Your guide to bone health

Nutritionist and registered dietitian Jo Travers offers some expert suggestions for looking after the health of your bones

Osteoporosis is one of the most common bone-related conditions, with 200 million people affected worldwide. In the US and UK alone, approximately 30 per cent of post-menopausal women have osteoporosis, with many more having osteopoenia. Both these conditions cause bones to become weaker.

Osteopoenia is defined as having lower than normal bone mineral density and can be a marker of progression towards osteoporosis (though it is possible to have osteopenia and not progress to osteoporosis if action is taken to protect bones). Osteoporosis occurs when bone density drops significantly below that of healthy bone. Diagnosis is made using a bone density scan with bones given a mineral density score.

The term osteo (meaning ‘bones’) porosis (meaning ‘porous’) perfectly describes the condition of bones, which feature a honeycomb of large pits and holes compared to dense, healthy bone. This low density weakens bones, leading to the risk of fracture. The bones most commonly affected by osteoporosis are those of the hips, spine, wrists and shoulders.

The causes of osteoporosis

Although a family history of osteoporosis is a risk factor for developing the condition, it is not a forgone conclusion. Taking care to modify the factors which can be modified can still prevent – or at least slow down the rate of – bone loss. Bones are constantly remodelling themselves, but as we age the process of bone breakdown is much faster than bone building, creating the risk that bone density may fall over time.

There are two main reasons why this process may tip over into osteoporosis: pre-existing low peak bone mass and conditions that cause bone breakdown. Developing osteoporosis is much more likely if you already have low peak bone mass. This can occur when insufficient bone is stockpiled during teenage and young adult years – the time when nutrient absorption rates are high and the skeleton is geared up for bone building.

Low peak bone mass means that there is less of a ‘buffer zone’ for bone loss when osteoblasts (the body’s bone-builders) are less active in adulthood. Conditions that cause excessive bone breakdown or insufficient formation of bone can also cause osteoporosis. Inadequate nutrition is a common factor in these conditions. One of the functions of bone is to act as a reservoir for minerals such as calcium and magnesium. When these micronutrients are running low in the body, mechanisms exist to make sure that these elements are released from bone into the blood so that they are available for use.

Other causes include hormone imbalances (occurring in menopause or as a result of hormone disorders), which interfere in the communication between bone cells; a low level of exercise, which means that bone growth isn’t stimulated; and a lack of sleep or poor sleep patterns which can increase the turnover of bone.

As we age, the amount of bone that is laid down by osteoblasts decreases and there are also changes in the mineral structure of our bones. Our ability to maintain the collagen mesh needed to ‘trap’ the slippery citrate that reduces friction between individual bone crystals deteriorates, allowing citrate to escape. This causes crystals to fuse together and become rigid, rather than sliding over one another, which decreases bones’ ability to absorb impacts and makes them more susceptible to fractures.

The ‘silent’ disease

Osteoporosis is often called a ‘silent’ disease because it doesn’t have many symptoms in its early stages. Fracturing a bone is usually the first indication that someone has osteoporosis: this is particularly common in older women who may experience a relatively minor fall but end up with a serious fracture, such as a broken hip. This type of fracture can severely limit mobility and it is common for people to never fully recover their independence. There can, however, be some visible signs of osteoporosis. Small fractures in the vertebrae can lead to a curved spine and height loss, and are responsible for the condition known as ‘dowager’s hump’, which indicates osteoporosis.

Key recommendations

By taking a holistic approach that involves a number of positive diet and lifestyle changes, we can significantly improve our bone health. Here are nine key recommendations that you should practise to ensure good bone health throughout your life.

1. Maintain an appropriate weight for your height.
A good way to determine this is to calculate your body mass index (BMI) and see if it falls within the healthy zone. There are also online BMI calculators.

2. Eat a balanced and varied diet containing plenty of plant-based foods.
Eating plenty of fruits, vegetables, wholegrain carbohydrates (such as brown rice), protein and some fat will ensure you supply your body with the correct range of vitamins, minerals and phytonutrients.

3. Manage internal inflammation.
Some foods, such as refined sugars, cause inflammation in the body which can affect bone health. Following a diet like the Mediterranean diet will give you everything you need without too much of what you don’t, ensuring inflammation is kept to a minimum.

4. Get enough sleep.
Bone-building cells are linked to our circadian cycle and need us to sleep well and at the right times in order to function effectively. Seek advice from your GP if you have persistent sleep problems.

5. If you don’t get a lot of sun, take a vitamin D supplement.
This is important if you have dark skin, cover your skin, or spend most of your time inside, even in the summer.

6. Do regular weight-bearing exercise.
This type of exercise strengthens bone and encourages bone regeneration. Combining weight-bearing exercise with activities that involve impact and balance brings even greater benefits.

7. Take steps to reduce stress in your life.
Reducing cortisol levels is important for bone health. Try practising meditation or mindfulness to alleviate stress and seek medical help if you find you cannot manage your stress levels.

8. Give up smoking.
This will benefit your whole body, not just your bones.

9. Limit alcohol intake to under 14 units a week.
Alcohol in moderate amounts is unlikely to harm bones, but excessive intake can affect bone density.

Extracted from The Bone-Strength Plan by Jo Travers (£12.99, Welbeck Publishing). Jo Travers is a professional, evidence-based nutritionist and registered dietitian. She runs a consultancy called The London Nutritionist where she carries out one-to-one consultations and delivers workshops.

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