I broke my wrist on a gorgeous Sunday afternoon in the park. I was doing backflips off the monkey bars with my boys and I might have gotten carried away. I over-rotated the landing and was heading right for my tush (which is what I should have let happen) but instead, I stretched out my hand to protect my fall and landed with the full force of my weight on my wrist — my bone didn’t stand a chance.
Refusal to grow up aside, the incident (which happened a few years ago) reminded me of just how disabling it can be to break a bone.
Although bone mass generally peaks somewhere in our twenties, that’s not the end of the story. Bones are not the fixed, lifeless structures we sometimes imagine. Instead, they are growing, living tissue that is constantly being remodeled and there’s plenty to do – at all ages – to help preserve bone integrity, improve bone strength and minimize our risk of fracture.
background & risk factors
Globally, osteoporosis — a disease that causes bones to become weak and brittle — gives rise to over 8.9 million fractures annually causing both temporary and permanent disability.
Menopause is one of the biggest contributors of bone loss due to the role that estrogen plays in keeping bones healthy. As estrogen levels decline, loss of bone tissue begins to accelerate. The combination of hormone changes and lower muscle mass in comparison to men puts women at higher risk but osteoporosis is by no means a woman’s disease. At least 1 in 5 men will suffer from an osteoporotic fracture during their lifetime (and 1 in 3 women).
The two most important factors we can control in managing our bone health (other than staying off the monkey bars in our forties) are exercise and diet ~
1. Build Muscle Mass
Building muscle mass helps support and fortify the structures surrounding our bones. Spinal fractures, for example, are often caused by forces (or loads) on the vertebrae that are greater than what they can physically withstand. Exercises that target the muscles along the back can help strengthen the spine while improving posture.
Muscle also generates the force (mechanical stress) needed to keep our bones healthy, strong and responsive. When muscle mass declines, less stress is exerted on our bones which eventually makes them weaker and accelerates decline.
We build muscle mass through strength training which commonly comprises of weight lifting (with free weights or weight machines) and resistance exercise (with equipment like rubber bands and balls or by using the body’s own weight to create resistance: push-ups, planks and dips as well as squats and lunges). These exercises can be done at home or in a gym environment. Most fitness classes now also incorporate elements of weight-bearing and resistance exercises such as Pilates, yoga and interdisciplinary cardiovascular training.
2. Practice Balance & Stability
Balance and stability are key to improving movement, fluidity and coordination with a view to reducing our risk of falling ~ especially for those of us walking on ice surfaces 8 months of the year. Balance exercises can be practiced at home and many interdisciplinary group fitness classes also incorporate elements of core stability and balance. The gentle, low-impact art of Tai Chi (meditation in motion) is especially well known for cultivating balance and as a mind-body discipline, it’s also be very helpful for reducing tension and promoting calm.
3. Ensure adequate Calcium from a variety of sources
Calcium, the most abundant mineral in the body, is vital for building strong bones (and teeth) in childhood and maintaining bone health as we age. Our bodies cannot make calcium, it must be acquired through our diet. Calcium-rich dietary sources include plant-based foods, dairy and fish.
Current calcium requirements for adults aged 19 to 50 are 1,000 mg daily with women over the age of 50 requiring 1,200 mg. Children aged 9 to 18 require 1,300 mg of calcium daily.
Plant-Based Options — most of us think of dairy first when it comes to calcium-rich foods and there’s no question that the concentration of calcium by typical serving size of dairy food is impressive. But there’s a couple of reasons why I like to focus on plant sources. For one thing, if you’re a vegan or have an allergy/intolerance to dairy foods or simply prefer to vary your diet outside the dairy fold, it’s important to be aware of other sources of calcium. Another element is that many plant options not only provide calcium they also deliver a whole range of nutrients in the form of vitamins, minerals, antioxidants and fibre. Some of these nutrients also happen to be very helpful for bone health.
For example, calcium containing greens such as spinach, broccoli, Swiss chard, bok choy (pictured below), rapini, beet greens and kale, have the added advantage of being rich in vitamin K, a nutrient needed to maintain healthy bones. Studies have linked higher vitamin K intakes with a lower risk of bone fractures.
Tip: to maximize calcium absorption from greens, it is generally advised to steam/cook them to break down the oxalic acid – a natural compound that binds calcium and reduces its absorption.
Other plant-based sources of calcium include: tofu that is produced with calcium (look for calcium sulfate on the ingredients list); beans, almonds, blackstrap molasses and sea vegetables. Alternate milk beverages such as almond, rice, hemp, coconut and soy milk for example that are calcium fortified are also concentrated sources (generally in the range of 330 mg of calcium per cup).
Dairy Options — when it comes to dairy, some of the best sources of calcium can be found in milk, yogurt and cheese. One cup of milk, 3/4 cup of plain yogurt and 1.5 ounces of cheese each contain roughly 300 mg of calcium.
Fish Options — rich in calcium and omega-3 fatty acids, canned salmon and sardines are an excellent and affordable option. 3 ounces of canned salmon with bones delivers approximately 190 mg of calcium while 3 ounces of canned sardines with bones delivers in the range of 325 mg of calcium.
Salmon and sardines also happen to be one of the few dietary sources of vitamin D which is essential for absorbing calcium (more below). Although the calcium in fish comes primarily from their bones, you can grind them up in a blender and combine the paste with a little hummus, natural mayo or your own favorite spread to enjoy in a sandwich. Sardines have a delicious umami flavor that adds great taste to recipes. The small fillets can be chopped up and tossed into salads or ground up entirely and incorporated into soups, sauces and dressings.
For a full breakdown of calcium concentration by food item search the National Nutrient Database.
4. Dose up on Vitamin D
In addition to its potential role in disease prevention, vitamin D is crucial for absorbing calcium.
Very few foods contain vitamin D naturally (though milk, alternate milk beverages and many orange juice brands are fortified with vitamin D) ~ our best source comes from the sun. During the non-summer months, when the northern latitude sun is not sufficiently strong, supplementation becomes necessary for most individuals. Adults are advised to take at least 1,000 IUs (international units) of vitamin D per day while older adults, those with dark-coloured skin and those falling within certain risk categories may require more. Be sure to speak with your health care practitioner regarding appropriate supplementation and keep in mind that your vitamin D levels can be easily tested through bloodwork upon request.
5. Best Practices
Our bodies lose calcium every day through sweat, urine and bowel excretion which needs to be continuously replenished. Certain foods, and food practices, can promote calcium loss while others inhibit absorption. Here are a few of the more common ones to keep in mind:
Sodium: excess salt can cause calcium to be excreted from our body. Most excess salt does not come from our salt shakers but rather from a heavily processed diet. Try to focus on whole foods in their natural state and be especially mindful of sauces, soups and dressings (in both liquid and powder form) that are sodium saturated. Be sure to read labels and opt for low-sodium options whenever possible.
Soft Drinks (cola): both diet and regular soft drinks (though not sparkling water) have been linked to lower bone density. Some experts suggest this is because overconsumption of cola displaces milk in the diet (a primary source of calcium and vitamin D), but other studies point to the phosphoric acid content in cola, a flavour additive/preservative that can interfere with calcium absorption by binding calcium in the intestinal tract and preventing it from being absorbed into the bloodstream. When blood levels of calcium drop too low, the body draws calcium from the bones to maintain balance.
Divided Doses: while it is generally preferable to obtain calcium from food sources first, if you are supplementing keep in mind that the body can only absorb 500 mg of calcium at any one time.
The information in this post is provided for educational purposes only and is not intended as a substitute for the advice of your physician. Always consult your physician or other health care professional directly before beginning or changing a course of health treatment.