On October 20th it is World Osteoporosis Day. The Osteoporosis foundation is raising global awareness for the importance of strong bones and launched the campaign “Love your bones. Protect your future”. 5 key messages on bone health.
Sometimes people think that when they grow older that their bones do not ‘grow’ anymore. This is not true. Bone tissue is continuously broken down (bone resorption) and built up (bone formation) for recovery after minor ‘damage’ and in order to adapt the bone strength to the exerted load. This remodeling process occurs by specialized bone resorbing osteoclasts and bone forming osteoblasts. (1-4).
2. Maximum bone mass at 30 years
During this first 30 years of life, the bone density increases, resulting in a peak bone mass. In this phase bone formation exceeds bone resorption. The adolescence period goes with fast bone growth. At an older age bone mass is still formed, however from the age of 50 bone resorption starts exceeding bone formation. This results in an overall decrease of the bone mass. With women this process goes faster due to hormonal changes. The higher the peak bone mass, the stronger the bones at a later age. (1-4)
Genetics accounts for 60 to 80% of the variation in peak bone mass. Besides genetics, life style factors such as exercise and a healthy and varied diet with sufficient amounts of calcium, vitamin D and protein play a role in the maintenance of bone mass. (1)
3. Intake of calcium & vitamin D
Calcium is an important building block for the bones. As 99% of the calcium in the body is stored in the bones. (5) Next to calcium, protein, phosphorus, zinc, magnesium, and the vitamins K and D contribute to the maintenance of normal bones. These nutrients are part of the bone matrix, or in the case of vitamin D contribute to the absorption of calcium and phosphorus.
During the ODIN project’s (http://www.odin-vitd.eu) recent international scientific conference, held in Cork (Ireland) on September 5th and 6th, current insights from vitamin D research in Europe were presented. It was clear from the conference presentations that, in general, the vitamin D intake in Europe is relatively low in most populations relative to the recommended intake of 10 mcg/d, and this needs to be addressed. This low intake contributes to the fact that one out of eight people in Europe have a 25(OH)D concentration lower than 30 nmol/L and 40% of the European population has an 25(OH)D concentration lower than 50 nmol/L (6). To boost the vitamin D intake products naturally rich in vitamin D could be chosen, as well as food products enriched with vitamin D. In some countries milk or other dairy products are fortified with vitamin D to increase the vitamin D intake. Hiligsmann and colleagues (2017) examined the public health effect of vitamin D enriched dairy products (7).
4. Foods patterns for strong bones
Bones consist of a protein matrix, which is filled with calcium phosphate and other minerals, such as sodium, magnesium, potassium and zinc. However, people do not consume nutrients but foods within a food pattern. A position statement of the International Osteoporosis Foundation is therefore giving an overview of food patterns supporting bone mass, which includes food products like milk(products) and fruit and vegetables. Milk naturally contains protein, calcium and phosphorus. These nutrients contribute to the maintenance of bone mass. Fruit and vegetables provide nutrients such as potassium, magnesium and vitamin C and therefore fruit and vegetables could support the maintenance of bone mass. (8)
5. Exercise, especially weight-bearing activities
Exercise is beneficial for strong bones. Especially weight-bearing activities such as walking, jogging, playing football or dancing are supporting the development and maintenance of bone mass. However, as mentioned in a report of the International Osteoporosis Foundation (8) more research is needed on the potential interaction between exercise and diet quality, as well as more insights on dose response effects of exercise.
In conclusion, the bone mass at a younger age determines the bone mass at an older age. Therefore: “Love your bones. Protect your future”!
- International Osteoporosis Foundation (2001). Invest in your bones. How diet, life style and genetics affect bone development in young people. International Osteoporosis Foundation, 2001. Switserland, Nyon.
- R. et al (2010). Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone, 2010; Vol. 46, pp. 294-305.
- International Osteoporosis Foundation (2017). Bone development in young people. International Osteoporosis Foundation, 2017. Retrieved via www.iofbonehealth.org in October 2017. https://www.iofbonehealth.org/bone-development-young-people-0
- Dawson-Hughes, B. et al. (2013). Bone care for the postmenopausal woman. International Osteoporosis Foundation 2013. Zwitserland, Nyon.
- ILSI (1999). Calcium in nutrition. ILSI Europe Concise Monograph Series. International life sciences institute, Brussel, België, 1999.
- Cashman et al. (2016). Vitamin D deficiency in Europe: pandemic? American Journal of Clinical Nutrition, doi: 10.3945/ajcn.115.120873.
- Hiligsmann, M. et al. (2017). A scoping review of the public health impact of vitamin D-fortified dairy products for fracture prevention. Archives of Osteoporosis, 2017; 12:57
- Weaver, C.M. et al. (2016). The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis International, 2016; 27:1281–1386.