When you think about Osteoporosis it’s common to treat it as a condition that only affects older adults. However, we are seeing Osteoporosis or pre-Osteoporosis affecting more women at younger ages. Here we will discuss bone health, how it can be impacted as we age, and what lifestyle choices you should consider to improve or maintain bone health.

Bones are made up of collagen and protein, this collagen and protein calcify to form crystalline deposits that make up the matrix of the bones (Huether, 1996). Bone remodelling is the process by which bones repair damage from everyday wear and tear. This remodelling is what is required to maintain bone density (Siddiqui & Partridge, 2016). Bone cells known as osteoblast and osteoclasts are responsible for this repair. Osteoclasts absorb bone, to harness the minerals while osteoblasts come behind and reform the bone that has been dissolved. Some osteoblasts stay within the bone matrix as osteocytes, they serve as communication cells within the bone, notifying the osteoclasts of the need for the bone, or if the minerals are available for alternate use (Huether, 1996, p. 1013). If we are sedentary, the bone will be absorbed so that the minerals can be used for other purposes.

Hormone function in bone turnover

The hormones estrogen and testosterone play a role in stimulating the activation of osteoblasts and osteoclasts. Oestrogen activates the bone cells in the spongy bone in the centre of the bone, while testosterone activates the bone cells in the hard-outer shell of the bone. Both of these hormones perform the same function in both sexes (Narla & Ott, 2018). Testosterone and oestrogen are both classified as steroid hormones, meaning their base is made from triglycerol (Stoker, 2013, pp. 989-990). As we get older the production of these hormones declines, this means that bone remodelling slows down as well. This is why our senior members of the community are more at risk of bone breakages.

Liver function

While the hormones are produced by the testes, ovaries, adrenal glands (Stoker, 2013, p. 690) and adipose tissue (Kim, Cho, & Kim, 2014), the building blocks for these hormones (triglycerol) are produced by the liver. Conversion of these hormones into other forms also takes place in the liver. For instance, the aromatisation of testosterone into oestrogen must take place in hepatic cells (Grossmann, Wierman, Angus, & Handelsman, 2018). Optimal liver function is therefore essential for the balance of oestrogen and testosterone (Gawrieh, 2015).

Glycaemic control

When carbohydrates are broken down into their basic form which is glucose, insulin needs to be released to facilitate the transport of glucose into the cell membrane where it can be converted into ATP, the energy currency of the body. When we have consumed a lot of glucose-rich food, the pancreas has to produce a lot of insulin to move the glucose into the cells (Stoker, 2013, p. 911). While the role insulin plays in the body is to move glucose into the cell, it is not the only function that insulin plays. Insulin supports a growth factor in all living organisms. It is insulin that determines the size a species will grow to. When excess insulin needs to be produced to cope with spikes in blood glucose, it results in this growth factor having an impact on other body systems (Hyun, 2013). The liver is directly impacted by excess insulin, as this results in a spike in fat accumulation and inflammatory markers in liver cells. These result in a slowed function in the liver (Kitade, Chen, Ni, & Ota, 2017). When blood glucose levels are not balanced, this will also have an impact on bone density (Grossmann et al., 2018).

Low glycaemic foods

To protect the liver from insulin spikes, eating foods that will gradually raise blood sugar, instead of raising the blood sugar quickly is required.

Some examples of low glycaemic (GI) foods include:

• Oats
• Legumes
• Sweet potato
• Basmati rice
• Barley
• Quinoa
• Chia

Used hormones and cholesterol then need to be eliminated from the colon so that they are not reabsorbed (Ross, Pusateri, & Shultz, 1990). For the effective elimination of waste, fibre is required in the diet (Whitney, 2013). This is just one reason why regular bowel movements are so important!

Calcium

Calcium stores for the bones peak in adolescence and are then maintained throughout life (Davidson (2014). Owing to the steep decline in bone mass in people over the age of 70, the calcium requirements of a 70+-year-old are equal to that of an adolescent at 1300mg per day. It is however important at this point to not exceed the daily limit of 2500 mg or risk forming kidney stones (Whitney, 2013, p. 391).

Cows milk is a hotly contested topic, because of the high number of allergies and intolerances associated with its consumption. We refer to milk as the primary food because we are mammals and our infants require milk, preferably milk that closely resembles breast milk nutritionally at a younger age (Seppo et al., 2017). Milk is however not the only source of calcium available. We can get creative here, in how we include calcium in the diet. Green vegetables like beans, pulses, broccoli, bok choy and kale as well as nut milk fortified with calcium are all high in calcium. Just be cautious when consuming these veggies with spinach, as the oxalate present in spinach may interfere with calcium absorption (Rogerson, 2017).

Zinc

Zinc is an essential mineral that plays a role in the formation of new DNA (Trickey, 2011). Zinc is also a key component of enzymes within the body (Babatunde, Bourton, Hind, Paskins, & Forsyth). Low zinc levels are associated with low testosterone levels in males (Kow et al., 2019). It is therefore essential in males, that foods high in zinc are consumed. Foods are preferable to supplementation unless recommended by your health care practitioner.

You should also know that zinc competes with iron for absorption, and incorrect zinc supplementation could result in iron absorption reduction (Whitney, 2013).

Foods high in zinc include dairy products, animal-based protein and seafood.

Physical activity

Research indicates that resistance training has a positive impact on bone density, while impact exercise does not (Babatunde et al.). Lowered vitamin D levels have a negative effect on bone density (Kow et al., 2019). These findings point to, that light outdoor activity daily, will have a greater impact on increasing bone density than would expensive gym contracts. Outdoor activity will both raise vitamin D levels and increase natural resistance training, that will not impact joints negatively.

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