Bone Health

Bones are dynamic, specialized connective tissue that play an integral role in maintaining the proper functioning of the body. Healthy bones are strong and dense, and play the following essential roles in the body:

• providing support for body structure and muscle attachment, allowing us to move and exercise freely
• protecting vital organs
• housing bone marrow, where blood and bone cells are formed
• participating in hormonal homeostasis
• serving as a storage depot for minerals like calcium and phosphorus

Given this remarkable range of responsibilities, bone health is multifaceted and inextricably linked to other organ systems (e.g., muscular, endocrine, and gastrointestinal).

Bone health is first assessed by a medical provider through a detailed history and physical exam, which may include validated risk factor screening tools for bone-related issues. Findings from this assessment dictate whether and how bone health will be measured. Bone mineral density (BMD) is the most common way to measure someone’s bone health.

An appropriate and well-designed exercise program is an excellent way to preserve and improve bone health. Not only does exercise increase BMD, but it also protects against falls/injuries through enhanced muscle strength, balance, and coordination. The exercises that are most beneficial for bone health vary somewhat depending on one’s age and comorbidities, but resistance training (like weight lifting),^[1] plyometrics (like bodyweight jumps),^[2] weight-bearing exercises (like running and stair climbing),^[3] and activities that promote multidirectional loading of bone tissue (like playing sports)^[4] are all effective for promoting bone health. Resistance training may be especially important for postmenopausal individuals and older adults who are at higher risk of osteoporosis.^[1][5]

It is important to note that too much exercise may be detrimental to bone health. Excessive exercise without adequate recovery and nutrition may result in a condition known as relative energy deficiency in sport (RED-S), which is characterized by decreased bone mass.^[6]

Calcium and vitamin D have been extensively studied for their effect on bone health in a variety of populations. Although a diet that contains adequate calcium and vitamin D is important for bone health, there is little evidence that calcium supplements — administered with or without vitamin D — reduce the risk of fractures.^[7] However, calcium and/or vitamin D supplementation may confer a small benefit to BMD and reduce fracture risk in two groups of people: those with extremely low baseline levels of calcium or vitamin D, and older adults who are at an increased risk of @osteoporosis.^[8]

Other supplements that may affect bone health can be found in the Examine Database for bone health, below.

A well-balanced diet that matches a person’s energy needs is important for bone health. Three nutrients that are particularly vital for bones are calcium, vitamin D, and protein. These nutrients contribute to establishing peak bone mass in childhood, and, in adults, they maintain bone mass and prevent bone loss with age. Low-protein diets are associated with reduced bone mass and fracture risk in older adults.^[9] A lack of vitamin D and calcium can cause soft, weak bones in children, a condition known as rickets. In adults, this condition is known as osteomalacia.^[10]

Other beneficial nutrients for bone health include copper, zinc, fluoride, magnesium, phosphorus, vitamin C, vitamin K, and omega-3 fatty acids.^[11][12] Diets that contain fruits and vegetables (e.g., the Mediterranean diet), dairy products, seafood, and a low intake of alcohol, caffeine, and sodium are all associated with better bone health.^[11]

The best diet for bone health also depends on a person’s pre-existing medical conditions. For example, a gluten-free diet may improve bone mass in people with celiac disease.^[13]

Having underweight, smoking cigarettes, being a woman, being of white or Asian descent, having a family history of osteoporosis, and long-term use of certain medications (including corticosteroids, breast cancer treatments, selective serotonin reuptake inhibitors (SSRIs), and proton pump inhibitors) are risk factors for poor bone health.^[14][15]

Certain diseases may elevate the risk for poor bone health. These include anorexia, cancer, type 2 diabetes, inflammatory bowel disease, liver or kidney disease, multiple sclerosis, thyroid disorders, lupus, alcohol use disorder, Cushing’s disease, and rheumatoid arthritis.^[16]