When Should I Worry About My Bones? Now!

As women move past their 30s and get closer to menopause hot flashes, poor sleep, brain fog and chronic diseases (such as cancer and dementia) are typically top of mind. Maintaining bone health is often overlooked until there is an actual problem. The same holds true for men, as they can also develop osteoporosis

Did you know that the average woman can lose 10-20% of their bone mass in the first five years of menopause, largely due to the loss of estrogen? Men can lose 13-18% of their bone mass between the ages of 40 and 80. A few facts:

• Yearly, there are more than 2 million osteoporosis related fractures with vertebrae and hip fractures being the most common.

• In post-menopausal women the frequency of fracture due to bone fragility is greater than strokes, heart attacks and breast cancer combined. 

• After a hip fracture, 50% of people never return to their previous level of independence and 20% are institutionalized.

• It’s well documented that fractures frequently lead to a decreased quality of life: chronic pain, depression, anxiety and a change in social roles. 

But, you say, I’m only 25 and not even close to menopause or old age. Awesome! Now is the perfect time to maximize bone density, as it reaches its peak around the age of 30.

Some Basic Information

Bone mineral density is the amount of calcium and other minerals in your bones. The more minerals, the stronger your bones are and the less likely they are to break.

Osteoporosis is a fairly well-known term that refers to a decrease in bone mineral density that can lead to brittle or porous bones and increase your risk of a fracture.

Osteopenia is a less advanced form of osteoporosis that, if not addressed, can lead to full-blown osteoporosis. 

Risk Factors 

Given that 50% of women and 33% of men over the age of 50 have osteopenia and 15% and 4%, respectively, go on to develop osteoporosis, knowing your risk factors is important. 

Many risk factors are out of your control, such as being female, being post-menopausal, having a parental history of a hip fracture, and being white or of Asian descent. However, others are risk factors that are well within your control: a BMI below 20, smoking, lack of calcium and vitamin D, being sedentary, and excessive alcohol intake.

There are also certain health conditions and medications that create a higher risk of decreased bone mass. This includes use of glucocorticoids (such as prednisone), some breast cancer drugs, Inflammatory Bowel Disease, a history of bariatric surgery and celiac disease. 

Don’t let these risk factors overwhelm you. No matter your age, you can improve your bone density by improving overall nutritional and exercise habits.

Eating for Better Bone Health

Eating to maintain and improve bone health is not a lot different than traditional healthy eating guidelines. Read on to learn what’s important.

Calcium: 1000 mg/day for men and 1200 mg/day for women is the recommended daily intake. It’s important to know that calcium from food is preferred over calcium supplements. If you are meeting your calcium needs with your diet alone, there is no research to show that supplements offer additional benefits. 

Having said that, there is nothing wrong with taking a calcium supplement if you aren’t getting enough dietary calcium. Your body cannot absorb more than 500 mg at one time, so spread your intake throughout the day.

• Food sources: Dairy products, leafy greens (kale and bok choy!), canned fish with soft bones (i.e. canned salmon or sardines), fortified orange juice, plant milks or tofu that is made with calcium. 

Vitamin D: 600 IU/day for people under 70 and 800 IU/day for those over 70 is the general guideline for vitamin D intake. Vitamin D and calcium work together to create healthy bones, so it’s important to get both.  

• Food sources of vitamin D include dairy products, fatty fish such as salmon and sardines, egg yolks, and fortified foods.  

• Sunlight will also provide some vitamin D, but not nearly enough to meet your nutritional needs. 

• If your vitamin D level is low, a supplement is definitely appropriate – 2000 IU of vitamin D3 daily is what is typically recommended. 

Vitamin K2: This vitamin is needed for bone strength and though it does seem to work together with vitamin D for overall bone health, there are conflicting recommendations regarding the benefits of taking vitamin K2 as a supplement. As with other nutrients,  getting K2 through food is your best option.

• Your daily needs can be met by one serving of leafy greens such as kale or spinach. Note: If you are taking a blood thinner such as coumadin, it’s important to keep your vitamin K intake consistent - don’t eat three servings of kale one day and none the next!

Protein: Of course, protein is important for bone health. A daily intake of 0.45 to 0.60 grams per pound is recommended specifically for bone health. This is approximately 65 grams for a 120 pound person and 100 grams for a 180 pound person. Stick to lean options that will also provide some of the above vitamins such as whole eggs, Greek yogurt, hard cheese such as cheddar, kefir or canned fatty fish (with the bones, such as salmon or sardines).

Fiber and the Microbiome: Believe it or not, a healthy gut helps your bones. Bacteria in your gut produce short chain fatty acids (SCFA) when you eat high fiber foods, leading to better bone mineral density. Foods to include in your diet:

• Oats, barley, lentils, beans and whole grains.

• Prebiotic fibers such as onions, garlic, leeks and asparagus.

• A wide variety of fruits and vegetables to ensure intake of polyphenols and various types of fiber.

Prunes: Yes, prunes. Research has shown that eating 50 grams of prunes each day (about 4-6 prunes) helps prevent bone breakdown. If you haven’t tried them yet, now is a great time to start. A word of warning: start slowly as prunes do have a laxative effect. Try eating one or two a day, eventually working your way up to six.  

Exercise

As with all things health related, research tells us that in addition to eating properly, exercise is critical for bone health. You can follow the above advice perfectly but if you aren’t including weight bearing or resistance exercises in your week, you are not taking care of your bones. If you aren’t sure where to start, there are some great resources online. Explore the Instagram accounts of Dr. Jocelyn Wittstein, Dr. Nick Trubee and Dr. Lisa Moore, DPT, and @findurfituk. Please note that, as with any new exercise routine, you should start slowly to prevent injury and connect with your doctor for their approval. 

Bottom Line

It can be hard to keep track of all this information so to simplify your nutritional plan for bone health, do the following:

• Get 1200 mg of calcium and 600 IU of vitamin D each day, mostly from foods (versus from a supplement). 

• Follow a healthy Mediterranean/Dash style diet each day: 

  • 5-7 servings of fruits and vegetables

  • 3 servings of dairy products or other high calcium foods

  • 30+ grams of fiber

  • Lean protein 

  • 6 prunes 

• Limit alcohol and high salt foods

• Weight bearing exercises 2-3 times a week

Protecting the health of our bones cannot be overemphasized if we want to remain independent and enjoy a good quality of life in our later years. Keep in mind, male or female, it’s never too early to start! If you’d like to make sure you are optimizing your diet for bone health, please reach out. I’d love to hear from you!