Bone health is something that nutrition plays a major role in. Poor nutrition lacking in important vitamins and minerals, especially in childhood and adolescence years when bones are developing, can be detrimental to bone strength. Peak bone mass is reached by about30-35 years (Waugh and Grant, 2014). At around 40 years bone mass begins to slowly decrease with age. For women a phase of rapid bone loss occurs during the first 5 – 10 years post menopause, then the bone loss slows down (Gandy, 2019). It is believed that this is due to reduced oestrogen levels (Waugh and Grant, 2014). Therefore, women are at higher risk of developing Osteoporosis later in life.

Osteoporosis Effects over 10% of the world’s population and 1 in 2 women over the age of 50 (Weaver, 2017). Osteoporosis is also the most common bone disorder among elderly males and females. It occurs when the bones become porous and fragile due to loss of minerals, this means they are more susceptible to breakages and fractures. Common symptoms include.

Gradual loss of height because the vertebrae become compressed
Bone pain
Fractures
Osteoporosis is not caused by a nutrient deficiency at the time when diagnosed, but having a diet low in important nutrients such as Calcium and vitamin D during childhood and adolescence means your peak bone mass won’t be very high, meaning as your bone mass decreases with age (this happens naturally as we age) you will be at higher risk of developing Osteoporosis. Therefore, it’s so important for children and teenagers to have balanced diets and to avoid going on restrictive diets that could limit their intake of important nutrients. About 60% of adult bone mass is gained during puberty (Waugh and Grant, 2014).

It’s not just nutrition which affects your risk of developing Osteoporosis. Genetics plays a massive 70-80% role in determining bone strength (Waugh and Grant, 2014). Other factors include age (bones begin to weaken at around the age of 40), gender (females are typically more at risk for osteoporosis than males), nutrition and lifestyle.

One bone disorder which is influenced by a nutrient deficiency is Ricketts or Osteomalacia. These occur when bone is inadequately mineralised due to a vitamin D deficiency. Now this vitamin D deficiency could either be caused by a diet lacking in vitamin D or by malabsorption meaning the vitamin D consumed isn’t absorbed by the body. In children whose bones are still growing this leads to Ricketts. In adults it’s referred to as Osteomalacia. Same as the Shingles is an adult version of the Chickenpox!

Now for the nutrients you need to include in your diet from childhood right up to adulthood to keep those bones strong and healthy!

Nutrient Why it’s important Sources RDA
Calcium Calcium and phosphorus make healthy bones and the bones are the main storage site for the body’s calcium.  The body can’t make Calcium so it must be consumed via food, drink or supplement. Dairy, green leafy veg, calcium fortified almond or soya products, fortified bread, fish when the bones are eaten (like in canned sardines or salmon), dried peas & beans 18-24 (men & women) is 1000mg/day   ≥25 (men & women) is 950mg/day   Upper limit is 2500mg/day
Magnesium Magnesium deficiency may be a risk factor for developing osteoporosis.  Studies have shown that diet rich in Magnesium are associated with higher Bone Mass Density in the elderly Green leafy veg, nuts & seeds (pumpkin seeds, almonds, cashews & peanuts), wholegrains 300mg/day for females   350mg/day for males
Potassium A diet rich in Potassium can help reduce urinary calcium loss.  Same as how a diet low in Potassium can increase urinary calcium loss. Bananas, oranges, apricots, cantaloupe, honeydew, grapefruits, potatoes, sweet potatoes, cooked spinach, cooked broccoli, mushrooms, peas, cucumbers 3500mg/day for males and females
Zinc Zinc plays a role in osteoblastic bone formation and mineralisation  (Yamaguchi, 2010) Wholegrains, oysters, red meat, poultry, baked beans, chickpeas, nuts (almonds & cashews) 7.5-12.7mg/day for females (over 50 it’s 8mg/day)   9.4-16.3mg for males (over 50 11mg/day)   Upper limit is 25mg/day
Iron Iron is a co-factor for the enzymes involved in collagen synthesis.  Low Iron levels have been shown to lead to low bone strength.  Vitamin C increases the absorption of Iron (Minerals for Bone Health – American Bone Health, 2016) Haem iron (more easily absorbed by the body)-offal and red meat   Non-haem iron (less easily absorbed by the body) – dark green leafy veg Females – premenopausal (≥18) is 16mg/day Post menopause (≥40) is 11mg/day   For males it’s 11mg/day
Copper The body uses copper to synthesis connective tissue (Minerals for Bone Health – American Bone Health, 2016) Avocados, chickpeas, nuts (cashews), mushrooms, beef liver, oysters, potatoes, wheat-bran cereals, whole grains, tofu, and chocolate. Females 1.3mg/day Males 1.6mg/day The upper limit for males and females is 5mg/day
Vitamin A Vitamin A influences the osteoblasts (bone building cells) and osteoclasts (bone break-down cells).  However, too much vitamin A has been shown to reduce bone density. Cod liver oil, eggs, fortified breakfast cereals, fortified skimmed milk, orange and yellow fruits & veg, dark green leafy veg Females 650µg/day   Males 750µg/day   Upper limit is 3000µg/day
Vitamin C Used by the body to synthesis collagen which is abundant in the connective tissue of cartilage and bone.  Collagen makes up 30% of our bones. All fruits and vegetables especially brightly coloured ones Females 95mg/day   Males 110mg/day
Vitamin D Aids the absorption of Calcium and Phosphorus in the intestinal tract Egg yolks, liver, mushrooms, oily fish, red meat, fortified foods For males & females 15µg/day   Upper limit is 100mg/day
Vitamin K Vitamin K is important for normal bone growth & development.  About 50% of our required daily amount of vitamin K is made by the good gut bacteria.  Vitamin K helps attract Calcium to the bones  (Vitamins for Bone Health – American Bone Health, 2016) Dark green leafy veg, fish liver oil, meat, eggs, cereal For males & Females 70µg/day
Protein Meat, fish, poultry, dairy, soya and soya products, nuts and seeds, legumes (peas, beans and lentils) 0.8g/kg of body weight per day for the average person 1.2-2g/kg of bodyweight per day for athletes

(Dietary Reference Values | DRV Finder, 2017)

So that’s all the nutrients that are important for bone health, but what nutrition and lifestyle choices can decrease bone health?

  • Animal protein -I know above it says how important protein is for bone health, but too much animal protein could be harmful.  Animal proteins (especially eggs) contain sulphur which changes to sulphuric acid.  This increases the acidity of the blood and as the body tries to neutralize the blood bone dissolves into the bloodstream and filters through the kidneys.  This doesn’t mean you have to go full on Vegan if you don’t wish, but it is a good idea to explore sources of vegetable protein and try to incorporate more of these into your diet when you can.
  • Too much sodium would mainly be associated with causing high blood pressure, but it can also affect bone health.  Sodium encourages Calcium to pass through the kidneys instead of strengthening the bones.  Reducing your sodium intake by 1-2g/day could reduce your required Calcium intake my 160mg/day!
  • Phosphorus is a form of phosphate and 80–90% of the mineral content of bone is made up of calcium and phosphorus, and 85% of the phosphorus found in the body is in the skeleton. Phosphorus is very important for healthy bones.  It is recommended that an intake of about 550mg/day of phosphorus should be adequate for most adults needs.  However a higher total dietary intake of Phosphorus has been associated with increased Parathyroid Hormone (PTH) secretion and lower serum Calcium concentrations in healthy individuals (Takeda et al., 2014).  Thus, leading to weakened bones.  Phosphorus can be found in many foods.  These include dairy products, meats and poultry, fish, eggs, nuts, legumes, vegetables, and grains.  Food additives also contribute about 10 – 50% of Phosphorus intakes in most Western diets (Itkonen et al., 2017).  Soft drinks, especially cola drinks, contain Caffeine and Phosphoric acid which may adversely affect bone health.
  • Long term heavy alcohol consumption, especially in teenage years, increases a person’s risk of developing Osteoporosis.  Basically, alcohol inhibits the absorption of Calcium by the stomach.  It also affects the absorption of Calcium and vitamin D by the pancreas.  The liver also plays a role in activating vitamin D, which is so important for Calcium absorption, and alcohol also adversely affects the liver (Davis, 2010).
  • Smoking restricts blood flow that nourishes bones, muscles and joints with oxygen and helps them heal. A smoker’s body’s ability to absorb calcium is adversely affected, leading to lower bone density and weaker bones. Nicotine also slows the production of the bone-forming cells that are so crucial to healing.
  • Inactivity may not be a nutritional element to bone health, but it’s no less important.  Weight bearing and resistance exercises will help keep your bones and muscles strong.  Pilates and yoga are very safe and effective ways to keep your muscles, bones and joints strong.

So, in conclusion what I hope you take away from this is that bone health isn’t something your can physically keep an eye on till it’s too late.  Until you get that fracture or start getting bone pain.  That’s why a healthy balanced diet from childhood to adulthood is so so important.  Calcium and vitamin D are the two nutrients most people associate with strong bones and that’s probably due to the dairy industry advertising their products as great sources of these.  Which is true but remember there are other nutrients that also play a role in making and maintaining strong healthy bones.  If you don’t consume dairy for whatever reason be it by choice as a Vegan, maybe you have an allergy or intolerance, you must remember to substitute with other foods rich in the vitamins and minerals dairy foods would have provided.  It can be done!

Reference

Davis, J.L. (2010) Osteoporosis Tips for the Tipsy Available from https://www.webmd.com/osteoporosis/features/alcohol [accessed 20 March 2021].

Dietary Reference Values | DRV Finder (2017) Available from https://www.efsa.europa.eu/en/interactive-pages/drvs [accessed 19 November 2020].

Gandy, J. (2019) Manual of Dietetic Practice. John Wiley & Sons.

Itkonen, S.T., Karp, H.J. and Lamberg-Allardt, C.J.E. (2017) Bioavailability of Phosphorus. In: Dietary Phosphorus: Health, Nutrition and Regulatory Aspects. 1st edition 14.

Minerals for Bone Health – American Bone Health (2016) Available from https://americanbonehealth.org/nutrition/minerals-for-bone-health/ [accessed 20 March 2021].

Takeda, E., Yamamoto, H., Yamanaka-Okumura, H. and Taketani, Y. (2014) Increasing Dietary Phosphorus Intake from Food Additives: Potential for Negative Impact on Bone Health. Advances in Nutrition, 5(1) 92–97. Available from https://doi.org/10.3945/an.113.004002 [accessed 19 March 2021].

Vitamins for Bone Health – American Bone Health (2016) Available from https://americanbonehealth.org/nutrition/vitamins-for-bone-health/ [accessed 20 March 2021].

Waugh, A. and Grant, A. (2014) The musculoskeletal system. In: Ross and Wilson Anatomy and Physiology in Health and Illness, 12e. 12th edition Edinburgh ; New York: Churchill Livingstone, 390–435.

Weaver, C.M. (2017) Nutrition and bone health. Oral Diseases, 23(4) 412–415.

Yamaguchi, M. (2010) Role of nutritional zinc in the prevention of osteoporosis. Molecular and Cellular Biochemistry, 338(1–2) 241–254.

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