Recent reports have shown that rickets is increasing in children in the UK. This is not only a problem for children that have the condition currently but also an indication that children’s bone density may not be achieving optimal peak bone mass by their twenties; this may have a negative effect on the health of those children in the future.
Osteoporosis is a condition where bone density is reduced leading to an increased risk of fractures. It is generally associated with ageing especially in women, although it does affect males too.
Although osteoporosis may not sound like a particularly serious condition it has a significant impact on mortality and morbidity in later years. This is due to the fact that the risk of fractures is significantly increased. Hip fractures in the elderly are extremely serious and often lead to complications such as infections, poor healing and loss of mobility.
In the US, 90% of hip fractures in women between 65 and 84 are due to osteoporosis. Osteoporosis is more prevalent in women because oestrogen has an important role in maintaining bone density through inhibiting osteoclasts which stimulate bone resorption. When women reach the menopause their production of oestrogen reduces significantly and therefore bone density decreases at a more rapid rate.
Bone density begins to decrease, on average, after the age of 28. Prior to that, bone mass rapidly increases throughout childhood, the rate slows down in the teens but continues throughout the 20’s, although the majority of bone mass is achieved by the age of 17.
Although the length and shape of bone does not normally change after ossification (bone formation) is complete, bone tissue is continually being remodelled and replaced when damaged throughout life.
After the age of 28 women’s bone mass tends to decrease by an average of 0.4% per and then by 2% for the first 5-10 years post-menopause and then the rate of decrease slows again.
Therefore, it is important to take care of your bone density much earlier in life than we tend to think. If we can achieve a healthy bone density throughout childhood, teens and 20’s we will be more greatly protected from osteoporosis later in life. So what do we need to do?
Reduce risk factors
There are many factors that can contribute to a loss in bone density, so these should be considered.
Smoking: Female smokers have been shown to lose bone mass more rapidly. The reason for this is not clear but it is thought that smoking may interfere with oestrogen metabolism.
Acidic Diet: Foods such as animal and dairy products decrease the pH of the blood (acid forming), when the pH decreases calcium needs to be liberated from bone in order produce buffers to maintain acid-base homeostasis.
Sedentary lifestyle: Weight bearing exercise is so important for healthy bone density because it stimulates osteoblasts which are the cells responsible for building bone. People who have undergone prolonged bed rest or are confined to a wheelchair experience a rapid and dramatic loss of bone.
Soft Drinks: Drinks that you or your child consume may also be impacting on calcium and your bones. For a number of years, concern has been expressed about the consumption of phosphoric acid in fizzy drinks as a potential cause for the loss of calcium.
However, the Framingham Osteoporosis Study did not confirm this. The research did find, “cola intake in women was associated with significantly lower bone mineral density at each hip site, but not the spine. Similar results were seen for diet cola and, although weaker, for decaffeinated cola”. (Tucker et al 2006)
Exposure to hormones: The amount of time that the body is exposed to oestrogen has a significant effect on bone density, therefore late onset of menses or early menopause are both risk factors for osteoporosis.
It is essential therefore during menopause, particularly if it is early onset, to support the adrenal glands which take over oestrogen production from the ovaries. See Cytoplan Blog: menopause and osteoporosis.
Consider nutrients for bone health
As well as reducing the risk factors above there are many ways in which we can support bone health and help to protect it long term. This involves a combination of diet, lifestyle and supplement support in order to optimise bone health.
It should be remembered that the most important time to think about this is in the teens and twenties however adopting these at any time will still have an impact.
Nutrients essential for supporting bone heath particularly in early life are:
Calcium: The importance of calcium intake for bone health has long been reported. However some of the main dietary sources of calcium such as meat and dairy products are acid-forming and therefore, as mentioned above, can have a negative effect on bone density.
Calcium is abundant in many foods and can also be found in green leafy vegetables, nuts and seeds, bony fish such as sardines as well as unfiltered tap water. Adequate calcium intake during childhood is essential in order to achieve peak bone mass. Calcium intakes for adolescent females have been reported as inadequate.
You will often find Vitamin D and calcium are supplemented together. Vitamin D helps to regulate calcium metabolism and calcification of bones. Therefore calcium is useless for bone health without the help of Vitamin D.
Vitamin D also increases the absorption of calcium through the gut and decreases excretion through the kidneys. In the UK we are often deficient in Vitamin D as UV light from the sun is required to manufacture cholecalciferol from cholesterol in the skin which is then converted by the liver and then the kidneys in to the active Vitamin D3 or calcitriol.
Animal based sources of D3 include; oily fish, egg yolk, butter and liver. If you are considering supplementing Vitamin D it is important to ensure that it is in the active D3 form. Long term high doses of Vitamin D combined with sun exposure can lead to Vitamin D toxicity, so if taking high doses long term, Vitamin D status should be tested regularly.
There are two forms of naturally occurring vitamin K – vitamin K1 and K2. Vitamin K1 is found naturally in plants, especially green vegetables. K1 goes directly to the liver and helps maintain healthy blood clotting, or it can be converted to K2. Vitamin K2 is made by gut bacteria and goes to bones, blood vessel walls and tissues other than the liver.
The Framingham heart Study data showed a decreased incidence of hip fractures with those recording a higher intake of vitamin K. See Cytoplan Blog: Vitamin K2 – For Cardiovascular Health, Fighting Cancers and Osteoporosis? The blog also discusses studies which have shown that Vitamin K2 supplementation can reverse bone loss in patients with osteoporosis.
Again adequate Vitamin K intake in early life will aid bone building helping to achieve peak bone mass by the age of 20. Food sources of Vitamin K1 (which can be converted to K2 but this process can be inefficient) are: dark green leafy vegetables eg broccoli, lettuce, cabbage, spinach, and green tea.
About 55-60% of our magnesium is found in bone. Magnesium works synergistically with calcium and helps to regulate its transport and metabolism. It is thought to be as, or more, important as calcium for contributing to bone density.
As well as aiding calcium transport to bone it also is a co-factor in the conversion of D2 to (active form) D3 and mediates parathyroid hormone and calcitonin (hormones involved in bone density regulation). Magnesium can also be found in dark leafy green vegetables as well as nuts, seeds and wholegrains.
Other nutrients which are important for bone structure and maintenance are; Boron, Manganese, Phosphorus which are also constituents of bone. Vitamin C is also an essential component in collagen formation and bone growth.
Protecting our bones for the future
The message then, to protect bone health, is to start as early in life as possible:
- Participate in weight bearing exercise such as walking and running, remember exercises such as swimming and cycling are not weight bearing. Ensure children lead an active lifestyle and get outside for at least 30-45 minutes per day, increase activity by walking to school or joining a club. As you age ensure that you obtain 1 hour of moderate activity at least 3 times a week and make sure arms bear weight as well with weight or strength training.
- Maintain adequate levels of all nutrients as if we have sub-optimal levels of even one or two nutrients the body will place survival ahead of long term health. So ensure your diet contains adequate levels of calcium, magnesium, zinc, boron and vitamin K. Vitamin D is obtained primarily from sunshine. Even optimal diets can be lacking in certain nutrients so you may want also to consider a good quality multivitamin and mineral.
- Consider digestive health, absorption of key minerals is reduced if stomach acid levels are insufficient. Also healthy gut bacteria are important for assisting digestion, absorption and Vitamin K synthesis, as well as preventing inflammation which can have a negative effect on bone health.
- Get some sunlight. Fifteen minutes sun exposure, between 10 am and 2 pm, to the face and forearms as often as possible between April and October is important for Vitamin D production (avoid reddening). Consider a vitamin D3 supplement over the winter months.
If you have any questions regarding the topics that have been raised, or any other health matters please do contact me (Amanda) by phone or email at any time.
firstname.lastname@example.org, 01684 310099
Amanda Williams and the Cytoplan Editorial Team: Joseph Forsyth, Emma Williams, Simon Holdcroft, Clare Daley and Helen Drake
Relevant Cytoplan Products
Little People – Multi Vitamin and Mineral Formula designed for children, teenagers and lightweight adults. Contains D3 and vitamin K.
Cytogold – multivitamin and mineral with added calcium and magnesium, as well as D3 and vitamin K.
Pregna-Plan – all-round multivitamin and mineral designed for pregnancy. Includes vitamin D, vitamin K and 334 mg calcium plus 117 mg magnesium.
Bone Support – formula specifically designed to support bone density as we age. A combination of calcium, magnesium, D3, K2 and isoflavones.
Phyto-Flavone – 100% natural isoflavones for during and after the menopause.
Wholefood Vitamin D3– Available in high potency (62.5ug), suitable for individuals with low Vitamin D levels or to take over winter months, or a lower dose of 15ug suitable for longer term supplementation. Both provide vegan sources of vitamin D3 from lichen.
Wholefood Calcium – calcium supplement extracted from calcified seaweed.
Biofood Magnesium – organic matrix from of magnesium.