Beyond Osteoporosis: How To Promote Bone Health

National Institutes of Health (NIH) osteoporosis expert Dr. Joan McGowan likens our bones to “any other engineering material.” Some structures reach a point where they can no longer support the weight put on them. Bones affected by osteoporosis are the same.

People who are inactive physically have a higher risk of developing osteoporosis, as do those who are very thin, or have a very small body frame – particularly as they get older, because bones will become weaker and thinner with age.

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In June 2008, stakeholders concerned about osteoporosis and bone health met in Washington DC, and used the Surgeon General’s Report (see above) as the basis for an organized strategy to improve bone health. In the resultant National Action Plan for Bone Health (see sources below) they stated that there were four priorities. 

The defined priorities were to:

1. Develop a national alliance on bone health and in this way increase awareness amongst professionals and the public.
2. Promote bone health in an endeavor to prevent disease – including focusing on good nutrition, the importance of adequate calcium and vitamin D, and the value of exercise.
3. Improve both diagnosis and treatment relating to bone health, and reduce the risk of “fragility fractures.”
4. Enhance research, surveillance and evaluation of bone health, including detection of bone disease as early as possible and identification of high-risk people.

Research Considers Challenges Of Maintaining Bone Health

There has substantial research into bone health, much of which is supported by the NIH. However, as the National Action Plan for Bone Health points out, it is critical that cutting-edge scientific research continues and is expanded. It is also vital to find effective ways to use the research that has already been carried out.

According to research discussed in the bone health plan, a lack of vitamin D is one of the major issues related to osteoporosis and bone health. In fact “insufficiency” of this vital vitamin has been found to be one of the medical conditions that is most commonly not recognized. Additionally, 25 percent of adults and adolescents in the US are thought to be vitamin D deficient, and 70 percent of those over the age of two years don’t get enough calcium daily.

Dr Michael Holick from the Department of Medicine at Boston University has carried out substantial research on vitamin D and its importance for bone health. He has found that vitamin D deficiency in utero and during childhood can result in skeletal deformities and increase risks of hip fracture in adulthood. In adults deficiency of this vitamin has a direct link with osteoporosis, is known to cause muscle weakness, and further increases the risks of bone fracture.

Studies relating to high calcium intake are not as definitive, and researchers at Harvard have not found any association between the risk of fractures and high calcium intake. These include a study undertaken last year (2014) titled Milk consumption during teenage years and risk of hip fractures in older adults, and another in 2007, Calcium intake and hip fracture risk in men and women, as well as several older studies. There is also some suggestion that calcium needs are not as high as generally recommended (see Tips on Promoting Bone Health, below.) For instance, research in several countries, including Japan, India and Peru shows that the incidence of bone fracture is relatively low even when people take only 300 mg daily.

There has also been some research on the effects of vitamin K on bone health, and it has been found to minimize the risks of hip fracture. However, a 2000 study found it didn’t affect bone mineral density in elderly people.

Since exercise is another key to good bone health, several studies have focused on this topic.

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Researchers from the Pakistani Institute of Physical Medicine and Rehabilitation at the Dow University of Health Sciences in Karachi compared the effects of walking versus an Osteoporosis Prevention Exercise Protocol (OPEP) for preventing osteoporosis in 64 women aged between 20 and 30 years. Those in the OPEP group (32) participated in three types of exercise: stretching, strengthening, and high impact weight bearing types.

Their report published in April 2015 stated that there were “significant changes” in the bone mass index (BMI) of the OPEP group, but none in the walking group. However there were no significant changes in the bone mass density (BMD) of either group. However the study was only carried out for a 12-week period of time, with three sessions per week, and the researchers conceded that studies should be carried out to evaluate the long-term effects of OPEP.

An earlier Japanese study undertaken in 2004 by the Department of Orthopaedic Surgery at Tokyo’s Keio University School of Medicine looked at the effects of walking exercise on the bone metabolism of 32 women aged between 49 and 75, all of whom were postmenopausal and suffered from osteopenia or osteoporosis. A further 18 women formed a control group.

This study was carried out over 12 months, with participants doing “moderate” exercise, walking (at least 8,000 steps) for at least an hour per day, four days a week. Intensity measured 50 percent of maximum oxygen consumption.

Ultimately the study found that there were no significant changes in the lumbar bone mineral density of the women in the control group, but it increased for those in the exercise group. This positive response was found to be “the suppression of bone turnover,” but researchers concluded that the efficacy of this type of exercise positively affecting bone metabolism would probably be “quite modest.”

Tips on Promoting Bone Health

There is a lot that people can do to promote bone health, from childhood right through life until they get as old as most people get before passing on. The ultimate irony is that it isn’t just bone health we should be considering, but overall health that leads to a good health and vitality. For example, a good balanced diet, so important for general good health, should include the nutrients that will maintain healthy bones.

If there is a possibility that you aren’t getting vital nutrients, including minerals and vitamins that are considered essential to bone health, take suitable dietary supplements. 

Add Calcium to Your Diet. According to the NIH, women older than 50 need 1,200 mg of calcium daily, while men require slightly less - 1,000 mg until they are 70, at which point daily intake should be increased to 1,200 mg. Calcium is found naturally in all dairy products, as well as dark green leafy vegetables including kale, morogo, and collard greens.

The Surgeon General’s report (see above) states that it is not difficult to get sufficient calcium from “a normal diet,” including non-fat milk. However, the report quotes Institute of Medicine (IOM) figures that are higher than those recommended by the NIH. Children and teenagers (from nine to 18 years) should take 1,300 mg daily for good bone development; and it also defines “a safe upper limit” for calcium of 2,500 mg per day.

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Increase Your Vitamin D Intake. The ideal daily intake of vitamin D is, according to the NIH, 200 international units (IU) per day. This requirement increases to 400 IU for those aged between 50 and 70 years, and then to 600 IU thereafter. Sunshine is one of the best sources of vitamin D, though many people avoid excess exposure to sunshine because of the risks of skin cancer. The suggestion is to try and spend some time in the sun – and to eat foods that contain vitamin D, including milk, eggs and fatty fish.

Do Weight-Bearing Exercise. Exercise doesn’t only improve bone density, it also improves balance and increases confidence. But it does depend on the type of exercise you chose. For example tai chi isn’t a weight-bearing form of exercise, but it can help improve coordination and balance quite dramatically. Jogging, tennis and walking are good.

Other Important Nutrients. According to the IOM, other important nutrients for bone health include phosphorus and magnesium, as well as vitamins K (found in green leafy vegetables) and C, and certain minerals including manganese, zinc, copper and iron.