, and avoiding factors that can be detrimental to bone health where possible. Second, more than adequate dietary calcium levels can be achieved by adopting a diverse wholefood, plant-based diet that excludes dairy. And third, from a purely nutritional perspective, while calcium forms a critical dietary contribution to bone health, there are many other dietary factors that work to either optimise or hinder bone health.

If you already eat a diverse diet rich in whole plant foods while minimising processed foods, you are well-on the way to achieving and maintaining bone health. Let’s explore some important nutritional requirements required for healthy bones.

Calcium

It is well known that calcium is an important nutrient for healthy bones, and over 98 percent of our body’s calcium is held within our bones. Here’s the catch with that pervasive milk marketing: while dairy products contain calcium, they also regularly contain growth factors, lactose sugar, occasional contaminants, and often a significant amount of fat and cholesterol, making them an unfavourable choice for obtaining this nutrient.

As a general rule, the most healthful calcium sources are green leafy vegetables and legumes. Broccoli, Brussels sprouts, kale, and other greens are loaded with highly absorbable calcium and a host of other healthful properties. Exceptions are spinach and chard, which contain a large amount of calcium but hold on to it tenaciously, making it difficult to absorb. You will also find plenty of calcium in legumes including chickpeas, beans, and lentils. Soy products like tofu and soy milk are available fortified with calcium (look out for at least 100mg of added calcium per 100mL). These also contain phytoestrogens, or plant compounds, that have a similar structure to oestrogen and help to reduce excessive bone breakdown.

Magnesium

Approximately 60 percent of this essential mineral is found in bone. Low magnesium intake is associated with a lower bone mass. Beans and greens are magnesium rich, while other great sources are whole grains, nuts and seeds, bananas, and even dark chocolate (80 percent cocoa or more). Stick to a high-quality vegan variety and remember, don’t go crazy, it comes with other additives we are best to minimise.

Vitamin D

The importance of vitamin D for bone health is evident through the range of bone conditions that can be experienced when intake is inadequate, in particular Rickett’s disease and osteomalacia. While vitamin D is often considered a dietary requirement, it is primarily obtained from sunlight, and only small quantities actually come from our food. Vitamin D is crucial in promoting calcium absorption into the bloodstream from the gastrointestinal tract. The best and most efficient way for us to obtain vitamin D is through sunlight exposure. If you can’t obtain adequate sun exposure, then a supplement is recommended.

Vitamin K

Several studies have found low vitamin K intake to be associated with low bone mass and increased risk of fractures. Good sources of vitamin K include dark green leafy vegetables such as spinach and kale. Just one cup of raw spinach will provide more than the recommended daily intake. Other sources include Brussels sprouts, broccoli, cauliflower, and blueberries.

Zinc, Copper, Manganese and Phosphorus

Zinc, copper, and manganese have been shown to play an important role in bone health while phosphorous is necessary to support increases in bone mass, and is predominantly stored with calcium in bones. All of these can be found in abundance in a variety of plant foods: wholegrains, legumes, nuts, seeds, fruits, and vegetables.

The bone thieves

So, we now know eating a variety of whole plant foods is important for supporting strong bones. But there are also factors that can diminishdimmish bone health These are often referred to as the ‘bone thieves’. Here’s what you might want to avoid or limit where possible.

Alcohol

Excessive alcohol consumption is a well-recognised risk factor for decreased bone mass and osteoporosis. Simply put, it has a toxic effect on our bone forming cells.

Medications

Corticosteriods Corticosteroids such as prednisone suppress bone formation, contributing to a decline in bone mass and an increased risk of osteoporosis. Certain anti-seizure medications are associated with Vitamin D deficiency, also negatively affecting bone health. It’s important to remember that medication is frequently necessary. In situations where chronic usage is unavoidable, a proper assessment of bone health should be conducted and bisphosphonate treatment may be considered.

Smoking

There are many reasons to take heed of this message, although you may be interested to know that achieving and maintaining healthy bones is one of them. Smoking creates an imbalance in bone turnover, contributing to lower bone mass and an increased risk of osteoporosis.

Sugar-sweetened drinks and caffeine

Soft drinks are high in phosphates that tend to inhibit calcium absorption. Both soft drinks and sugar-sweetened beverages (especially cola drinks) are associated with increased risk of fractures. Be aware that caffeinated beverages such as coffee are associated with accelerated bone loss. It’s best to keep coffee to a minimum and, ideally, eliminate sugar-sweetened drinks.

This article is republished with permission from nourishmagazine.com.au.