Original article by Amy Gianotti. Updated September, 2023.
Bone is a type of active tissue that is continually broken down and rebuilt throughout life.
Bone mineral density (BMD) is a measure of the strength of our bones and we reach our peak BMD between the ages of 20 to 30 years. If you imagine this to be a peak, you want this peak to be as high as possible because after around 30 years of age our bone mineral density declines.
For women, when they reach menopause, the age-related bone mass loss is accelerated due to the absence of oestrogen, which puts them at an increased risk of an osteoporotic fracture, a consequence that often diminishes their independence.
Childhood and adolescence is, therefore, a critical stage for bone health; to ensure the greatest amount of bone is accumulated.
What factors affect bone mineral density?
Both genetics and lifestyle factors – especially calcium, vitamin D, and exercise – determine an individual’s peak bone mass and their risk of osteoporosis (brittle bones) and fractures later in life.
Osteoporosis is a chronic condition where the bones are weakened, which increases the risk of fractures. Currently in Australia, one in two women and one in three men over the age of 60 will sustain a fracture due to osteoporosis.
Maintaining the health of our bones, or our skeleton, is often overlooked. Maybe this is because we don’t see it unless we have an x-ray or MRI. But it’s important because our bones make up our framework; we depend on them in order to be active for the rest of our life. We also may not recognise how weak our frame or bones are, until we have a fall which results in a fracture.
Photo by Julia Larson
How can you improve and maintain bone health?
I live and breathe an active and independent lifestyle, so personally, I would be devastated to suddenly lose my ability to walk, run, or weight train. I would find it very challenging to lose my independence or struggle to undertake my daily living activities such as showering.
I will admit it wasn’t until I did my placement in the hospital and rehab centres during my dietetics degree that I realised how prevalent osteoporosis is, and how damaging it can be to your physical and also mental health. The patients I saw were not old; they were just like me, living an active, healthy, and happy life.
So, to help you achieve optimum bone health, here are my tips:
1. Perform regular weight-bearing exercises.
Find something you enjoy and get into a routine. Some examples are group fitness classes such as aerobics or resistance classes (excluding cycling), weight training, running, and ball or racquet sports.
2. Ensure your vitamin D levels are in the optimum range.
Vitamin D is vital for calcium absorption. A blood test from your GP will determine if your levels are too low. A vitamin D supplement may be required during cooler months or if your lifestyle limits getting adequate sun exposure.
3. Ensure you meet your daily calcium requirements.
The RDI for adult males and females is 1000mg/day and for women when they reach menopause, it increases to 1,300mg/day to compensate for the reduced calcium uptake from the decline in oestrogen. Dairy is the richest source of readily available calcium. For adults, calcium requirements can be achieved by consuming 2.5 servings of dairy per day (1 serving = 250ml milk, 40g cheese, 200g yoghurt). Women over the age of 50 years will require 4 servings per day to meet the increased requirements. Reduced fat varieties are preferable for those trying to lose or manage their weight. Calcium content will be the same, the energy (calorie) and saturated fat will be reduced and protein is often higher. Just play cautious with yoghurts, as often sugar is added. Natural or Greek yoghurt is preferable. And no, they don’t add sugar to low-fat milk unless it is flavoured milk.
4. If you cannot have dairy due to a food allergy or intolerance include ‘dairy alternatives’ such as rice, soy, oat, or almond milk.
‘Lactose-free’ varieties are now commonly available for those with a lactose intolerance and provide the same beneficial nutrition as regular cow’s milk. NOTE: It is only classified as a dairy alternative’ IF contains a similar calcium content. This will often mean it has been fortified with calcium (calcium added). To check if the nutrition information panel on the packaging meets the criteria, refer to the ‘calcium per 100ml’. You want to read that it provides at least 100mg/100ml of calcium. Most almond milk and organic varieties will not meet these criteria. If you fail to choose a good ‘alternative’ you will struggle to meet the recommendations. Supplements can also be used.
5. Irregular or the absence of the menstrual cycle in young women should not be ignored.
The importance of bone health
Seek professional advice from a GP or endocrinologist (hormone specialist) for a management plan. In women, bone loss increases rapidly after menopause as oestrogen levels drop. Because oestrogen acts like a transport vehicle for calcium into the bones, any time there is a drop in oestrogen, bone loss typically follows. This can also occur in female athletes who become amenorrhoeic (their periods stop) or in the eating disorder anorexia nervosa.
Thanks to Amy Giannotti for this article.
Amy is a Sports and General Dietitian, Personal Trainer, Author, and Athlete.
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