Impact on our bone health starts early. Peak bone mass is achieved around age 30 – and this is a major determinant of how strong (how dense) your bones will be as you age. Luckily our bodies want to be strong and healthy, and when we provide the right nutritional factors and exercise then our bodies work with us.
This means that at any age you can provide the right factors to improve bone health (and in fact overall health) and get results. At any age you can make enormous improvements in your bone health and overall body health, no matter where you are starting from or what your goals are. Keep in mind what is right for your bones is right for your whole body – the side effect of taking care of your bones is that your whole body will be healthier and stronger!
Let’s start here with the basic science, so you can understand why what you do works.
Bones hold us up, produce blood cells in their interior, and provide a storage of calcium for when we need it. Like all tissue bones turn over – meaning they break down and are rebuilt regularly. When we are young this happens in balance. As we age, bone breakdown can outpace replacement.
A scaffold made of collagen provides flexibility and supports the calcium-based mineral called hydroxyapatite that provides density. The process of building and breaking down old bone is regulated by a few different types of cells, mainly osteoblasts which create bone, and osteoclasts which break it down. Regulating the activity of these two opposing cells is how we affect bone density.
This video provides a great overview of the basics of bone building and breakdown:
A note on density and DEXA scans: DEXA scans measure the density of bone, but they do not measure flexibility. Quite a lot of small-boned women might be diagnosed with osteopenia or even osteoporosis, though they would never fracture. Unfortunately, there exists no test for flexibility, and the DEXA scan is not predictive for fracture. A fuller understanding of bone health and additional factors is needed to predict general fracture risk. This can be done here.
Your body doesn’t manufacture calcium or phosphorus, or a lot of the amino acids required to build bone, nor the vitamin C or trace minerals required to make the collagen scaffold strong. We must get these from our diets, or from supplements. And we must have the right nutrients in the right ratios to ensure they function for us.
Whole foods contain enzymes and additional factors that help us absorb the nutrients, so whole foods are the ideal source of nutrients. However, there are some nutrients such as vitamin D and vitamin K2 that are harder to get from food sources, and we must have enough of them to ensure the bone building process works in favor of bone growth rather than loss.
Estrogen and testosterone affect the process of bone turnover, and loss of hormones as we age does affect bone health. However, it is not the case that normal estrogen (or testosterone) loss means we are in danger of osteoporosis or fracture. In almost all cases, proper nutrition and exercise will increase bone density and decrease fracture risk significantly.
The presence of estrogen in any form (our own, HRT or phytoestrogen) increases the benefit of impact exercise on bone. Retired osteoblasts move to the interior of the bone to help maintain oxygen and mineral levels, and signal the body to strengthen the bone in response to exercise.
When you work with the OsteoStrong® machines, mechanical pressure is put on your body, and on your bones. The pressure causes hydroxyapatite to emit little currents of electricity, called the piezoelectric effect, which in turn kick osteoblasts into action to build bone. If you do not put stress on your bones, the signal is sent that bone formation does not have to happen. This signaling is carried out by osteocytes. Osteocyte death increases with the loss of estrogen. Therefore, phytoestrogens in the diet can be helpful in keeping bones strong especially when you are exercising.
Phytoestrogens have been controversial, when it was thought that they might negatively affect the reproductive system. This however has been shown to be incorrect, and phytoestrogen intake in the form of soy has shown reduction in breast cancer. Phytoestrogens tend to dock in our beta estrogen receptors, which are anti-tumor. Estrogen-positive cancers express the alpha receptor, triggering cell division and tumor growth.
Providing the correct building blocks and signals to your body will in most cases result in stronger, healthier bones, and mitigate fracture risk.
If however you have severe bone loss and are in danger of fracturing, then pharmaceuticals might be warranted at the start to keep you safe.
In general, though there are different modes of action, pharmaceuticals for bone provide some increase in bone density. This is good for improving DEXA scores. This however does not necessarily remove fracture risk, shown by what are called “bisphosphonate fractures”; fractures that occur after bones have increased density from bisphosphonates, the most widely-used pharmaceuticals for osteoporosis.
The reason for this appears to be because though more bone is being deposited the quality of the bone is not intact. The reason for the bone loss in the first place was likely due to lack of nutritional factors and exercise. So, the pharmaceuticals don’t fix the issue of quality, and only if you address the nutrient aspect of bone health will your body then provide high-quality bone.
If you are at high-risk and decide to take pharmaceuticals, it remains vital for you to address the nutritional and exercise components of your bone health. This will enable your body to deposit higher quality bone, and drastically lessen your need for pharmaceuticals in the long run.
The scaffold is made up of collagen and held together by trace minerals and vitamin C; this part of bone provides flexibility if it is properly built.
The mineral salt that provides density is made mainly of calcium and phosphorus.
Osteocalcin (and its counterpart matrix Gla protein) both contribute to ensuring the calcium goes where it should – to the bones (and not to the arteries). Research has shown that these must both be activated properly to ensure bone health, as well as avoid arterial plaque deposition. Their activation is dependent on Vitamin K2, as well as Vitamin D and Magnesium.
These make up the basics of bone building.
Maintenance nutrition is different than medical nutrition. Medical nutrition is the idea of targeted, therapeutic dosages in order to restore balance. If you have severe bone loss, have had progressive loss over time, or have suffered a fracture due to loss of bone health, then therapeutic doses are suggested for the first 3-6 months minimum. Here is the basic starter list of nutrients needed:
Notice there is no calcium on the list – this is because most of us in the US get enough calcium from our diets. It is the additional factors listed here that we are very often missing. Also note that all nutrients – all vitamins and minerals – are needed to produce strong healthy bones.
The only sure way to know, however is to test.