Facts and Myths about Bone Health

Bones play many roles in your body. They basically form the structural framework of your body, protect your organs, anchor your muscles and store calcium. It is important to pay attention in childhood and adolescence so that your bones become strong and healthy. At the same time, it is essential to take the right steps as an adult to preserve bone health.

"I have heavy bones..."

Is there any basis to the claim that you have "heavy bones" or that extra kilos are actually just excess fat?

It is true that there are quantitative differences in skeletal size among people, but the harsh reality is that this does not significantly affect total body weight. Bones are not the "culprits" when someone is overweight. According to a 2018 survey, Hungary led the EU in obesity rates, and globally only the United States, Mexico and New Zealand were ahead of us.

Why is bone health and bone mass important?

Because the skeleton is constantly changing—new bone is formed while old bone is broken down—this is a sensitive and vulnerable system. When you are young, your body speeds up new bone formation while slowing down the breakdown of old bone, so your bone mass increases.

Healthy bone is about one quarter water and another quarter organic components—mainly collagen fibers. The remaining 50 percent is inorganic material, primarily calcium compounds.

Your body's optimal bone composition develops between about ages 25 and 35. Bone remodeling continues thereafter, but breakdown slightly outweighs growth. From around age 40, your bone mass decreases by roughly 1% per year, so your bones become noticeably lighter.

How likely you are to develop osteoporosis (a condition in which bones become weak and brittle—the medical name is osteoporosis) depends on how much bone mass you achieved by age 30 and how quickly you lose it afterward. The more bone mass you build during the growth phase, the less likely you are to develop osteoporosis later in life.

What affects bone health

The denser your bone mass, the heavier your skeleton and the better the chances of having healthy bones in older age. Several factors can influence this:

The amount of calcium in your diet

A low-calcium diet contributes to decreased bone density, early bone loss and an increased risk of fractures.

But be careful with calcium intake! A professor at the University of Auckland analyzed 15 studies over a 20-year period involving data from 12,000 patients. The result was surprising. Calcium consumption increased the number of heart attacks by 30%, while it reduced hip fractures by only about 10%.

Calcium helps muscle function and contributes to the health of bones and teeth, yet excessive calcium can cause muscle cramps. This is due to a relative magnesium deficiency. It is "relative" because it is not that there is too little magnesium per se, but that magnesium needs to be proportional to the calcium consumed.

Some populations consume only one-third as much calcium as the Hungarian average, yet osteoporosis is virtually unknown among them.

Several publications in recent years have pointed not to inadequate calcium intake as the cause of osteoporosis, but to deficiencies of vitamin D (more on that below) and vitamin K2 (which directs excess calcium in the blood into the bones, preventing calcium from depositing on blood vessel walls). Without sufficient vitamin D and K2, calcium is not properly incorporated into bone.

Physical activity

Physically inactive people are at greater risk of developing osteoporosis than their more active peers.

Smoking and alcohol consumption

Research shows that smoking weakens the skeleton. Similarly, women who drink more than one alcoholic drink per day or men who drink more than two per day may increase their risk of osteoporosis.

Sex

Women are at higher risk of osteoporosis because they generally have less bone tissue than men.

Body type

You are at greater risk if you are very thin (a body mass index of 18 or less) or short, because you start with less bone mass to lose as you age.

What is the body mass index (BMI)? It is a statistical measure that relates a person's weight to their height. It is calculated by dividing weight in kilograms by the square of height in meters. BMI is widely used today to categorize healthy weight, overweight or underweight. Recently, modifications to the formula have been suggested because it can be misleading for some body types.

A widespread medical application of BMI has the risk of misclassification—for example, tall people may be incorrectly labeled overweight even when their weight is normal for their height, while some short people may appear to have normal weight when they may be overweight. It is also important to know that BMI is not a reliable measure for children and the elderly because of bone development and rapid bone loss.

Age

Bones become thinner and weaker with aging.

Race and family history

Your risk of osteoporosis is highest if you are of white or Asian descent. A parent or sibling with osteoporosis also increases your risk, especially if there have been fractures in the family.

Hormone levels

Excess thyroid hormone can cause bone loss. In women, bone loss increases dramatically during menopause due to declining estrogen levels. Prolonged absence of menstruation before menopause (amenorrhea) also increases osteoporosis risk. In men, low testosterone levels can lead to bone loss.

Eating disorders and other conditions

Severe dietary restriction and low BMI contribute to bone weakness in both men and women. Additionally, weight-loss surgery and conditions such as celiac disease can affect the body's ability to absorb calcium.

Adverse effects of medications

Long-term use of corticosteroid medications (used to reduce inflammation, treat allergic reactions and suppress the immune system) — such as prednisone, cortisone, prednisolone and dexamethasone — damages the skeleton.

Other drugs that may increase the risk of osteoporosis include: aromatase inhibitors used in breast cancer treatment; selective serotonin reuptake inhibitors (SSRIs) — a type of antidepressant; methotrexate — used for certain leukemias and cancers of the breast, skin, head and neck, lung or uterus, and for severe psoriasis and rheumatoid arthritis in adults; some anticonvulsant drugs such as phenytoin (Dilantin) and phenobarbital; and proton pump inhibitors, whose main effect is prolonged reduction of stomach acid production.

If you must take any of these medications, pay special attention to adequate high-quality dietary supplements, exercise and your psychological well‑being.

What can I do to preserve my bone health?

There are a few simple steps you can take to prevent or slow bone loss. For example:

Include plenty of calcium in your diet

The recommended daily allowance (RDA) for adults aged 19–50 and for men aged 51–70 is 1000 mg of calcium. The recommendation rises to 1200 mg daily for women aged 51 and older and for men aged 71 and older. However, as mentioned above, always be cautious about calcium intake.

Good sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products such as tofu — eat everything in moderation and maintain a varied diet. If you feel you cannot get enough calcium from your diet, ask your doctor which supplements they recommend.

The importance of vitamin D

Vitamin D is best known for strengthening bones because it promotes calcium absorption from the intestine, participates in the process of incorporating calcium into bone, prevents osteoporosis and strengthens the immune system. Moreover, few diseases do not have some link to vitamin D deficiency.

Vitamin D is considered an anti-inflammatory vitamin that alone can be sufficient to alleviate many chronic complaints (since these are often associated with chronic inflammatory processes).

In Europe the suggested maximum dose is 2,000 international units (IU) per day, but clinical studies show that long-term intake of 10,000 IU is not associated with risk. A study published in the Oman Medical Journal indicates that overdose can occur at daily intakes of 50,000 IU and in cases of high blood calcium (hypercalcemia). It is important to note that when taking vitamin D you should also take vitamin K2 and magnesium in appropriate amounts to aid absorption and proper utilization.

Good sources of vitamin D are oily fish such as salmon, trout, mackerel and tuna. Mushrooms, eggs and fortified foods like milk and breakfast cereals are also good sources.

Sunlight also contributes to your body's vitamin D production. If you think you cannot get enough from your diet, ask your doctor which supplement they recommend.

Make physical activity part of your daily routine

Weight-bearing or weight-maintaining activities such as walking, jogging, stair climbing and even cycling can help you build strong bones and slow bone loss.

Avoid harmful habits

Don't smoke. Women should avoid drinking more than one alcoholic drink per day; men should avoid drinking more than two per day.

Seek medical advice

If you are concerned about your bone health or your risk factors for osteoporosis, especially if you have recently suffered a bone fracture, consult your doctor.

You can have a bone density test performed. This examination helps estimate your current bone mass and determine the extent of bone loss. With this information and an assessment of risk factors, your doctor can determine whether you need medication to slow further bone loss.