The real way to build strong bones

We all know that calcium is important for preventing osteoporosis, right? Make sure you get your three servings of dairy foods per day and you've done your bone protective work. Wrong. There is so much more to attend to in building the dynamic tissues that make up our bones.

This post will largely be speaking to women, since they are the main gender impacted by osteoporosis at epidemic levels.

Let's start with the fact that the nations of the world which have the highest rates of osteoporosis also have the highest consumption of dairy products: so eating dairy cannot be a major force for good in protecting bones (I won't get into a post about the negative aspects of diary products, but let's just say it should be a condiment and not a food group!). So what does protect our bones?

I want to say that osteoporosis is by no means an inevitable or natural part of ageing. It is almost unheard of in indigenous people: Bone is actually designed to build and remodel itself based on lifestyle inputs and outputs, throughout the life cycle. Bone tissue is in a constant motion between construction and demolition teams of molecules. You can rebuild bone strength, even if you've lost some. It really is never too late to start doing the right thing by your bones (with obvious human failures dotted in between!).

It is also important to say that if, like me, you are a smaller person and have been told you have low bone density, it does not remotely mean osteoporosis is inevitable. I may have low bone density, but what about the quality of the bone I do have? It could be, and probably is, absolutely good enough. Quality not quantity :-)

Are you in construction or demolition bone mode?

1. Nutrition: Calcium is important, but so are magnesium, boron, vitamin D, vitamin C and other trace minerals. Are you getting these in your diet? Similarly, if your diet is high in refined carbohydrates, inadequate fresh, plant sourced food (leafy greens, fruits, nuts) and too much salty, oily, devitalised junk; you're in demolition.

2. Physical Activity: Are you getting enough weight bearing exercise? Bones need vertical force (you need to stand, not lie) for at least four hours per day to trigger the construction forces. If you're sitting for most of the day your bones are losing density. Do NOT overexercise either; over training will impair mineral uptake and absorption which is needed for bone building processes.

3. Dietary over restriction: Are you often going on diets? Restricting calories? Anorexia, or yo yo dieting (which involves periods of under eating) compromise bone strength by bringing a females body to a place of less than 18% fat. Even if you remain more than 18% fat, dieting often involves the removal of nutrient dense food from the diet; if you're malnourished, your bones are not building themselves. Much of the female hormone, estrogen, is made in female fat cells. If those fat cells aren't there, not enough hormones are there. If your diet doesn't contain essential nutrients, the bones don't have 'bricks' to build with. Estrogens, and other hormones, are bone protective. Being too skinny is not healthy.

4. Not menstruating: Periods are important. They are a sign your hormones are working properly. These hormones protect your bones from demolition. If you're suffering from painful periods or bad PMT/S, change your lifestyle to combat inflammatory levels in your body (nutrition and exercise will transform how you experience your periods). But don't take them away with artificial hormone treatments; your bones will not thank you.

5. Don't smoke: Chemicals in cigarettes poison your ovaries and decrease levels of those bone protective hormones.

6. Get outside: Protect your skin from burning in the sun, but don't overuse sun cream or hide inside. We make vitamin D from sunshine; it is extremely important, and not just for bones. Between May and September let your skin feel the sun and get nice and warm from it. Take a supplement of vitamin D3 if you're low through the winter.

7. Limit alcohol intake: Do not exceed 25g of alcohol per day.

8. Take care of your liver: Your liver helps to produce and metabolise estrogens (which protect your bones). Excess alcohol and prescription medications tax your liver. A stressed out liver reduces bone density. Sometimes medications are important to take, but if you find yourself popping an ibuprofen too often, or taking statins for cholesterol, why not try nutrition and exercise changes to make a difference first? I promise they are life changing with no negative side effects. And you don't have to eat bran, or boiled veg to get there, I promise.

9. Excess caffeine: Exceeding more than 2 units of caffeine per day helps deconstruct bone tissue. Enjoy your coffee if you tolerate it, but make it a ritual, rather than a mindless habit.

10. If depressed, get help: Depression causes high levels of an immune chemical (IL-6) and the stress hormone cortisol, to be released throughout your body. These can help trigger bone density loss. If you're suffering from depression, get treatment: See your doctor, get natural light and exercise every day and do what you need to do to feel better. Reach out and don't suffer alone.

Osteoporosis is not a death sentence in that it doesn't directly kill a person. But anyone who has worked with elderly people in hospitals can recite a story of how a hip fracture marked a fast demise in a patient who was older, but had a very fulfilling life. The rapid decline of muscle and bone strength in a bed ridden patient after such a fracture can lead to an immense drop in a will to live: To suddenly be so dependent, to feel so frail and not be mobile at all is a tremendous shock: The mortality rate within a few months of hip fracture is notably high.

Our bones frame us and shape us; don't neglect them.