Healthy Bones - Why They Matter and How to Protect Them

Why bone health matters

When bone mineral density reduces, your risk of fracture and osteoporosis increases. This impacts mobility and quality of life.

What do healthy bones need?

Hormones

Lots of hormones play a role in bone health, but the sex steroid hormone oestradiol is particularly important in both men and women. In men, testosterone is converted to oestradiol, and one of the functions of this is for bone health.

Calcium and vitamin D

Calcium is a mineral that helps give bones their strength and structure. Vitamin D helps the body absorb and use calcium effectively.

Strength-based exercise

Exercise, particularly strength-based or resistance type exercise, has a bone-building effect. The formation and reabsorption of bone cells is a continual process. By loading the bone (adding weight) and exercising regularly you send strong messages to your bone cells that they need to re-form and lay down new cells, and you encourage the production of Growth Hormone (GH). This helps keep bones strong and can help slow down natural decline of both bone and muscle/strength.

When the balance tips…

It is important to note, however, that training load needs to be matched by energy and nutrient intake in order for bone cell formation to happen - low energy intake compared with output and repetitive loading, can lead to reduced bone density and fracture. This needs to be a key consideration for athletes and fitness enthusiasts of all levels and of all different sports and pursuits, particularly those that are perveived to require a physique with a lower body fat percentage.

What reduces bone mineral density?

Hormone function

Sex steroid hormones decline naturally as we age - for both men and women. But women reach a lower 'peak bone mass' than men, and they experience a more rapid decline in sex steroid hormones from that peak. Men experience a gradual decline in testosterone (and therefore oestradiol) over time, whereas women experience a sharp fall in oestrogen at menopause. The combination of reduced hormone and reduced stimulation from muscle and strength contributes to reduced bone density. One in two women and one in five men will experience an osteoporotic fracture over the age of 50.

Women may experience premature ovarian insufficiency (POI), surgical menopause (hysterectomy with ovaries removed), or chemical menopause well before the average age of menopause, which is 51, and so hormone decline can happen sooner for some.

Over-exercising, or excessive exercising

Reduced hormone function can happen if you over-exercise. When energy and/or nutrient intake does not match your requirement and output, if you diet for long periods, and/or if you are underweight, then you may produce less oestradiol. These things can impact hormone function in both sexes and lead to reduced bone mineral density at a younger age.

In women, the absence of periods can be a serious warning that hormone function is being negatively impacted by either training or diet, or both, that is often overlooked or under-estimated.

Obesity and chronic disease

Being very overweight and very inactive can also disrupt hormone function, in men and women, with the knock-on effect of reduced bone mineral density at any age.

Other risk factors that are outside the scope of this article include chronic disease that impacts hormone function and/or absorption of nutrients, and certain medications and treatments.

What you can do to look after your bones

HRT

Oestradiol plays a crucial role in bone health and for women. Hormone replacement therapy (HRT) can play a key role in helping to mitigate this risk and help keep bones strong. For men, testosterone replacement therapy (TRT) may be a consideration.

Resistance exercise

Exercise, particularly resistance exercise, is important for both men and women, and it's never too late to start.

Nutrition and vitamin D

Inadequate nutrition can negatively impact hormones and bone health. Dietary intake needs to match requirement for adequate energy availability, and should include protein and calcium. for most people (particularly in the UK), supplementing vitamin D should be a key consideration, too.

Lifestyle

Hormones and health respond to environmental and lifestyle choices, so as well as diet and regular exercise of the right intensity, consideration should also be given to things like smoking, alcohol, caffeine, and sleep as these can all impact bone health, too.

Want to find out more?

Discuss any health concerns with your doctor, and ask them for a DEXA scan if you are concerned about your bone health and want to assess it.

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