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Most people think weak bones and osteoporosis only affect the elderly, but this couldn’t be further from the truth!

Bone health results from complex interactions between your genes, lifestyle (diet and exercise), hormones and vitamin D status. If you eat a poor diet, suffer from eating disorders, avoid exercise or suffer from malabsorption disorders, your bones may be in jeopardy!

 The essential nutrients for bone health include protein, vitamin D, calcium, phosphorus, magnesium, vitamin c, vitamin k and potassium. That said, you don’t achieve optimal bone health from single nutrients. You achieve it by eating a healthy, balanced diet.

Want to learn how nutrition affects your bones and the foods you must eat to maintain healthy bones?

Keep reading for the answers.

But before we jump in, let’s cover some basics.

Bone Metabolism

Throughout life, your bones, just like your skin and gut lining, are continuously broken down and replaced – a process called ‘modelling’ in young children and ‘remodelling’ in adults (Raisz, 1999)

Cells called osteoclasts break down old bone cells and tissues, and other cells called osteoblasts lay down new bone. A variety of hormones regulate the activity of osteoclasts and osteoblasts (Raisz, 1999; El Sayed et al., 2020).

In healthy children, the body produces new bones cells faster than it breaks them down. By adolescence, healthy children attain approximately 40% of their total bone mass.

Adults achieve peak bone mass by their 30s, and as long as they remain healthy, bone breakdowns at the same rate as new bones form. However, by menopause in women and late middle age in men, the bone breakdown exceeds bone formation, leading to osteoporosis in the following decades.

The main factors that determine if you achieve and maintain peak bone mass include (Rubin et al. 1999):

• Genetics
• Hormones (sex hormones, insulin-like growth factor, parathyroid hormone etc.)
• Diet especially intake of calcium, vitamin D, phosphorus,
• Lifestyle factors, e.g., weight-bearing exercise, protein/calorie nutrition, alcohol intake and tobacco smoking
• Other factors, e.g., nutritional factors such as obesity, malabsorption syndromes, and anorexia; chronic diseases such as cystic fibrosis and chronic renal failure or pregnancy and lactation.

Genetics, hormones, physical activity and chronic diseases are beyond the scope of this article. Today we will focus on nutrition and bone health.

The Essential Nutrients for Bone Health

Protein

Yes, protein!

Protein is crucial for bone health.

About 50% of bone volume and 33% of bone mass is made up of proteins. Protein is part of the collagen structure of bone.

The protein in your diet affects the release and action of insulin-like growth factor I (IGF-1), a hormone necessary for bone formation. IGF-1 improves your gut’s ability to absorb calcium and phosphorus, your kidney’s ability to re-absorb phosphate and promotes the production of calcitriol (the active form of vitamin D).

Insufficient dietary protein impairs bone health.

Previous studies suggest that high (animal) protein diets increase acidity and blood calcium levels, causing bone breakdown and, eventually, osteoporosis with increased risks of fractures (Bonjour, 2013).

However, these studies were done in people with chronic kidney disease and extrapolated to healthy individuals, which is not justified (Bonjour, 2013).

Recent studies show that high protein intakes are associated with higher bone mineral density (strength), reduced hip fracture risk and slower rates of bone loss (Rizzoli et al., 2018).

High protein intakes with weight-bearing activities improve muscle mass and bone strength (Taylor, 2019). And in older adults, it slows bone loss and lowers hip fracture risk.

Please note that your calcium intake must be adequate to achieve these protein benefits. And this is why foods rich in both protein and calcium are beneficial for bone health.

Good sources of protein include fish, poultry, and legumes (Burd et al., 2019).

Calcium

99% (totalling approximately 1-1.5kg) of the calcium in your body is stored in your bones. The remaining 1% circulates in your blood where it regulates your hormones and genes, and maintains nerve, muscle and heart function.

If your calcium intake is low, the quantity of calcium in your blood remains stable, but your bone health becomes compromised.

The best way to get enough calcium is by eating a healthy, balanced diet.

Dairy foods, including milk, yoghurt and cheese, are the richest, most bioavailable sources of calcium. Green leafy vegetables are good sources of calcium, but you may absorb slightly less calcium from them than animal products because of their fibre, oxalate and phytate content (Charoenkiatul et al., 2008).

You may need to take a calcium supplement in cases of severe deficiency or if you have difficulty absorbing calcium from your diet.

Calcium citrate-malate supplements are better absorbed than calcium carbonate supplements, but they are not readily available worldwide. Calcium supplements cause adverse effects in some situations, so use them only under the supervision of your healthcare practitioner (Bolland, Grey and Reid, 2015).

You have a higher risk of calcium deficiency if your diet is very high in fibre and salt. And if you use antacids or consume carbonated drinks with phosphoric acids frequently.

Vitamin D

Vitamin D regulates calcium and the bone modelling and remodelling process.

Sunlight is the best source of vitamin D. Vitamin D is available in small quantities from oily fish (salmon, sardines, mackerel), egg yolk mushrooms and some fortified dairy and dairy alternative products.

If you have dark skin, live in a temperate region, and cover your skin regularly, you may need vitamin D supplements.

Please consult with a healthcare professional before taking vitamin D supplements.

Potassium

Potassium reduces acid load and calcium loss from bones. It also promotes calcium retention in the kidney (Munoz-Garach, Garcia-Fontana and Munoz-Torres, 2020).

High potassium intakes are associated with greater bone strength in the hip and leg bones in older men and menopausal women (Kong et al., 2017).

Good sources of potassium include plantains, avocado, watermelon, and coconut water.

Magnesium

Magnesium is essential for nerve activity and muscle contractions.

It helps to shuttle calcium and potassium ions across your cell membranes, and about 60% of the total magnesium in your body is stored in your bones (Munoz-Garach, Garcia-Fontana and Munoz-Torres, 2020).

Magnesium promotes new bone formation and activates vitamin D (Uwitonze and Razzaque, 2018).

Good sources of magnesium include almonds, bananas, green leafy vegetables, legumes (black beans, soybeans), seeds (pumpkin, sesame, sunflower), whole grains, sweetcorn and nuts (cashews, almonds) (Razzaque, 2018).

People who consume more processed foods have lower levels of magnesium (Roasanoff et al., 2012). While no randomised studies have investigated the effects of magnesium on bone health, small-sized studies show a link between low magnesium levels and osteoporosis (Brodowski, 2000).

Low magnesium intake causes excessive calcium loss from the bone in the elderly, weakening their bones and increasing the risks of falls and fractures (Veronese et al., 2017).

Phosphorus

Phosphorus is an essential nutrient in many processes including carbohydrate metabolism, energy metabolism, signal transduction and skeletal mineralisation (Calvo, 2015

More than 80% of total body phosphorus is stored in your bones and teeth, but phosphorus is present in your cells as part of energy molecules and free anions. Phosphorus is also a critical part of virtually all enzymes and cellular messengers in your body, and certain hormones need it for activation.

Phosphorus deficiency causes bone mineral loss even before blood concentrations drop. And rickets and muscle weakening can occur in people with chronic phosphorus deficiency

Phosphorus is rich in meat, milk, cheese, cereals, dairy, fish and shellfish and vegetables (Takeda et al., 2012).

Phosphorus is present in processed meats as they contain phosphate-based additives that improve food’s consistency and appearance. Beverages such as sodas, juices and sports drinks also contain phosphorus additives (Takeda et al., 2012). But because manufacturers aren’t required to declare them on labels, many people don’t realise.

Excess phosphorus is just as bad as a deficiency for your bones.

Diets high in phosphorus and low in calcium create complexes that make your bones release calcium into your bloodstream (Vorland et al. 2018). For every extra 100mg of phosphorus, the risk of fractures increases by 9% (Takeda et al, 2012).

Cola beverages contain phosphoric acid, which interferes with calcium absorption and causes calcium loss. Other beverages (with some exceptions) do not.

Women who drink large quantities of cola have a low bone strength (Tucker et al., 2006).

Vitamin K and C

Vitamin K is involved in bone matrix formation during mineralisation.

Vitamin K exists as K1 – found in leafy green vegetables and K2 present in animal liver, cheese and natto. Vitamin K deficiency can occur because of poor diets and health problems like liver disease, cystic fibrosis, alcoholism or IBD. Medications like anticoagulants can also deplete vitamin K.

Observational studies show that low dietary intake of vitamin K1 and K2 increases fracture risk (Feskanich et al., 1999). However, clinical trials have not shown conclusive results. High-quality trials involving patients with low serum vitamin K values and insufficient dietary intake are needed to clarify the role of vitamin K in fracture risk.

Vitamin C has antioxidant properties and can suppress osteoclast activity. It promotes osteoblast and collagen synthesis. Meta-analysis and systematic reviews positively correlate vitamin C intake with higher bone mineral density at the femur neck and lumbar spine and lower risk of hip fracture and osteoporosis (Malmir, Shab-Bidar and Djafarian, 2018).

While nutrients are essential for human health, other compounds with beneficial health properties are being continuously being discovered and studied (Jew et al., 2015). Many more compounds exist in food that scientists haven’t discovered, and researchers believe that these compounds work together to provide health benefits in humans. (Jacobs and Tapsell, 2007)

The key to achieving healthy bones isn’t in focusing on single nutrients but in looking at your diet holistically and building a healthy eating pattern.

A dietary pattern with a high intake of fruits, vegetables, dairy products, whole grains, poultry, fish, nuts and legumes is beneficial to bone health. It is associated with better bone mineral density, lower risk of fracture and osteoporosis and levels of bone resorption markers.

If you would like to learn how to eat a healthy, sustainable and balanced diet that’s unique to your needs and personalised to your lifestyle, click on the link at the bottom right corner of this page to book a free 15-minute discovery call with me.

Until my next post, eat whole, move your body and surround yourself with people and things that matter.

-Somi-

REFERENCES

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