I've been digging into osteoporosis lately, and the equation EXERCISE + CALCIUM = STRONG BONES, isn't as simple as is seems. Although these are important, there are also many other factors that contribute to how your bones will hold up (literally) as you age. Prevention is KEY when it comes to osteoporosis, as it is actually considered a pediatric disease with geriatric consequences. At least 1 in 3 women, and 1 in 5 men will suffer from an osteoporotic fracture in their lifetime. Here are some things to consider NOW, that may be affecting your family's bone health.
1. Calcium intake - are you getting enough? The obvious sources are dairy and fortified beverages, but there are several other sources of calcium, including canned fish, tofu, beans, some nuts & seeds, and cooked spinach. Check out this resource to find out more. However, calcium for bone health isn't that simple, also need to consider its absorption and deposition in bones.
2. Low Vitamin D - this hormone is essential for maintaining blood calcium levels, enhancing absorption of calcium, and depositing calcium and other minerals into bone. The RDI of 600-1000IU/d may not be enough to maintain optimal blood levels. It's a good idea to get your blood levels checked by your health team if you live in Canada or have other symptoms of vitamin D deficiency.
3. Vitamin K (1&2) - are responsible for activation of the bone-building protein called osteocalcin, and helps attract calcium to bone, reducing bone turnover and improving bone strength. Foods rich in vitamin K1 include cabbage, cauliflower, spinach, cereals, and soybeans. Vitamin K2 is found in meats and cheeses. Long-term supplementation with vitamin D should often be balanced with vitamin K - talk to your health team about what's best for you.
4. Other important minerals are also part of bone structure and balancing calcium levels. These include boron, strontium, silicon, manganese, magnesium, zinc, & copper. Typical diets are often deficient in these minerals, and supplementation may be necessary.
5. Excess red meat, soda, & caffeine - these acidify the gut & blood, reducing calcium absorption and causing blood to be less alkaline, which leads to breakdown of bone structure. Avoid these foods and/or balance them out with lots of alkalinizing foods, including most veggies and fruits! Children who consume 3+ servings of vegetables per day have lower excretion of calcium in their urine, meaning more is being deposited in their bones!
6. Too much OR too little protein harms your Bone Mineral Density (BMD), which is the ultimate marker of fracture risk. Medical screening of BMD doesn't occur until later in life, so consider optimizing your protein intake now. Healthy protein intake is dependent on weight, sex, activity level, and your dietary sources (plant vs. animal protein). Talk to someone trained in nutrition to decide how much protein you need daily, and which sources are best for your health.
7. Exercise. Active children and young adults continue to deposit bone until about 30yoa, but maintenance of that bone strength through adulthood and aging also requires regular physical activity. Consider using the stairs when possible and regular resistance or weight training. This causes your muscles to push and pull against your bones, telling your body to form new bone tissue, which strengthens your bones. It also helps with coordination and balance to prevent falls!
8. Stress, Cushing's syndrome & Corticosteroids overuse can increase the risk of osteoporosis due to the indirect action of cortisol on calcium absorption in the intestine, direct effect of glucocorticoids on bone-building cells (called osteoblasts), inhibition of hormones such as insulin-like growth factor-1 that promote bone deposition, and increased bone breakdown & excretion of calcium from the kidneys. Other conditions that may affect bone health include hyperthyroidism or thyroxine overuse, hyperparathyroidism, multiple myeloma, and more (see below).
10. Gut & Malabsorption syndromes such as IBS, inflammatory bowel disease, celiac and liver disease can impact your ability to absorb calcium and other nutrients. This often leads to secondary osteoporosis and significant increase in risk of osteoporotic fracture (among other conditions). Management of these conditions, improving nutritional adequacy, and limiting use of medications such as proton-pump inhibitors and glucocorticoids will help reduce your risk.
9. Menopause + low estrogen in women. Typical bone loss in premenopausal women is quite slow, but increases significantly post-menopause due to a decrease in estrogen production by the ovaries. In the 5 years after menopause, nutritional supplementation has very little effect on bone loss, as rapid loss of estrogen causes high bone resorption rate. Although important to maintain nutritional intake of calcium, vitamin D and the others mentioned, I must emphasize the importance of bone building before menopause occurs, and maintenance of bone health during menopause. Inquire with your health team about your risk, and botanical and dietary recommendations to help balance hormones. For the men - yes, testosterone deficiency in men can also affect bone strength in similar ways. Talk to your doc about other signs/symptoms of testosterone deficiency and optimization.
If you're over 40 and have had a BMD scan, learn more about your fracture risk with the the FRAX risk assessment tool.
We're all healthy until we're not.
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In health & happiness,
Dr.Nicole
Note: not all recommendations are right for everyone, and are for information purposes only. Talk to your healthcare team about your health and options for preventing bone disease.