How to Improve Bone Health
Bone health has been a frequent topic lately in my practice. Its importance spans the lifetime – from growing new healthy bones as children, to building and maintaining bone density in our 30s and 40s, and preventing bone loss in our 50s and beyond.
In this post I’ll be speaking specifically to prevention of bone loss in women during the perimenopause and menopause years. Osteoporosis, a condition characterized by decreased bone density and increased fracture risk, is more common than many realize, especially in women over 50. But the good news? There’s a lot we can do to protect and even improve bone health during these decades of life.
Background
Bone is a living tissue that is constantly remodeling throughout the lifespan. Women reach peak bone density by age 30, which then starts to decrease around age 40.
Risk factors for osteoporosis:
- Low body mass index (BMI)
- Lack of exercise or a sedentary lifestyle
- Poor nutrition status
- Alcohol use and smoking
- Perimenopause and menopause
- Parathyroid conditions
- Medication side effects (such as corticosteroids)
- Severe digestion or malabsorption issues (Crohn’s, ulcerative colitis, IBS, Celiac)
- Family history of osteoporosis (genetics)
Assessing bone health depends on your age and medical history, but often includes a combination of lab tests and imaging (called a Dexa-Scan, or DXA).
The Foundations of Bone Health
Nutrition
Nutrition is fundamental to maintaining bone density, and getting these nutrients from food is always best. Focusing on a diet rich in calcium, magnesium, vitamins D and K, and protein is a great starting place. Specific protein needs are determined by several factors, so speaking to your provider about your personalized protein need is best.
Food sources of calcium include dairy, dark leafy greens, soy, figs, canned small fish and fortified foods. Here is an excellent resource for discovering more calcium rich foods: A Guide to Calcium-Rich Foods - National Osteoporosis Foundation (nof.org)
Avoiding high phosphorus beverages (soda, seltzer, flavored bubbly water) and excessive caffeine can also be helpful as they lower calcium levels in the blood.
Dark leafy vegetables (kale, collard greens, romaine, spinach, Swiss chard) are not only high in calcium, but also vitamin K. *Please always speak with your provider prior to changing intake (dietary or supplemental form) of vitamin K if you are on prescription medication, specifically blood thinners.
Exercise
Weight-bearing and resistance exercises are some of the most effective ways to stimulate bone formation. This includes walking, hiking, jogging, stairs, tennis, or dancing. Strengthening exercises help build stronger muscles, which in turn help build stronger bone during those resistance exercises. Strength training exercises utilize weights and might include exercises like shoulder presses, squats, or deadlifts. Weighted vests are gaining popularity and can also be helpful for building bone density. Speak with your provider about weighted vests as they may not be a good option for those who’ve already been diagnosed with osteoporosis.
Supplementation
Calcium: Depending on age, adult females need between 1,000 to 1,200 mg of calcium per day. This should come in large part from the diet, and the rest from a supplement (if needed). For example, if you are getting 900 mg of calcium from food, the remaining 100-300 mg can come from a supplement. Taking more calcium is not necessarily better – several meta-analyses have shown concern for increased cardiovascular disease in adults supplementing with an excess amount of calcium.
Vitamin D: Most people living in the PNW do not meet their need for vitamin D though sun exposure and food intake alone. Supplementation is therefore recommended, with dose based on your current lab value.
Other nutrients often considered for supplementation include zinc, magnesium, boron, strontium, manganese, and vitamin K2.
Gut Health
As we age, changes in the gastrointestinal system can impact absorption of key micronutrients, adding to the need to ensure proper intake of the above-mentioned nutrients. On top normal age-related changes, several commonly prescribed medications can also impact the absorption of these nutrients. Lastly, the impact of our microbiome also extends to bone health, as the less diversity we see in the microbiome, the less healthy the intestinal lining becomes, and the less productive our intestines are at absorbing nutrients.
Conclusion
From a naturopathic perspective, we look at the whole person. That means addressing digestive health (since poor gut function can impair nutrient absorption), reproductive hormones (like estrogen, which helps protect bone mass), and personalizing supplementation when necessary. If you're concerned about your bone health, or simply want to age with strength and resilience, talk to your provider. Together, we can create a plan tailored to your unique body and lifestyle.