Bone health: What I wish my younger self knew

Osteoporosis may sound like something you only care about when you hit your 50s or 60s but every woman could be doing something to prevent this starting in their teenage years, and definitely by their 40s.

I wish I had been more cognizant of my calcium intake during my adolescent years because this is the time during which the foundations for strong bones are laid down. If you can build up a high bone density, then you 'have more to lose', so to speak. I don't like to cry over spilt milk, so since I cannot do anything about my poor calcium intake as a teenager, I CAN teach anyone who would listen, and also proactively ensure my daughter gets enough in her diet while she goes through puberty. 

Osteoporosis runs in my family.

My maternal grandmother had severe osteoporosis and had multiple falls, the complications of which then led to her passing 😢. Falls might sound like nothing, but the risk of death after a fall is significant, and the disability that ensues equally so. 

My mom also has severe osteoporosis but is proactively trying to prevent her bone density from worsening... so bone health was already on my radar when I entered my 40s. 

I knew that I had to work on my bone health, but it wasn't until I my primary care physician ordered a DEXA scan (at my request - yes, you can request this if you have a family history or other risk factors), that I really started to double down. 

My DEXA scan showed I had Osteopenia - the very beginning stages of osteoporosis, and I am only 46. With declining estrogens from this point onwards, I only have worsening bone density to look forward to - unless I start taking action NOW.

So I dove into the research and books and compiled a protocol for myself. Here are the key tenets: 

1) Ensuring I get enough calcium in my diet

The research on calcium supplementation, however, is nuanced.

There are multiple studies showing calcium supplementation does not prevent fracture risk, and even some data showing it may increase cardiovascular risks (the biggest killer of women) due to calcium buildup in the arteries....we know calcium supplementation is associated with an increased risk of kidney stones and perhaps colonic polyps (the precursor to colon cancers).

Having said that, there are also studies showing calcium supplementation COULD reduce fracture risks. 

What to believe? 

Obviously I encourage you work with your doctor because everyone is different, and there is large bio-individual variability here. However my current understanding is that, in people who are getting enough calcium in the diet, calcium supplementation does not prevent fracture risks, and in fact, may be harmful. 

However, if your diet is deficient in calcium, there may be a case for calcium supplementation.

How do you know if your diet is deficient? There's only one way to find out - write down everything you eat in a day over the course of a week (i.e. you are tracking everything from snacks, meals, to beverages) and then enter it into a nutrition tracker like MyFitness Pal, or another calculator you like. See how much total calcium you are getting per day, and then average it out for the 7 days. 

How much Calcium should I be getting every day?

Calciuim requirements vary by life stages (e.g. adolescents, and pregnancy need more) - so I'm only speaking generally about adults. Here's the requirement for other groups.

Now here's where it gets interesting. The guidelines vary by country! As a UK family physician, I used to tell my adult patients (without any health issues) they needed 800mg a day (it is now 700mg). If my patients had certain health conditions, e.g. celiac - then they needed more (because the gut is not as efficient at absorbing). 

However, in the US, it seems the calcium recommendations are way higher, and I don't know why there is this gap...When I first moved to the US, I was shocked to see the recommendation was 1000mg for women under 50, and 1200mg for women over 50. 

I'm personally going with the UK guidelines because that's the medical training I received, but if I see new data coming out that I need more, I will change course. However, I am NOT telling you this is ok for YOU. We are all different so you may have circumstances that necessitate the US recommendations - discuss with your own doctor. 

If you do supplement with calcium, the consensus is that our bodies can not absorb that much calcium in one go. Be sure to speak to your doctor about an appropriate dose for you and stay under 500mg at any one time. 

How about dairy? Should you consume dairy for your bones? 

Growing up, we all heard the slogan "milk does the bones good"... but does it? The data is mixed. In my opinion, what matters is that we get enough calcium. However, where you get it from really doesn't matter. If you can tolerate dairy and you like it, then it's fine to use it as your source of calcium. 

Dairy is one of the top allergens and many people cannot tolerate it. So if you are dairy-free, it is possible to get enough calcium in your diet but you need to be mindful of eating enough calcium-rich foods like soy (provided you don't have an allergy/intolerance), sesame seeds, leafy greens particularly collard greens. 

Interestingly, a very large study of 60,000+ people published in the BMJ a few years back showed milk drinkers had a HIGHER fracture risk due to the D-galatose - a molecule our bodies make from cow's milk that is pro-inflammatory. This was an observational study, albeit a big one - so not by any means conclusive but worth keeping at the back of mind. 

Calcium is not the only nutrient we need for bones

Other nutrients to be mindful of:

- Getting enough protein in your diet - did you know protein is important for bone health? I used to aim for 0.6g per lb (of my ideal body weight) per day, because of data showing too much protein can activate mTOR (over-activation of which is linked to insulin resistance and cancer). For me, this used to be 70g per day - pretty easy to hit through whole foods.

However, as I am now headed towards 50, I do want to stimulate mTOR a little for muscle synthesis, so I now try get 1g per pound of ideal body weight (ideal body weight being your optimal weight which is not necessarily current weight).

For me, this is 115g per of protein per day - MUCH harder to do just through whole foods. I aim to get at least 30g of protein at each meal with protein-rich snacks in between to hit that goal. To help, I started incorporating a plant-based protein powder (code:platefulhealth note I only do vanilla because they won't show me the COA for the other flavors).

- Collagen - I am actively researching this right now but came across some data suggesting 5g per of the RIGHT type of collagen may help. More to come on this as I find out more. There are issues with collagen - pesticides, contaminants, heavy metals so it is not something I am jumping into without careful assessment. 

- D3 and K2 - these help our bodies absorb and then direct calcium to the right places to be used. I get my vitamin D3 checked in the fall every year at the minimum so I can supplement with the right dose. 

- Magnesium - I sometimes supplement - depends on my lifestyle and diet. There are so many different forms of magnesium... I will do another post on this separately. 

These are the key ones, but others like phosphorus, zinc also play a role - if you are eating a nutrient-dense diet, you should be getting enough of these, but if you are in doubt - check with a dietician. 

If you want to know the supplements I take for bone health, be sure to subscribe to my newsletter, I will do another article just on how to get more calcium in your diet and supplements. 

 2) Weight Bearing Exercise

I've always weight-trained but I have been making this a regular part of my exercise routine and hired a trainer to help me build up slowly. Due to declining estrogen, achy joints and injuries are more likely to happen in the peri-/menopause. Therefore, if you are new to weight training or have join/muscle issues already, be sure to work with a trainer or get educated on how to do this safely. 

Something I've started doing more of is jumping. 

Whether that's 10 jumping jacks on the spot in the morning, or box jumping in the gym - my newfound favorite I have to say. I started doing this after seeing this study which showed that 16 weeks of high-impact jump-training improved bone mineral density at the hips. The participants jumped 10 or 20 times, twice daily, with 30 seconds of rest between each jump. 

The height of your box determines how high the 'impact' (i.e. the impact is when you land -  this sends a stimulus to the bone to reduce resorption and build more). The taller the box, the higher the impact. HOWEVER. you need to do this safely without injuring yourself - commonly done. Going back to my earlier point - declining estrogen and increased inflammation mean a higher risk of injuries in peri-/menopause so please be guided by a trainer or take proper education on how to do it properly, if you are considering high-impact jumping. 

- Other weight-bearing exercises - hiking with a weighted vest (or I just carry a comfortable heavy backpack), running, even walking around the block counts! Start where you are and build up. 

3) Hormone Replacement Therapy

We know that HRT can help with bone density, especially when taken early as prevention. It has been somewhat unfairly villainized due to the Women's Health Initiative where the study was done on older women, who also had co-morbidities, using certain forms of hormones that carried higher risks.

The medical community is starting to have a change of heart moment with HRT, and I'm actively researching this because I am considering adding HRT into the mix for myself down the line. I will share more in another article, but I am currently reading a book called Estrogen Matters, written by an MD and PhD, which provides a science-based analysis of the data on estrogen - a good summary in my opinion but obviously - this is 2 people's opinion and I will be going directly to the studies also to form my own opinion.  

As with anything, there are always pros and cons and what I stand FOR is getting educated and armed with information so you can make the best decision for yourself. 

Ok, that's it for now! In the coming months, in addition to my usual content, expect articles on

1. how I get enough calcium in my diet
2. supplements I take when I need one
3. HRT
4. reducing inflammation
5. optimizing blood sugar  

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