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You May Not Think About It Much, But Your Bone Density Is Really Important

You May Not Think About It Much, But Your Bone Density Is Really Important


What is it and why is it important?

As you grow from infancy and absorb calcium into your body, your bones continually grow stronger throughout your youth and early adulthood. That’s because bone density, or the solidity and mass of your bones, increases during those years as new bone tissue is added faster than old bone tissue breaks down. The process of breaking down old or damaged bones and replacing them with new ones is called remodeling. However, that building process peaks around age 30 and then naturally begins declining for the rest of your life, leading to a gradual loss of bone density as you get older.


Graph: Bone mass across the lifespan with optimal and suboptimal lifestyle choices. Source: Reproduced unmodified from Weaver et al. (C. M. Weaver, 2016)

A strong skeletal structure to hold your body upright requires healthy bone density. Bones are hard on the outside but not actually solid because they have tiny pores on the inside to allow proper blood flow. The consequence of low bone density is an increased risk of breaking your bones because they have become too porous inside and their outer walls have thinned. Osteopenia is the onset of low bone density, relative to the norm for your age, that’s a precursor to osteoporosis, which is a metabolic bone disease characterized by dangerously low bone density that can easily lead to fractures. Neither has a cure.



Signs of low bone density

Knowing whether your bone density is low is a challenge because you can't see your own skeleton and certainly not what's happening inside your bones. For that reason, low bone density can develop over time with few clues, if any. However, if your height declines by 1.5 inches (3.8 centimeters) or more or your back begins to hunch, it could be a sign that you need to see a physician about your bone density. (Mayo Clinic Staff, 2022) Breaking a bone in a low-impact fall or collision would also be a clear warning sign.



Can bone density be measured?

Yes, it can. Physicians perform a BMD (bone mineral density) test to measure the amount of calcium hydroxyapatite in your bones. Calcium hydroxyapatite is a form of calcium your body easily absorbs, and it accounts for roughly two-thirds of the weight of your bones. (Tutut Ummul Habibah, 2022) The test is performed by taking a dual-energy X-ray absorptiometry (DXA) scan of a section of bone, typically in the spine, hip area (the femur, specifically), or forearm, to then determine how many grams of calcium it contains, as those are the bones a person would most likely break due to osteoporosis. (Mayo Clinic Staff, 2022)

The test produces both a T-score and a Z-score. The T-score tells how your bone density compares to that of a healthy young adult of the same sex, regardless of your age at the time of the test. The Z-score compares your bone density to that of someone of the same age, sex, body type (height, weight, etc.), and ethnicity. For example, if your T-score is anything less than -1, it’s an indication of the onset of osteopenia or even osteoporosis.


Why low bone density is a higher risk for women

Osteopenia, simply put, means that one’s bones are starting to become too porous. Left unchecked, it can progress to osteoporosis. Middle-aged women are at higher risk than men of developing these conditions because of the hormonal changes, particularly decreased estrogen, they go through post-menopause that lead to a significantly faster rate of bone density loss. In fact, women are four times more likely to develop osteoporosis than men. (National Council on Aging, 2022) That said, it doesn’t mean that men aren’t at risk for low bone density as well. The fact remains that the gradual loss of bone density due to aging occurs in both sexes.



Vitamins, minerals, and dietary choices that aid bone density and health

In terms of your diet, vitamins and minerals work interdependently, so you need to be eating a variety of healthy foods and covering as many bases as you can. For your bone health, consume foods with calcium, vitamin D, magnesium, protein, phosphorous, and zinc.

Your body needs to keep enough calcium in the bloodstream, or else it will siphon calcium out of your bones. That, of course, would cause your bones to grow more porous and weaker. Some good sources of calcium are beans, broccoli, dairy, kale, nuts, spinach, seafood such as sardines, and seeds.

Vitamin D helps your body absorb calcium so it can be supplied to the bloodstream. Not only does it regulate the amount of calcium in the bloodstream, but it also regulates the amount of phosphorous. Many people don't realize it, but the best way to get vitamin D is by going outside. Your body absorbs vitamin D directly from sunlight, making regular walks outdoors doubly beneficial. Vitamin D is not widely available from food sources, but you can get some from cod liver oil, eggs, herring, milk fortified with vitamin D, salmon, and sardines. Plant sources of vitamin D are scarce, with the exception of some kinds of mushrooms that receive a lot of sunlight exposure.

Magnesium is a mineral vital to synthesizing the aforementioned vitamin D. Without magnesium, vitamin D is not bioavailable (i.e., absorbed and usable by the body) and will simply be stored inside your body. Avocados, bananas, beans, fish, legumes, nuts (especially cashews and almonds), seeds, spinach, and whole grains supply good amounts of magnesium.

Most people know protein is essential for maintaining and building muscle, but it’s less well known that it’s essential for bone health as well. 35% of bone is actually made of protein (Andrea L. Darling, 2020), and when you work out, protein provides the amino acids to build both muscle and bone mass at the same time. Asparagus, beans, beef, broccoli, dairy, fish, legumes, nuts, poultry, seeds, tofu, and whole grains are some good sources of protein.

85% of the mineral phosphorous in your body is contained in your bones (Colby J. Vorland, 2017), and it’s readily available from food sources, so there is very little risk of having a phosphorous deficiency. It’s abundantly available in beans, dairy, lentils, liver (especially chicken), nuts, pork, poultry, seafood, seeds, and whole grains.

Zinc plays multiple roles in your bone health. It prevents existing bone from deteriorating and helps new bone form. It also boosts your immune system and mitigates inflammation that can cause damage to your bones. Zinc is commonly found in asparagus, chicken, beans, beef, dairy, eggs, lamb, legumes, mushrooms, nuts, pork, seafood, seeds, turkey, and whole grains.


Could I be unknowingly doing things to increase my risk?

Yes, and a lot of people are, in fact. Most people think rarely, if ever, about their bone density, and as mentioned earlier, the loss of bone density is not visible to the naked eye, so it’s easy to be oblivious to it. Some common risk factors under your control are smoking, alcoholism, low-calorie diets and diets deficient in calcium and vitamins, an unhealthy weight (either too low or too high), and a low-energy, sedentary lifestyle.



How to lower your risk through activity

Obviously, you want to go in the opposite direction from the risk factors above. Our first recommendation is that you engage in strength training on a regular basis. This point cannot be overstated because bones rebuild themselves stronger as an adaptation to bearing heavy loads, allowing you to significantly slow the rate of bone density loss as you get older.

Another even simpler thing you can do is just walk a lot. Whenever you walk, your skeleton supports all your weight, which helps to keep your bones strong. Here again, your bones will adapt to the loads you place on them. So, unless you have a physical impairment that prevents it, you should make it a habit to walk more often. That includes taking the stairs instead of the escalator or elevator as well.




Andrea L. Darling, D. J.-N. (2020, November 13). Dietary protein and bone health: towards a synthesised view. doi:https://doi.org/10.1017/S0029665120007909

C. M. Weaver, C. M. (2016, February 9). The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. doi:https://doi.org/10.1007/s00198-015-3440-3

Colby J. Vorland, M. E. (2017, October). Effects of Excessive Dietary Phosphorus Intake on Bone Health. doi:10.1007/s11914-017-0398-4

Mayo Clinic Staff. (2022, September 21). Bone density test. Retrieved September 13, 2023, from www.mayoclinic.org: https://www.mayoclinic.org/tests-procedures/bone-density-test/about/pac-20385273

National Council on Aging. (2022, May 12). What Is Bone Density? A Practical Guide for Older Adults. Retrieved September 12, 2023, from www.ncoa.org: https://www.ncoa.org/article/what-is-bone-density-a-practical-guide-for-older-adults

Tutut Ummul Habibah, D. V. (2022, September 12). Hydroxyapatite Dental Material. Retrieved September 12, 2023, from www.ncbi.nlm.nih.gov: https://www.ncbi.nlm.nih.gov/books/NBK513314/

*This newsletter has not been authored in whole or in part by any artificial intelligence tools.
*No content on this site, regardless of source or date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.


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