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Fighting fractures - improving bone health through the menopause

What is osteoporosis?

In the United Kingdom, women's bone health remains a significant health concern, particularly as they age. Estrogen, a hormone produced by women’s ovaries, plays a pivotal role maintaining a delicate balance between bone formation and breakdown. Decreasing estrogen levels during the perimenopause and beyond can lead to accelerated bone loss which affects the integrity of the bones honeycomb structure and their strength. Data from the Royal Osteoporosis Society (2020) states that 50% of women over the age of 50 will have a bone fracture linked to poor bone health compared to 20% of men.


What affects the strength of our bones?

While genetics can predispose people to osteoporosis, bone health is influenced by numerous other factors. Individuals of a healthy and heavier weight are likely to have more fatty tissue, which serves as an estrogen storage site contributing to the retention of bone mass. In addition having a heavier physique will typically translate to stronger bones, as bone density adapts to the loads we carry. Engaging in weight-bearing and resistance exercises will therefore significantly benefit bone strength, as will cutting back on smoking, drinking alcohol and excessive salt consumption; which are all associated with increased risk of fractures.


The role of nutrition in bone health

Nutrition throughout our lives plays a pivotal role in ensuring an adequate supply of minerals and nutrients essential for skeletal health. It is never too late to start focusing on ensuring your diet is rich in certain foods:


Calcium

The hard crystals of the mineral calcium are used by our bodies to fill in the gaps between the collagen fibres in our bones, alongside phosphorous, making bone stronger. We can get calcium from our diet by ensuring we have adequate intake of the following foods:


  • Dairy products, such as yogurt, cheese and milk. Lower fat versions typically have the same level of calcium and can be useful for reducing the levels of saturated fats we consume.

  • Canned oily fish are often a good source of calcium as they have small fine edible bones. Oily fish are also rich in omega 3 fats, which may also be beneficial for bone health.

  • Bread - UK bread has calcium added, wholegrain is best for fibre content.

  • Green vegetables such as kale, pak choi, okra, brussel sprouts and brocolli contain good amounts of calcium. However sometimes the calcium is not as available to us as it binds to phylates and oxalates (found in plants), so for this reason it is wise to get your calcium from a variety of sources.

  • Soy products which can be set with calcium, fortified with calcium or contain calcium.

Soy in the diet is safe for women (even those at high risk of cancer). Spreading the intake of soy through the day and partnering consumption with walking and sources of vitamin K1 (e.g.  green kiwi, spinach, broccoli and kale), will also help improve bone health.


Vitamin D

Vitamin D helps the body to take calcium from the food we eat and assists with its uptake into bone. It is found in oily fish (e.g. mackeral, salmon, sardines), in eggs, in mushrooms that have been exposed to UV light and in foods fortified with vitamin D. Whilst our skin will make some vitamin D from 15-20 minutes exposure to sunlight between March and October, it can be very helpful to take a supplement for the rest of the year.


Protein

The bodies protein requirement increases as we get older and is vital for both bone health and muscle maintenance. In the Women's Health Initiative Study, a protein intake of 1.2g/kg of body weight was associated with better physical function and 32% lower risk of frailty (1). Achieving ~20-30g of complete protein at each meal ensures efficient muscle protein sysnthesis (2). Good sources of complete protein include eggs, dairy, fish and meat or combinations of plant proteins (e.g. oats and nuts or hummus and brown pitta).


Omega 3 fats

Alongside the beneficial nature of omega 3 from oily fish, studies also show that increasing your intake of the omega 3 alpha-linolenic acid (ALA) can improve your bone mineral density (3). Good examples of rich sources of ALA are flax seeds, chia seeds and walnuts.


Summary

For women over the age of 50 European guidance for the diagnosis and management of osteoporosis recommends a daily intake of 1000mg/day calcium, 800IU/day of vitamin D and 1g of protein per kg of body weight each day. One example of a dinner that would be rich in these suggested foods is a smoked salmon, broccoli and cream cheese wholemeal quiche with a spinach and walnut salad. If you are watching your weight and your levels of saturated fats then you can always go crustless and use low fat dairy options.


If you feel your diet is deficient in these foods then it can be very helpful to consult a Registered Nutritionist or Dietitician. Why not fill out a discovery request to see how Metabolic Health Nutrition can assess your current intake and recommend ways to increase these nutrients in your diet in way that works for you!



Further information



References

1. Beasley J.M., LaCroix A.Z., Neuhouser M.L., Huang Y., Tinker L., Woods N., Michael Y., Curb J.D., Prentice R.L. Protein intake and incident frailty in the Women’s Health Initiative observational study. J. Am. Geriatr. Soc. 2010;58:1063–1071. doi: 10.1111/j.1532-5415.2010.02866.x.

2. Groenendijk I, den Boeft L, van Loon LJC, de Groot LCPGM. High Versus low Dietary Protein Intake and Bone Health in Older Adults: a Systematic Review and Meta-Analysis. Comput Struct Biotechnol J. 2019 Jul 22;17:1101-1112. doi: 10.1016/j.csbj.2019.07.005. PMID: 31462966; PMCID: PMC6704341.

3. Lavado-García J, Roncero-Martin R, Moran JM, Pedrera-Canal M, Aliaga I, Leal-Hernandez O, et al. (2018) Long-chain omega-3 polyunsaturated fatty acid dietary intake is positively associated with bone mineral density in normal and osteopenic Spanish women. PLoS ONE 13(1): e0190539.

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