Building Healthy Bones by Aliza Beer, MS RD

Health & F tness Building Healthy Bones

By Aliza Beer MS, RD, CDN

With the cold weather setting in, the desire to stay wrapped in a warm blanket with a hot chocolate or a delicious pasta dish is all too appealing. While going for a walk or a run in the fresh air and preparing a nutritious dinner may feel like a burden, it is during the winter months, when the UV index is low, that prioritizing such tasks is even more essential in order to protect our bones.

Bone Anatomy

Bones are made up of both dense cortical and less dense trabecular tissue, and the bone matrix forms the mass of the bone. The bone matrix is composed of both organic and inorganic substances. The organic component of the bone matrix is largely collagen, while the inorganic component mostly consists of the minerals phosphate and calcium, as well as bicarbonate, sodium, potassium, citrate, magnesium, zinc and bramium. In order to perform their key functions, which include supporting locomotion, protection of the bodies’ tissues, as well as calcium and phosphate storage, our bones are continuously being broken down and remodeled. These processes are tightly controlled by the interactions of numerous bodily hormones and the cellular bones. When these processes fall out of sink and bone resorption exceeds the formation of new bones, osteoporosis may occur. Osteoporosis is a bone disorder, characterized by low bone mineral density and compromised strength, which predisposes individuals to an increased risk of fall and or fracture. According to the World Health Organization standards, a bone mineral density score measured by a DEXA (Duel-energy x-ray absorption) scan, 2.5 standard deviations (SD) below the mean is indicative of osteoporosis and that the skeleton is unable to sustain ordinary strains. A score between 1-2.5 SD of the mean osteopenia, or low bone mass.

It is estimated that 10 million people age 50 years and older in the U.S. have osteoporosis, with the majority being women and around 2 million being men. While many factors contributing to osteoporosis are non-modifiable – such as family history, age, sex, race and ethnicity – diet and exercise, as well as many other lifestyle factors also may contribute or prevent the onset of osteoporosis.

Risk Factors

1. Body Weight • There is a strong correlation between bone mineral density and body weight. • Lower body weight is associated with low bone mineral density and a greater fracture risk 2. Age • Bone loss coincides with menopause, when the ovaries stop producing estrogen. • The decline of estrogen is associated with greater bone breakdown. 3. Cigarette Smoking • Smoking has both direct and indirect cellular effects on bone, as well as possible hormonal changes and lower dietary calcium absorption. • Associated with poor diet and decreased physical activity 4. Disease • Diabetes, chronic renal disease, hyperthyroidism, hyperparathyroidism, chronic obstructive pulmonary disease, intestinal malabsorption, chronic diarrhea 5. Medications • Corticosteroids, Heparin, Lasix and Thiazide diuretics, thyroid hormone, Phenothiazine derivatives, Tetracycline, Phenobarbital 6. Sedentary lifestyle 7. Poor diet 8. Lack of sunlight

Nutrition Energy/Calories

While overall caloric consumption does not have an effect on bone health, inadequate calories, leading to lower body weight, is an increased risk factor for the development of osteoporosis. Maintaining adequate caloric intake to meet your nutritional needs is important for maintaining overall health.

Protein

Protein is an important component of peak bone mass. Protein is a major component of all our cells, including bone cells. Bone undergoes continuous remodeling, and adequate protein is needed for the formation and support of bones. A higher protein diet, combined with high calcium intake, has been found to increase intestinal absorption of calcium. Additionally, consuming protein suppresses the activity of hormones, such as parathyroid hormone, which stimulates the breakdown of bones to maintain blood calcium levels.

For individuals with osteoporosis, research has suggested that a minimum of 1.0-1.3g protein per kilogram of body weight can prevent and reverse muscle loss, increase strength and reduce the risk for falls and fracture. High sources of protein include meat, fish, eggs, and low-fat dairy products, such as Greek yogurt. Plant-sources of protein are soy, nuts, beans and seeds.

Fiber

Certain forms of fiber, such as prebiotics, which stimulate the growth of healthy bacteria in your gut, have beneficial effects on calcium absorption. Ensuring you maintain adequate fiber in your diet by consuming, through the consumption of whole-grains, oats, fruits, nuts, legumes as well as the vegetable peel, is important for your bone health as well as your digestive system.

Calcium

Calcium is required for the formation and maintenance of healthy bones. It is estimated that around 99% of the body’s calcium is in the bones. Calcium works alongside the protein collagen to make bones flexible and strong. It is a mineral critical to obtaining peak bone mass. While the majority of calcium is in your bones, your cells also require calcium for numerous processes such as wound healing, muscle function and sending nerve impulses. Maintaining blood calcium levels is a priority over bone calcium, and therefore when blood calcium levels are low, your bones will be broken down so the calcium in your bones may be obtained. Maintaining adequate levels of calcium in your diet is essential to mitigate this process and maintain your bone health.

While dairy products contain the most calcium, calcium may also be found in leafy green vegetables, figs, almonds,

fish, tofu, nuts, seeds, beans and lentils. Certain products are also fortified with calcium, such as breakfast cereals, bread and some crackers. Calcium supplements may be recommended for individuals who are unable to meet their calcium recommendations such as for individuals with low bone mass, individuals with a lactose intolerance, post-menopausal women, or those on medications such as corticosteroids, which negatively impact calcium in the body.

Phosphorus

Phosphate is another mineral crucial for bone growth and mineralization, and in its absence, bone disorder may result. The maintenance of an optimal phosphate balance is managed by complex interactions between the gut, kidney, and bones. Calcium and phosphorus have an inverse relationship, and as phosphorus levels rise in the blood, the level of calcium falls because phosphorus binds to calcium. It is important to monitor calcium, vitamin D and phosphorus in order to maintain healthy bones.

Examples of dietary sources of phosphorus are chicken, turkey, fish, dairy, nuts, sunflower and pumpkin seeds, as well as soy and wholegrains. There is little demand on dietary phosphorus intake for optimal bone health as excretion of phosphorus may be reduced to low levels and phosphorus may be released from the bones and efficiently reused for mineralization in new forming bones.

Magnesium

About 60% of magnesium is stored in the bones, and it plays a key structural role in the formation of new bones. Dietary restriction of magnesium promotes osteoporosis and low intake may retard cartilage and bone formation. Sources of magnesium include dark chocolate, salmon and fatty fish, bananas, avocados, tofu, leafy greens, wholegrains, nuts and seeds. A minimum of 300mg a day is recommended for individuals with osteoporosis.

Vitamin D

Vitamin D is important for the absorption of calcium and maintains blood calcium and phosphorus levels within a constant range. Vitamin D is required to enable calcium to build healthy bones, and without enough vitamin D, calcium will not be able to achieve its full potential. Sunlight is the major source of vitamin D. Your kidney synthesizes active vitamin D (cholecalciferol) from exposure to UV rays. During the winter, a vitamin D supplement is often recommended when the UV index is low. For the treatment of osteoporosis, 800IU of vitamin D is recommended.

Vitamin D may also be obtained through dietary sources, such as the egg yolk (41 IU), cod liver oil (1369 IU), salmon (566 IU), maitake mushrooms (943 IU), tuna (100 IU), vitamin D for-

Breakfast:

• Low-fat Greek yogurt with figs, berries, chia seeds and a spinach smoothie • Whole wheat toast with lox and lowfat cream cheese • Steel-cut oats with almond butter, flaxseeds, and berries

• Chicken with whole-wheat pasta, spinach, and mushrooms • Salmon burger with sweet potato and burnt broccoli

Snack:

• Strawberries dipped in dark chocolate • Avocado chocolate mousse • Trail mix of nuts and seeds • Low-fat Greek yogurt and seeds • Whole-wheat crackers with low-fat cottage cheese or cream cheese

Diet and exercise may both help to combat and prevent the onset of osteoporosis. By focusing on food sources that are high in calcium, magnesium, and vitamin K, as well as adhering to a consistent exercise regimen, you can help to maintain strong and healthy bones.

Exercise is one of the best ways to strengthen your bones and prevent osteoporosis.

tified orange juice (137IU), vitamin D fortified milk (115 IU), and Swiss cheese (6 IU). The 25-hydroxy vitamin D test is the most accurate way to measure how much vitamin D is in your body. Levels of 50nmol/L and above are adequate, while above 125nmol/L are a concern.

Vitamin K

Vitamin K is another essential micronutrient for bone health. It is important for the production of proteins that impact bone matrix mineralization. Vitamin K may also help to decrease bone resorption, increase collagen content in bones, and affect the formation of osteoblasts, which are the cells responsible for bone formation.

Dietary sources of vitamin K include green leafy and cruciferous vegetables, such as spinach, kale, lettuce, mustard greens, romaine lettuce, broccoli, Brussel sprouts and Swiss chard, vitamin K may also be found in chicken, eggs, and hard cheese. It is recommended that individuals with osteoporosis should aim to consume 90-120mcg vitamin K daily.

Exercise

Exercise is one of the best ways to strengthen your bones and prevent osteoporosis. It enables you to build and maintain the volume and thickness of your bones. It is recommended that individuals with osteoporosis perform balance activities daily, weight bearing paired with aerobic exercise five or more days a week, resistance training two or more days a week, and to limit twisting or other activities that may lead to poor spine alignments. Working with a physical therapist is recommended to tailor an appropriate exercise regime to meet your needs.

Lunch:

Salmon salad with leafy greens, avocado, mushrooms, and pumpkin seeds

Tuna salad sandwich on whole-wheat toast with leafy greens

Farmer cheese with high fiber crackers and broccoli soup

Dinner:

• Steamed tofu with lentils, edamame beans, and rice

Aliza Beer is a registered dietitian with a master’s degree in nutrition. She has a private practice in Cedarhurst, NY. Patients’ success has been featured on the Dr. Oz show. Aliza can be reached at alizabeer@gmail.com, and you can follow her on Instagram at @ alizabeer.