Eating Well For Osteoporosis
Article by Abi Woodliffe-Thomas
*Trigger warning* This blog discusses eating disorders and disordered eating
Before we get into the science behind the nutritional benefits on bone health, it is important to understand what osteoporosis is and how it can develop. When linking to disordered eating patterns, low oestrogen levels are the main driver to significant losses in bone density, as well as the undernourishment of fuels to support bone health. Individuals with disordered eating, specifically anorexia, often produce cortisol (stress adrenal hormone) in excess, thus triggering bone loss.
What is osteoporosis?
Osteoporosis is a disease that weakens bones to the point where they are at a heightened susceptibility to break. Typically osteoporosis affects bones in the hip, spine and wrist.
While osteoporosis can be avoided, there are some important risk factors to be aware of for developing the degenerative bone condition: (1)
Gender - Females are at an increased risk compared to males, and even more at risk should their mother or family member have had the condition .
Poor lifestyle – Smoking, caffeine, and alcohol in excess, with the absence of exercise can increase one’s risk of osteoporosis.
Poor nutrition – Linking to disordered eating habits, malnutrition can enhance the development of osteoporosis as the body hasn’t got enough nutrients in order to protect, build and strengthen the skeleton.
Amenorrhea – This is the term used when a woman experiences the loss of her menstrual cycle. It is one of the biggest warning signs for disordered eating and is also a big red flag for osteoporosis. This is due to the reduction in oestrogen levels affecting calcium uptake and absorption in the bones.
A lifelong lack of calcium is one of the leading causes of osteoporosis, contributing to a diminished bone density, early bone loss and an increased risk in fractures. Eating disorders also have a role to play in the disease onset, this is due to the severe restriction of nutrients, persistent impactful force through overtraining and being underweight weakening bones in both men and women. (2)
Osteoporosis vs osteopenia
People often get confused between osteoporosis and osteopenia. Osteopenia is in-fact the stage before osteoporosis characterised by a lower-than-average bone density for your age, yet not low enough to be classified as osteoporosis.
The main difference is the severity of bone loss. Although osteopenia is characterised by bone loss that is less severe than that of osteoporosis, the risk of fractures is still high in osteopenia compared to normal bone, yet lower than someone with osteoporosis
Source: https://strongandstable.com.au/2017/10/osteopenia-osteoporosis-and-exercise/
Is osteoporosis reversible?
You can reverse the consequence of osteoporosis; however, you cannot completely reverse the condition. There are varying degrees of the severity of osteoporosis, and treatment, be it exercise, weight maintenance and/or nutrition can prevent the condition from worsening. You cannot, however, reverse bone loss alone.
Can amenorrhoea impact bone health?
As previously mentioned in the risk factors for osteoporosis, amenorrhoea has a profound impact on a female’s bone density, specifically in adolescence. Adolescence is a critical period for bone acceleration enhanced by modifiable factors such as calcium intake, vitamin D and a balance of good nutrition and exercise. (3)
Amenorrhoea is generally exacerbated due to overtraining and under-fuelling, and as a by-product causes a dramatic decrease in body weight and essential hormones, oestrogen and progesterone. The reduction in oestrogen and progesterone means that bone is unable to be built up as it should be, most commonly in the prime age where it should be occurring.
The effects of nutrition on bone health
Calcium
Calcium is the most abundant mineral to contribute to bone health, closely followed by magnesium. With 99% of calcium being in our bones and teeth, this mineral is essential in providing hard tissue with its strength. (4)
Calcium is found in most dairy products (cheese, dairy and eggs) as well as spinach, kale, oily fish and fortified foods such as soy and cereals, making it an achievable mineral to consume, even when following a dairy-free or vegan diet.
Our bodies use calcium continuously, so we must replace it regularly via our diet. The recommended daily allowance (RDA) for calcium is dependent on age and sex; adults aged 19 to 50 years old need 1,000 milligrams of calcium a day. After the age of 50, calcium requirements increase to 1,200 mg a day for women. For men, daily calcium needs increase to 1,200 mg after the age of 70. Children and teenagers, 9 to 18, require 1,300 mg of the nutrient each day. Younger children (aged 4 to 8 years) need 1,000 mg and one- to three-year-olds need 700 mg daily. (5) Your body's demand for calcium is greater during pregnancy and breastfeeding because both you and your baby need it. Therefore, women who are pregnant or breastfeeding should consume 1,200 mg of calcium each day to ensure bones remain strong once they have weaned their baby.
It is important to note that for individuals with disordered eating and/or osteoporosis, calcium intake is higher than the RDA. Individuals should therefore consume 3-4 servings of dairy (or equivalent) a day.
Vitamin D
Vitamin D works in tangent with calcium to promote good bone health. The two are actually a team, because vitamin D increases our absorption of calcium, which we know is integral for strong, healthy bones.
Vitamin D also improves the function of muscles, which can help your balance and decrease the likelihood of falling and suffering a bone fracture. It is advised that for those living in colder, less sunny climates supplement vitamin D between the months of October and April, whereby the recommended dose for children aged 1+, adults, those breastfeeding and even those with a vitamin D deficiency is 10 micrograms. (6)
Alongside the daily supplementation, there are many ways in which our nutrition can contribute to higher Vitamin D intake, and therefore increased calcium absorption. Oily fish, such as salmon, mackerel and sardine, as well as lean red meat, eggs (specifically the yolk) and fortified cereals and milks. It is important here to ensure they are fortified, as without the vitamin and mineral fortification, the nutrient profile will not be as supportive when focusing on Vitamin D.
Phosphorous
Phosphorus works with calcium and vitamin D in your body to keep your bones healthy and strong. To do this, your body's phosphorus, calcium and vitamin D all need to be in balance. In severe cases, too much phosphorus in your blood causes your body to pull calcium from your bones to try and keep your blood balanced. (7)
Hypercalcemia
As we have discovered, calcium is an essential mineral for health and well-being, however in some cases, calcium can accumulate, and over-reach recommended storage causes hypercalcemia. Hypercalcemia is defined simply as a condition in which the calcium level in your blood is above normal.
Hypercalcemia is not caused by over-consuming calcium rich foods, in-fact it has minimal connection to nutrition at all. Instead, is most generally caused by an overactive parathyroid gland (the gland responsible for continuously monitoring and controlling calcium concentration in the bloodstream) (8)
Osteoporosis treatment
Having touched on how the nutritional aspects of treatment can facilitate strong, healthy bones, exercise is also an important aspect to consider.
Weight
Participating in osteoporosis specific treatment is a fantastic way to increase bone health. However, it is critical that you are at a healthy weight in order to see the results.
Weight is a huge factor for recovery (both from a disordered eating pattern, as well as osteoporosis) so in order to have the most beneficial results, being a healthy weight is crucial.
Exercise
Being strong is essential in exercise - not just muscular strength, but also bone strength, which is often overlooked. Our bones are our physical structure and building blocks to existence, so adopting the correct exercise regime will enable us to enhance overall health and well-being.
There are three categories in which exercise can help bone health and movement for those with osteoporosis: (9)
Strong – promoting bone strength
Steady – improving balance
Straight – caring for the back
Our bones are living tissues that get stronger the more we use them, but what exercise is beneficial for your bone health?
For exercise to be effective at keeping our bones strong, combining weight-bearing exercise with impact and muscle strengthening exercises. (10)
Weight bearing exercises with impact can include:
Dancing
Walking
Star jumps
Running
Muscle strengthening exercises work by adding a resistance for the muscle to work against:
Body weight exercise, e.g., press ups and squats
Using hand-held weights
Using an elastic resistance band
Disclaimer: Undertaking any form of physical exercise when recovering from an eating disorder can be dangerous. It is important to seek advice from a qualified medical professional before engaging in any physical activity.
Summary
Whilst this is specific for all individuals, it’s important to reiterate the importance of calcium, and vitamin D, for those who are injured, elderly, pregnant, and adolescence, especially. Simply increasing dairy produce, incorporating dark leafy greens, and getting as much sunlight as we can in England, will help calcium absorption and potentially encourage the reverse of osteoporosis. So, whether you're an athlete or elderly, seek professional advice to support osteoporosis, bone health and calcium/vitamin D supplementation.
This blog post was written by Abi Woodliffe-Thomas, who graduated with a BSc (Hons) in Sport and Exercise Science, and MSc in Physiology and Nutrition for Sport and Exercise from Loughborough University. Abi is the Academy Performance Nutritionist at QPR Football club and Derbyshire Country Cricket Club Mens 1s team Nutritionist. Previously Abi has worked as a Performance Nutrition intern across a variety of sports, such as Swimming, Triathlon, Archery and Cricket. You can find regular recipes, education posts, and delicious food over on her instagram, @Happetite_.
References:
(1) MedicineNet. Osteoporosis Risk Factors. Available at https://www.medicinenet.com/script/main/art.asp?articlekey=20363
(2) nhs.uk. Osteoporosis. Available at: https://www.nhs.uk/conditions/osteoporosis
(3) Gordon, C.M. and Nelson, L.M., 2003. Amenorrhea and bone health in adolescents and young women. Current Opinion in Obstetrics and Gynecology, 15(5), pp.377-384.
(4) Calcium, I., Ross, A., Taylor, C., Yaktine, A. and Valle, H., 2021. Overview of Calcium. Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK56060
(5) Ods.od.nih.gov. Office of Dietary Supplements - Calcium. Available at: https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional
(6) nhs.uk. Vitamins and minerals - Vitamin D. Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d
(7) Moe, S.M., 2008. Disorders involving calcium, phosphorus, and magnesium. Primary Care: Clinics in Office Practice, 35(2), pp.215-237.
(8) Parathyroid.com. Parathyroid Gland Overview: Parathyroid Function, Parathyroid Location, Parathyroid Gland Disease. Available at: https://www.parathyroid.com/parathyroid.htm
(9) Theros.org.uk. Exercise for your bones. Available at: https://theros.org.uk/information-and-support/bone-health/exercise-for-bones
(10) Theros.org.uk. New exercise information and resources for patients with or at risk of osteoporosis. Available at: https://theros.org.uk/healthcare-sector-news/2019-03-15-new-exercise-information-and-resources-for-patients-with-or-at-risk-of-osteoporosis