How to keep your bones strong

Bone health is something we become increasingly aware of as we age, yet we may not know how best to preserve it.

With one in three women and one in five men over 50 estimated to suffer bone ‘fragility fractures’ in their lifetime, the risks from not taking action is high.

Dr Carrie Ruxton is an independent dietitian and works with businesses and industry bodies including The Health and Food Supplements Information Service, Quality Meat Scotland and The Nutrition Society.

She is a passionate advocate of eating a healthy balanced diet, but also emphasises the important role that exercise and hormones play in bone health.

She also provides nutritional and fitness coaching through family business Ruxton Fitness.

Why we should start today

Dr Carrie Ruxton

While we see bone health as something that deteriorates in mid-life, Dr Ruxton explains our bone mass peaks much earlier.

“Young kids and young people are generally very active. Bones are growing and developing all of those years.

“And in fact, bones don’t stop developing until mid 20s.

“Men’s bones age a little bit more slowly, so they’re peaking off at around about mid-20s. Women will peak in the early 20s.

“Your bones are a little bit like the old-fashioned sponges that have got lots of holes in them.

“The holes gradually fill up with minerals, particularly calcium, things like magnesium and phosphorus, and they get hard over time.

“The trouble happens with us women, when we get to the menopause and get a decline in certain hormones like estrogen.

“Estrogen is protective to bones so they start to leak out minerals and we’re losing that density.”

Though in an ideal world we should protect our bone mass right through life, we can start slowing decline at any age.

What to eat for bone health

Dr Ruxton said: “There’s a family of nutrients we need for good bone health. The biggest one is obviously calcium, because most of the calcium in our bodies is in our bones and teeth, and some of it’s circulating in our blood.

“Now the body has to keep the blood levels of all nutrients and substances within very tight ranges. If you then start to lose calcium in your blood for any reason then the bones will be the first port of call for pulling some of that calcium in.

“So we want to have calcium in our diets on a daily basis.

“The second one that’s most vital is vitamin D, because calcium can’t get into the bone matrix without vitamin D.

“Other important nutrients are things like magnesium and phosphorus, which are also minerals and proteins. So if you’ve got a very low protein diet, that’s also going to have an impact on your bones.”

For physically active people, Dr Ruxton recommends at least one gram of protein per kilogram of body weight spaced across meals.

She also flags vitamin C as being important for bone health because it helps us make collagen which holds our bone structure together.

Dr Ruxton cites dairy as being the best source for calcium but adds: “You can also find it in plant sources, including in green leafy vegetables, nuts and seeds.

“A lot of products are being fortified with calcium. So if you are vegan or avoiding dairy products and you’re taking a plant milk, then have a check of the label.”

And while we can source vitamin D from sunshine, that becomes more difficult in the winter months.

Dr Ruxton recommends taking a daily supplement, with up to 100 micrograms (4000ius) the highest strength within daily safety limits for those who may be very low in vitamin D.

The best forms of exercise for bones

Exercise also plays a vital part in maintaining bone density.

And while there has been a lot of attention played in recent years to the role of weight lifting and resistance training, Dr Ruxton also believes it’s important to get out of breath and create a little impact for our bones.

“I’m a huge fan of CrossFit because it’s functional fitness, it’s a combination of cardiovascular and also weight training.

“And before anybody says, ‘Oh, I’m far too old for weight training’, it’s is absolutely essential for people of all ages. It maintains and builds your muscle mass, and helps your strength and balance.”

The CrossFit programme covers a range of physical skills through high and low intensity exercises, factoring in cardiovascular and respiratory endurance, stamina, strength, flexibility, power, speed, coordination, agility, balance, and accuracy.

But if that sounds intimidating, Dr Ruxton has this to say.

“Everything can be scaled. So in my exercise class I’ve got a man in his 70s who’s recovering from cancer treatment and my daughter, who’s 14.

“If you’re just starting out with exercise, I would actually suggest getting down to your gym and getting a little bit of personal training just to get a programme you can follow.”

HRT

And when it comes to hormone replacement for bone health, Dr Ruxton acknowledges it’s a personal choice but has herself benefited from HRT.

She said: “I personally think HRT is a really good thing. I saw a study a few years ago which said that they had postmenopausal women doing weight training, and the group that were on HRT found it much easier to build muscle mass than the group who were not on HRT.

“It’s not just about bone health, it’s about muscle health and function as well. So I think it’s worth every woman who is interested in this to go and speak to their doctor. I certainly feel so much better.”

BONE HEALTH FACTS

  • Bones are made from living, growing tissue with three major components – protein, collagen and minerals.
  • The body is constantly remodelling the skeleton by building up new and breaking down old bone tissue.
  • Healthy bone needs a balanced diet, regular weight-bearing exercise and the right levels of various hormones.
  • The process of bone formation also requires an adequate and constant supply of nutrients including calcium and vitamin D.
  • Calcium is the most important mineral for bone health. But others play a role, including magnesium, boron, iron, copper, phosphorus, potassium and zinc.
  • Heavy drinking can damage bone health. It’s thought to interfere with the body’s ability to absorb calcium and vitamin D and can affect hormone levels.
  • Osteoporosis is a health condition that weakens bones making them fragile and more likely to break.
  • Many factors contribute to the condition, including declines in hormone levels as well as genetics, and lifestyle.
  • Women are more at risk of developing osteoporosis earlier than men. This is due to the hormone changes that happen in menopause directly affecting bone density.
  • Osteoporosis usually starts later and progresses more slowly in men but can still be a significant factor in healthy aging.