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The key to keeping your bones strong

Reading time: 6 minutes

There’s no question that your bone health is intimately tied to quality and length of life. Osteoporosis, a condition of severe bone loss, carries a markedly higher risk of bone fracture, the most serious being a hip fracture, which can lead to loss of independence and lower quality of life. The mortality rate after a hip fracture is 27 percent within one year and 79 percent by four years.1

Osteopenia, a diagnosis for bones that are clearly less dense than normal but not severe enough to meet the criteria for osteoporosis, also carries an increased fracture risk.

The standard therapy for osteopenia or osteoporosis, which is medication to block bone breakdown, does improve bone density but with serious potential side effects, including esophageal cancer, jawbone necrosis and atypical fractures of the femur after prolonged use.2 In atypical fractures, the leg bone breaks under minimal stress, likely because medication helps make the bones more dense, but also more brittle.

Healthy bones require a balance between laying down new bone, a process controlled by osteoblasts, and removing old bone, a process controlled by osteoclasts. Maintaining this balance leads to true bone strength, which factors in both bone density and bone quality. As the currently prescribed medication blocks osteoclasts from breaking down bone, it can ultimately lead to more brittle bones.

Clearly, the best situation is prevention. To that end, there are six key ways to maintain strong bones without medication. These suggestions are not only important for prevention but also vital if you already have a diagnosis. They can make your bones stronger, not just denser. Here are my top tips to naturally increase your bone strength.

1. Eat enough protein

Protein forms the scaffolding to which the minerals attach and is a key component of bone strength. How much protein is enough? A good estimate is 0.36 g of protein per pound of body weight. So, for example, if you weigh 150 lb, you should aim for at least 54 g of protein daily. This translates to about 8 oz of meat, fish or poultry, or eight eggs. That’s because 1 oz of meat or one egg contains about 7 g of protein.

2. Exercise

Strong muscles lead to strong bones. You can strengthen your muscles with weight-bearing exercise and resistance training (lifting weights), like the following:

  • Walking
  • Climbing stairs
  • Dancing
  • Jogging

Proper weight training puts just the right amount of tension on your bones to stimulate growth and strength. Concentrate primarily on your core, the area from your belly button to your knees, to increase hip-bone strength to prevent life-altering fractures.

Proper weight training implies adequate rest between exercises; otherwise, you’re overtraining, which results in muscle breakdown rather than building. Most studies recommend training the same muscle groups no more than two or three times a week. Debra Atkinson, fitness expert for women over 50, recommends twice-weekly training.

“What we have to consider is bone density at the expense of adrenal health. There’s not a lot of research that looks at both the overall need for recovery and the frequency of stress to bone. In our 8 years of application, we’ve witnessed students improve bone density year to year with twice-weekly training, and remain compliant because it’s doable.”

3. Optimize four key micronutrients

The next four tips relate to several micronutrients, vitamins and minerals that play a role in bone maintenance. While many micronutrients affect bone health, four stand out as major players.

Calcium is what most people think of as the main component in bone health, and it’s the mineral with the highest concentration in bone. There is a bit of controversy about the amount of dietary calcium needed to maintain healthy bones—the recommendation varies from 600 to 1,200 mg for adults.3 A Swedish study from 2012 found higher mortality from calcium supplementation of 1,400 mg daily, compared to 600–1,000 mg.4 While supplementation is tempting, obtaining this amount of calcium from dietary sources is better, as it’s absorbed more slowly.

Dietary sources of calcium:

  • Dairy
  • Canned, bone-in fish (sardines, salmon, anchovies)
  • Dark-green leafy vegetables
  • Seeds (especially poppy and sesame)
  • Almonds

Vitamin D is crucial to bone health for several reasons:

  • It’s essential for calcium absorption.
  • It helps deposit calcium onto the protein scaffolding for denser bones.
  • It improves muscle-building, increasing the stimulus to build stronger bones.5

Optimizing vitamin D requires either sun exposure or supplementation, as it’s not available in high quantities from food sources.

Skin cells make vitamin D out of cholesterol when triggered by ultraviolet light from sun exposure. People living in northern latitudes are more likely to need supplementation because the sun’s angle on the earth at these latitudes doesn’t trigger synthesis as much.

If you’re supplementing with vitamin D, it is important to note that it’s a fat-soluble vitamin, which means it will accumulate in the body over time. You can check your level by measuring a serum 25-hydrox-vitamin D level (25-OHD).The reference range at most labs is 30–100 ng/mL. The US-based Vitamin D Council recommends a level of 40–80 ng/mL to get the most benefit.6

Vitamin K2 helps with calcium modulation, ensuring that calcium stays in the bones rather than depositing in the joints and blood vessels.7 The official Recommended Dietary Allowance (RDA) of vitamin K is not very helpful relating to bone health as it’s based solely on vitamin K1 and blood clotting. It has not been updated to include bone strength. Studies of vitamin K2 (MK4 and MK7) and bone health are looking at a range of 50–180 mcg.8

Vitamin K2 is not readily available from food sources other than natto (fermented soy). If you supplement, read the label specifically to see whether it’s K1 or K2, as only vitamin K2 has been shown to improve bone strength.

Magnesium plays multiple roles in maintaining bone health: it’s part of the mineral content of bone, is necessary for vitamin D synthesis and is anti-inflammatory. Unfortunately many people have low magnesium, which is associated with increased fracture risk.9 The RDA for magnesium is 310–420 mg elemental magnesium, depending on gender and age.10

Dietary sources of magnesium:

  • Legumes
  • Leafy vegetables
  • Nuts
  • Whole grains

4. Reduce inflammation

Inflammation accelerates bone loss.11 A nonspecific measure of inflammation is high sensitive C-reactive protein (hs-CRP), which is associated with osteoporosis.12 Chemicals called cytokines are released from the immune system during inflammation, increasing bone breakdown.

Understanding that lifestyle factors play a key role in inflammation can help you decrease it and prevent bone loss. Two strategies to decrease inflammation are to decrease things that cause inflammation and to increase things that reduce it.

Measures to reduce inflammation:13

  • Avoid added sugar in your diet.
  • Avoid processed foods.
  • Don’t drink excessive alcohol.
  • Don’t smoke cigarettes.
  • Eat more vegetables.
  • Eat more fiber.
  • Eat more omega-3 fatty acids or supplement.
  • Exercise but don’t over-train.
  • Increase intake of vitamins C, E and A.

5. Get quality sleep

Multiple studies show a relationship between too little or too much sleep and osteoporosis.14 The ideal amount of sleep for optimal bone health is eight or nine hours a night. Significantly less or more than that can have a negative impact on bone health.

During sleep is when the body repairs. Growth hormone released during sleep is very important for repair as well as muscle and bone health.15 Poor sleep is also associated with increased inflammation leading to increased bone loss.

Strategies to improve your sleep:

  • Maintain a stable sleep schedule; go to bed and get up around the same times consistently.
  • Sleep in a dark, cool room.
  • Avoid caffeine within 8 hours of bedtime.
  • Don’t eat within 3 hours of bedtime.
  • Don’t nap past 3:00 p.m.
  • Get at least 30 minutes of natural sunlight daily, preferably first thing in the morning.
  • Do something relaxing for the 2 hours before bedtime.
  • Avoid computer screens within 2 hours of bedtime.
  • Turn your Wi-Fi off at night.

If you still struggle with sleep after doing these things, make sure to see a doctor. Sleep is very important for your bone, and general, health.

6. Reduce stress

Multiple studies show a relationship between high stress and bone loss.16 This is likely related to cortisol, the adrenal hormone that is released during times of stress. Glucocorticoid medications are well known to lead to bone loss and mimic cortisol.17

We live in a society where stress is deemed normal, even admirable. We pride ourselves on productivity and busyness. It’s good to be productive, but we also need downtime. We need to be able to step away from the stress to rejuvenate, yet too many people don’t.

Simple ways to reduce stress:

  • Meditate—it doesn’t have to be complicated. Many apps are available offering guided meditations.
  • Spend time in nature.
  • Keep a gratitude journal. Write down three things you are grateful for every morning.
  • Sing along with your favorite music. Singing activates the vagus nerve, relieving stress.
  • Try the Emotional Freedom Technique, which applies tapping or pressure at specific acupressure points. It’s inexpensive and easy to learn.

In summary, bone health is crucial to quality of life, and many things we can do to improve our bone health don’t require prescription medications. The beauty of these tips is that they will likely improve many other aspects of your health as well.

Dr Yvonne Karney, a functional medicine specialist and trained ob-gyn, focuses on healing chronic fatigue, fibromyalgia, autoimmune diseases and more. You can contact her at VitalityRenewal.org.

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References

References

1 

BMC Musculoskelet Disord, 2011; 12: 105

2 

BMJ, 2010; 341: c4444; Pathology, 2014; 72(10): 1938–56; Clin Orthop Relat Res, 2012; 470(8): 2295–2301; Amgen, “Highlights of Prescribing Information, Prolia,” Ref ID 4794786, 2019, AccessData.fda.gov

3 

NIH Office of Dietary Supplements, “Calcium: Fact Sheet for Health Professionals,” June 2, 2022, ods.od.nih.gov

4 

BMJ, 2013; 346: f228

5 

Nutrients, 2010; 2(7): 693–724

6 

Vitamin D Council, “For Health Professionals: Position Statement on Supplementation, Blood Levels and Sun Exposure,” 2018, VitaminDCouncil.org

7 

Kidney Int, 2013; 83(5): 835–44

8 

J Nutr Sci Vitaminol, 2015; 61: 471–80; Osteoporos Int, 2013; 24: 2499–2507

9 

Eur J Epidemiol, 2017; 32: 593–603

10

NIH Office of Dietary Supplements, “Magnesium: Fact Sheet for Consumers,” June 2, 2022, ods.od.nih.gov

11 

Immun Ageing, 2005; 2: 14

12

J Natl Med Assoc, 2005; 97(3): 329–33

13

PLoS One, 2013; 8(7): e67833; Ann Behav Med, 2012; 44(3): 399–407

14

Bone, 2011; 49(5): 1062–66; J Clin Endocrinol Metab, 2014; 99(8): 2869–77

15

NIH National Heart, Lung, and Blood Institute, “In Brief: Your Guide to Healthy Sleep,” 2011, nhlbi.nih.gov

16

J Epidemiol Community Health, 2019; 73(9): 888–92; Front Endocrinol (Lausanne), 2021; doi: 10.3389/fendo.2021.719265

17

PM R, 2011; 3(5): 466–71

Article Topics: Bone health, bones
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