How To Improve Your Bone Health
Osteoporosis Is More Common Than You Think
Recent figures show 14,000 women die each year as a result of complications from hip fractures, compared with 11,684 deaths from breast cancer. Your lifetime risk of a hip fracture is one in six compared to a one in nine risk of developing breast cancer. “As you age, your rate of bone turnover increases and, often, old bone tissue breaks down faster than your body is able to replace it,” explains Dr Naomi Newman-Beinart, nutritionist and specialist in health psychology working with Correxiko. “This process leads to bone density loss and, eventually, osteopenia and osteoporosis.”
Gabriella Espinosa, nutrition and lifestyle coach and yoga teacher, adds that conditions such as osteopenia, which is considered a midway point to osteoporosis where bones become thinner and less dense than normal, can occur without any major symptoms. Osteoporosis, on the other hand, comes further down the line, and creates small holes or weakened areas in bone mass, leading to an increased risk of breaks, fractures and loss of spinal flexion. “It is known as the silent disease as many women aren’t aware they have the condition until they are in their 70s and 80s and experience a fall, fracture or break a bone,” she adds.
It's Worth Getting Tested
The only way to check your bone density is through a special type of X-ray called a DEXA scan – a painless procedure that takes five minutes. If you had an early menopause, a broken bone after a minor fall or injury, have arthritis or are postmenopausal and smoke or drink heavily, have a family history of hip fractures, or a BMI of less than 21, your GP should arrange this X-ray for you. If you have osteoporosis or osteopenia, you will be offered further scans every two to three years. “If you are diagnosed with either of these, it could also be worth considering medical options for treatment, including bisphosphonates and hormone replacement therapy (HRT),” advises Gabriella.
It’s Not Too Late
“Looking after your bones, especially after the age of 50, is vital for longevity, and there is plenty you can do post-menopause,” Gabriella stresses. Most people think of the skeleton as being static and that it doesn’t change but, in reality, we replace our skeletons around every ten years. Skeletons are always undergoing a process of remodelling, meaning that’s it not too late to protect yours. As Gabriella explains: “The groundwork of your bone’s matrix is laid by your mid-20s with maximum bone density reached in your 30s. Bones begin their natural breaking-down process from your 30s and 40s, with accelerated bone loss in your 50s as oestrogen levels decline with the onset of menopause and continued gradual loss in older age. In fact, around 10% of a woman’s bone mass is lost in the first five years of menopause, but there are plenty of measures you can take during your 50s, 60s and beyond that can help build a stronger body.”
Up Your Protein Intake
The experts are evangelical about increasing your protein intake as you age, something they say is vital for a healthy body. “In order to flourish in your fifties and beyond, you need to include more protein in your diet,” stresses Dr Newman-Beinart. “Protein acts as the building blocks to the human body and is even more important as we age. Alongside the huge hormonal changes that happen to women over the age of 50, there is also a decrease in basal metabolic rate (the total number of calories your body needs to perform basic functions), muscle mass and bone density.” An increase in protein consumption aids all of these things and isn’t as scary as it sounds.”
She says that women over the age of 50 should be consuming around 1.2g of protein per kilogram of body weight. “Meat isn’t the only source of protein and shouldn’t be relied upon either. Try to include more oily fish, organic eggs, pulses, legumes and nuts,” she adds. If you needed further convincing of the importance of protein to preserve muscle mass, Dr Baker adds that by the age of 70, you’ll have lost half of the muscle you had when you were 25.
Think About Oestrogen, Too
As Rebecca Rohrer, clinical fellow for Bupa UK, explains, oestrogen also plays a vital role in protecting bone strength. “Women have lower levels of oestrogen as they age, especially post menopause. Women are more at risk of osteoporosis than men, particularly if you had an early menopause. Eating soya-based foods can help counter some of the negative effects of the menopause by naturally boosting oestrogen levels – try to eat more tofu, soy milk, miso, tempeh and edamame beans. A recent study found that adding soy protein to the diet of laboratory animals increased their bone density.”
Adopt A Calcium-Rich Diet
In an era of alternative milk mania, the belief that cow’s milk is critical for building bones may seem a little outdated. However, there may be something to it, says Gabriella. “Whole milk is an excellent source of calcium if you can tolerate it. Calcium is essential for keeping bones strong and maintaining bone density. You should aim for 1,000mg per day, especially if you have been diagnosed with osteoporosis.” Remember your daily dose of calcium needn’t always come from milk: “Dairy products are rich sources of calcium but they aren’t the only options out there,” adds Dr Newman-Beinart. “Other options include tofu, almonds, seeds and dried fruit, tinned fish like sardines and anchovies, and green leafy vegetables.”
Calcium goes hand in hand with vitamin D, adds Gabriella, who says that calcium cannot be properly absorbed by the body without the help of the sunshine vitamin, so ensure you’re getting 20 minutes of sun exposure each day and supplementing in the winter months. Professor Dr Maureen Baker, chief medical officer at Healthily, says you should aim for 600 international units of vitamin D daily. If, however, you have been diagnosed with osteoporosis, she adds, you may be prescribed a vitamin D supplement with a much higher strength.
Stay Active
“One of the best things you can do to preserve bone health once you hit your fifties is to stay active, especially with weight-bearing exercises,” says Gabriella. “Aim for 20-30 minutes of muscle-building strength training three days per week with light weights or resistance bands, in addition to daily weight bearing exercise such as walking, light jogging, yoga, Pilates, dancing and even climbing the stairs.” Rohrer agrees, adding that those who lead a sedentary lifestyle have a higher risk of osteoporosis. If you already lead an active lifestyle, consider high intensity interval training (HIIT), which research shows could be particularly beneficial for bones. One study, in fact, found women who did 60-120 seconds per day of weight bearing HIIT, including jumps and skips, had 4% better bone density than those who did less than one minute. Those who did more than two minutes of HIIT daily had 6% stronger bones.
However, don’t go overboard, advises Tania Adib, consultant gynaecologist for The Menopause Clinic at The Lister Hospital: “Being underweight as a result of excessive exercise can lead to reduced bone density, so aim for regular moderate exercise incorporating both cardiovascular and weight-bearing exercise.” Similarly, Ed Buckwald, osteopath and founder of Canamis Ed, says poor running form and wearing the wrong shoes will all place increased pressure on your bones. “Invest in quality footwear and replace your shoes every 450-500 miles. Orthopaedic footwear or running on softer ground can also help,” he advises.
Consider Taking Up Yoga
If a HIIT workout feels intimidating, studies suggest something gentler like yoga could also help support bone health. Gabriella told us that one particular study found participants who did ten yoga postures per day for around ten minutes experienced improvements in bone density. A 2010 review also found yoga is as effective or better than other forms of exercise at improving muscle strength and flexibility. “Yoga improves range of muscular motion and strength, enhances weight bearing pressure on bones and promotes balance – three key pillars to support bone strength, and prevent falls and fractures,” Gabriella explains. “Bone forming proteins synthesise after ten seconds of stimulating pressure on the bone and in yoga you are typically doing this while holding poses for up to 30 seconds. Yoga has the added benefit of reducing cortisol (i.e. stress) levels, another factor in decreasing bone density by inhibiting osteoblasts, your bone building cells.”
Think About Supplements
Even if you do eat your five-a-day, it could be worth boosting your nutritional intake with the right supplements – namely calcium and vitamin D – for optimal bone health. Ed also recommends taking a whole-body approach: “If you are forgetful or struggle to form a new routine, something as simple as a multivitamin supplement can help. Studies also show CBD oils can support new bone generation, so they are worth exploring. CBD supplements can also help reduce inflammation around joints and help contribute towards a more active lifestyle.”
It could also be worth taking collagen, says Dr Newman-Beinart. “Numerous studies have investigated the role of oral collagen peptides and its effects on bone mineral density in post-menopausal women aged between 55-70 with either osteopenia or osteoporosis. One study found that taking 5g of collagen for 12 months improved bone mineral density in the neck and lumbar spine, whereas women taking a placebo supplement showed no significant improvements.” She recommends taking up to 10g of collagen peptides per day (roughly two heaped tablespoons).
Be Wary Of Coffee & Alcohol
“Acidic food in general leaches calcium from your bones, so try and minimise caffeine, alcohol and excess salt,” advises Tania. However, Gabriella says that if you are getting adequate amounts of calcium and vitamin D from your diet, evidence suggests moderate caffeine intake won’t negatively impact your bones. “However, if you consume excessive amounts, this may increase stress, which can be a factor in decreasing bone density by inhibiting osteoblasts, your bone building cells,” she says. Studies have also suggested excessive alcohol intake interferes with the absorption of vitamin D, as well as oestrogen levels, which can take their toll on bone density.
For more information visit GabriellaEspinosa.com, Correxiko.com, Bupa.co.uk, HCAHealthcare.co.uk, Canamis.com and LiveHealthily.com. Gabriella Espinosa teaches Yoga for Bone Health classes on online platform Movement for Modern Life, sign up here.
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