Reviewed by: J. Mica Guzman, Jr., MD, MS, DABFM, CAQSM, and Lizette Taboada, RD, LD
Written by: Ashley Lawrence
Your bones provide many essential functions for your body and maintaining your bone health throughout your life can help prevent a variety of health conditions, including osteoporosis (a condition in which the bones become weak and brittle), osteopenia (a condition in which you lose bone mass), fragility fractures (a broken bone that results from a low-impact, non-traumatic force that would not fracture a normal bone), and stress fractures (tiny cracks in a bone that are caused by a repetitive, low-impact force) as well as other forms of bone loss that may occur as you age.
“Bones are, at their very basic nature, the skeleton of our body, and that skeleton serves multiple functions—it’s protective of all our soft organs, it’s supporting of our body, and it provides both structure and attachment points for our muscles to allow for movement,” explains UT Health Austin bone health expert J. Mica Guzman, Jr., MD, MS, DABFM, CAQSM, who serves as the Primary Care Clinical Director of the Sports and Injury Clinic within the Musculoskeletal Institute. “What some people may or may not know is that bone is alive and constantly changing to adapt to the daily forces placed upon it.”
In addition to its mechanical function, bone serves as a reservoir, or storage space, for a number of minerals, the most prominent of which are calcium and phosphorous. The bone stores 99% of the body’s calcium and 85% of the body’s phosphorous. Calcium and phosphorous work in conjunction with vitamin D to keep bones healthy and strong.
“Calcium is a mineral essential for both building bones and keeping them healthy,” explains registered dietitian Lizette Taboada, RD, LD, who also serves as the Nutrition and Behavior Change Lead for UT Health Austin’s Integrated Behavior Health team. “Vitamin D also plays an essential role as it promotes absorption of calcium in the gut, maintains adequate serum calcium and phosphate concentrations for normal mineralization of bone, and supports the process of bone remodeling.”
Assessing your bone health
Your bone health is dependent on multiple factors. If you have a history of osteoporosis or osteopenia, have experienced a stress fracture or a fragility fracture, are following a diet that may be affecting your bone health, are taking steroids long-term, or are taking other medications that can affect your bone health, you may benefit from seeing a bone health expert who can help you regain and maintain your bone health.
“A bone health expert doesn’t necessarily have to be a specialist but should be someone who is familiar enough and confident in both their expertise of the metabolism of the bone and their understanding of the bone,” shares Dr. Guzman. “While most people are familiar with bone loss related to osteoporosis or osteopenia, bone loss can also be the result of many other things, such as metabolism disorders or endocrine disorders. A bone health expert should be able to recognize when there is a potential harm or a potential track for causing damage to the bone or damage to the metabolism of the bone. In these cases, the bone health expert would either be able to respond to the patient’s concern or be mindful enough to help the patient navigate next steps if they don’t have the expertise to addressing the underlying condition themselves.”
Reaching peak bone mass
New bone tissue is created to balance the amount of bone tissue broken down and absorbed by the body in a natural process known as bone turnover, or bone remodeling. Throughout the early part of our lives, the amount of bone lost and the amount of bone gained remain balanced. Once individuals reach peak bone mass (size and thickness), more bone is broken down than is formed, causing the bone mass to slowly start to decline. The higher your peak bone mass, the less likely you are to develop osteoporosis, osteopenia, fragility fractures, stress fractures, and other forms of bone loss.
“You are never too young to begin focusing on your bone health,” emphasizes Dr. Guzman. “Bone health truly starts early in our childhood, or even infancy, because the bone is made up of living tissue that needs proper calcium, phosphorus, and vitamin D intake to build its structure and begin utilizing the bone as a reservoir for minerals to support bone metabolism. Building this storage component of minerals occurs up until your early 20s to mid-30s. You typically experience a peak at around the age of 30 and what you’ve managed to store is what you have for the rest of your life. If your peak wasn’t very high, you may be at risk of having weaker bone that becomes more brittle or is fragile, which can lead to complications, such as osteoporosis, osteopenia, or fragility fractures.”
Risks related to the loss of bone health may include:
- Bone and joint pain
- Disability or loss of independence
- Fragility Fractures (a broken bone that results from a low-impact, non-traumatic force that would not fracture a normal bone)
- Inability to participate in activities you enjoy
- Osteopenia (a condition in which you lose bone mass)
- Osteoporosis (a condition in which the bones become weak and brittle)
- Stress fractures (tiny cracks in a bone that are caused by a repetitive, low-impact force)
A fragility fracture is a broken bone that occurs when low impact or minimal stress is placed on the bone, such as from a fall from standing height or less, a cough, or a sneeze, that would not normally result in a fracture. If you have healthy bones, fragility fractures should not occur. Up to one-fourth of all men and nearly half of all women will suffer from at least one fragility fracture in their lifetime. Once you have suffered from one fragility fracture, your risk of suffering an additional fragility fracture increases by 2-4 times.
Improving outcomes related to bone health
“Everyone is going to experience bone loss,” says Dr. Guzman, “and what I mean by that is the metabolic feature that occurs after you’ve reached your peak bone mass. When others refer to bone loss, they’re likely referring to osteoporosis or osteopenia. There are ways in which you can regain some of that bone loss. Diet are exercise are at the top of that list, although antiresorptive medicines, which are medicines that help shift that balance from breaking down bone to building bone, may also be used.”
A diet low or deficient in calcium, phosphorous, and vitamin D puts you at higher risk for bone loss, which is why it’s important to make sure you are fueling your body with the appropriate intake of these vitamins and minerals.
“Not getting enough nutrients to develop strong bones puts people at higher risk for breaking a bone or developing osteoporosis or osteopenia,” says Taboada. “A healthy, balanced diet and a healthy weight can help prevent bone disease.”
Food sources of calcium include:
- Dairy products (reduced-fat milk, yogurt, and cheese)
- Green vegetables (collard greens, bok choy, kale, turnip greens, broccoli, spinach)
- Calcium-fortified foods (soymilk, almond milk, tofu, cereals, and breads)
Foods rich in phosphorus include:
- Beans and Lentils
- Beef and chicken liver
- Low-fat dairy products
- Meats (chicken, pork, and turkey)
- Nuts (almonds, Brazil nuts, cashews, pine nuts, and pistachios)
- Seafood (clams, crab, cuttlefish, salmon, and scallops)
- Seeds (sunflower and pumpkin)
- Whole grains (brown rice, oatmeal, quinoa, and whole wheat pasta)
Good sources of vitamin D include fatty fish, such as:
- Fish liver oils
- Beef liver
- Egg yolks
“Bones like impact,” explains Dr. Guzman. “Bones need impact for reinforcement, to continue providing support, and to make stronger structural changes. Impact exercises can involve just about anything activity where the bone comes into contact with the ground. Strength training is another great option as resistance exercises put stress on the bone and its muscular attachments in a different way that is beneficial to bone health.”
Impact exercises can include:
- Climbing stairs
- Jumping Rope
“While activities, such as swimming or bicycling, are fantastic and can help build and maintain strong muscles and contribute to excellent cardiovascular health, they are not the best ways to regain or maintain bone health as they do not involve direct impact or stress on the bone,” shares Dr. Guzman.
Resistance exercise can include:
- Leg presses
- Pull ups
- Push ups
- Use of resistance bands
Treating bone health conditions and concerns
UT Health Austin’s Musculoskeletal Institute offers patients (14 years and older) comprehensive care and personalized treatment plans that are designed with the intention of enabling patients to perform the activities they enjoy as well as reduce their risk of bone injuries or developing other conditions related to bone health. This is accomplished through:
- A comprehensive review of the patient’s medical history, including diet, prescribed medications, supplement usage, and any daily activity/exercise engagement
- Imaging that assesses bone mineral density
- Patient education related to the effects of physical activity, diet, and lifestyle on bone mass
- Performance lab testing
- Prevention services that help reduce the risk of secondary fragility fracture
- Ongoing monitoring and care
“While certain medications and activities can certainly increase your rate of bone loss,” says Dr. Guzman, “there may be other components contributing to that bone loss that may require the expertise of specialists in other fields. At UT Health Austin, we are happy to help coordinate that care for the patient.”
If you have concerns about your bone health, have received a diagnosis of osteoporosis or osteopenia, or have suffered a stress fracture or a fragility fracture, our team of specialists work with you to create a treatment plan that meets your unique needs. Treatment may include rehabilitation, exercise and diet recommendations, prescribed medications, supplement guidance, and more. For more information or to request an appointment, please call 1-833-UT-CARES (1-833-882-2737) or visit here.