How important is diet when it comes to developing stronger bones?

In addition to genes, physical activity and hormone optimisation, nutrition strongly affects bone health throughout our lives. It stems all the way back to what our mothers eat while pregnant with us, which can affect our eventual bone mass as adults.

As children, our bones experience rapid growth and development. If we break something, we tend to heal quite quickly and well (depending on the severity of the break).

By early adulthood, around 18 or 19 years old, we reach about 95% of our peak bone mass. Through our 20’s, we can continue to build some bone but by age 30, we stop making any more “bone deposits”. By the time we reach age 40, we slowly begin to lose bone mass. Women are particularly at risk of rapid bone mass loss after menopause. The good news is, however, we can take some simple steps to avoid long-term bone loss. For most of us, bone loss can be significantly slowed through proper nutrition. A healthy diet can help you prevent and manage chronic conditions such as osteoporosis and other related musculoskeletal disorders by assisting in the production and maintenance of bone.

What foods, minerals or vitamins are essential for healthy bones and bone density?

There are at least 20 bone-building nutrients that are essential for optimal bone health – “essential” in that our bodies cannot manufacture them on their own, so we must obtain them through our food and fluids. Let’s take a look and the major players below. It’s important to note that none of the following nutrients work in isolation – you require some of each and every nutrient so they can all work together to optimise and maintain strong bones throughout your life.

  • Calcium– The most well-known nutrient for bone health. Calcium is the major building-block of bone tissue (bone contains 99% or the body’s calcium) and is essential for formation, construction and maintenance of bone matrix. Good sources of calcium include: milk, yoghurt, cheese (highest), kale, broccoli, spinach and other green leafy vegetables, sardines, anchovies, salmon, and other edible-bone fish, tofu, legumes, nuts and seeds.
  • Vitamin D– probably the second most important nutrient for bone health because without it, our bodies cannot effectively absorb calcium as well as regulates how much calcium enters and leaves bone tissue in response to the body’s other calcium requirements. The best source of vitamin D is from sunlight. Many foods and fortified foods contain vitamin D, however, few contain enough to meet daily requirements for optimal bone health. Vitamin D is quite common amongst the Australian population so testing your levels is important to reduce your risk of osteopaenia (softening of the bones) or osteoporosis. Food sources of vitamin D include:oily fish (e.g. salmon, trout, mackerel, sword fish), mushrooms, fortified wholegrain cereal, dairy products, eggs.
  • Vitamin K (K2)– important for bone formation and mineralisation, as well as assisting the calcium to be deposited directly into the bones rather than the blood vessels. Good sources of Vitamin K include: dark green leafy vegetables, parsley, Brussels sprouts, asparagus, dried basil
  • Vitamin C – collagen is the main protein in the bone matrix. Vitamin C is essential for collagen production and formation. It is also a potent antioxidant, which helps fight off free radical damage and destruction of bones. Good sources of vitamin C include: citrus fruits, tomatoes, chilli, parsley and all vegetables.
  • Vitamin E – Similarly to vitamin C, vitamin E is also a potent antioxidant, as well as an anti-inflammatory agent, which not only helps fight free radical damage but reduces the risk of oxidation of fatty acids that can impair new bone formation. Good sources of vitamin E include: nuts and seeds, avocado, asparagus, dark green leafy vegetables, shell fish, olive oil,
  • B vitamins– help keep homocysteine (an amino acid) levels in check. Higher blood levels of homocysteine have been associated with lower bone density and fractures. Good sources of B vitamins include: wholegrains, nuts and seeds, legumes, dairy products, lean meats, poultry and fish, green leafy vegetables, soy bean, offal (liver), eggs, fortified food products.
  • Protein– makes up for 20-30% of bone mass. It is important for maintaining bone structure and strength, while assisting with the healing of fractures. It is essential for bone mass growth during childhood and adolescence, and is responsible for preserving bone mass as we age. Good sources of calcium include: lean red meat, poultry and fish, eggs, dairy foods, nuts and seeds, organic protein powders, legumes, tofu/tempe, wholegrains.
  • Phosphorus– phosphate makes up more than half bone mineral mass. It is important to note that too much phosphorus as well as too little phosphorus can impair bone health and quality of life. Sources of phosphorus include: Most dietary phosphorus is contained in protein-rich foods such as meat, milk, cheese, poultry and fish.
  • Magnesium– About 50-60% of the body’s magnesium is stored in the bones, which helps regulate calcium transport and enhances bone quality and strength. Good sources of magnesium include: dark leafy green vegetables, legumes, nuts and seeds, quinoa, fish, soy beans, avocado. Supplementation may be beneficial for certain population groups or those at risk of deficiency e.g. athletes, women of reproductive age, elderly, highly stressed. Always consult with a practitioner to see if you will benefit from supplementation.

Do any foods or substances decrease bone density?

  • Certain medications– particularly corticosteroids (immune-suppressing drugs) that are used to treat certain conditions such as asthma, cancer, rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease), Addison’s disease, chronic airway disease and other inflammatory conditions. Some of these medications include: prednisolone, cortisone, hydrocortisone and dexamethasone. Other medications include selective serotonin reuptake inhibitors (SSRIs) used for the treatment of depression and proton pump inhibitors (PPIs) used to treat reflux.
  • Alcohol– excessive alcohol intake can interfere with bone growth and replacement of bone tissue resulting in decreased bone density and increased risk of osteoporosis. A high alcohol intake may disrupt the balance of hormones responsible for regulating calcium metabolism and reduce the absorption of other nutrients (mentioned above) in the small intestines essential for optimal bone health. Regular and high consumption can also impair and damage your liver, which is important for activation vitamin D, which is important for calcium absorption.
  • Soft drinks– phosphoric acid, a major ingredient in most soft drinks might be the culprit to diminished bone density when consumed in high quantities. As mentioned above, phosphorus itself is an important nutrient for bone health. But if you’re getting a disproportionate amount of phosphorus compared to the amount of calcium, than can lead to bone loss as high quantities of phosphorus leaches calcium out of the bone.
  • Refined sugar– regular consumption of refined sugar increases loss of calcium from the blood through the urine. As a result, calcium is then leached from the bones into the blood vessels to maintain blood calcium levels. The reason for this is the fact that foods containing refined sugar generally do not contain calcium.
  • Smoking– nicotine and toxins in cigarette smoke generate a huge amount of free-radicals that damage cells, organs and hormones involved in keeping bones healthy. The toxins interfere with the balance of hormones (particularly oestrogen) responsible for maintaining bone strength. Therefore, smoking can make bone loss worse in women going through menopause. Smoking also increases your stress hormone, cortisol, which can lead to the breakdown of bone. Finally, smoking also damages blood vessels that can cause a poor blood supply of oxygen, and as a result lead to impaired healing of bone fractures.
  • Caffeine– high consumption of caffeine has been associated with reduced bone mass and increase in fracture risk. The reason for this is high doses of caffeine may interfere with calcium absorption in the intestines. Caffeinated beverages containing phosphoric acid e.g. soft drinks can increase this risk further.
  • Salt– A high salt (sodium) diet/intake may be associated with a loss of other essential minerals important for strong bones, particularly calcium through urine excretion. A simple way to avoid this is by watching how much salt you add in cooking and at the table, consume no-added salt versions where possible and avoid processed/deli meats and other fast foods.
  • Sedentary lifestyle– it goes without saying that people who are sedentary or do not engage in regular physical activity are at higher risk of lower bone density and osteoporosis. Bone requires constant forces in order to continue its normal process of remodelling. Therefore, by engaging in regular weight bearing activity, it can improve muscle strength, improve balance and slow the progression of bone loss.