Bone Health is one of those things we seem to take for granted. It is often thought that the most important time to be focusing on your bone health is during your childhood and adolescent years. Indeed, while 90% of adult bone mass is in place by the end of adolescence, continuing to look after your bones into your adulthood is still a critical factor in staying mobile for as long as possible. In fact Osteoporotic fractures are a significant cause of morbidity and mortality. Direct medical costs from such fractures in the UK are currently estimated at over two billion pounds per year, resulting in a substantial healthcare burden that is expected to rise exponentially due to increasing life expectancy.

It is well documented that we can continue to build our bone density all the way into our late 20s. After this point, bone density naturally starts to decline. While genetics do have a part to play in your overall bone health and strength, the process of decline, can be preserved or accelerated by a number of nutritional, lifestyle and environmental factors.


Staying physically active, doing weight bearing exercise has been shown to have a positive impact on bone health; the mechanical loading of the skeleton is essential for maintenance of normal bone mass and architecture.

Weight bearing exercise includes, walking, running, skipping, yoga and resistance training; it doesn’t include swimming, cycling or rowing. This is important to remember, particularly for those individuals who are very active in these latter sports. Combining training with some weight or land training is imperative to protect the bones.


Nutrition plays a critical role in bone health with key nutrients being calcium, phosphorus, magnesium, Vitamins D, C and K.

Calcium is one we often associate with bone development and health, especially during early years but actually continues to have a role to play throughout life. One of the best sources of calcium from the diet is dairy and the general recommendations are 1000-1300mg of calcium a day. In addition, dairy, specifically cheese, contributes towards the phosphorus needs of the body. The levels of calcium are very well controlled within the body, but there are some factors that can cause a decrease in absorption of calcium ions.

The first is a low Vitamin D level – this nutrient is essential for the absorption of calcium from the intestine. The second is the balance of nutrients within the diet.

In recent years, there has been a real push towards high protein diets, particularly in those who are very active. When we eat protein, it changes the pH within our body to slightly more acidic –this is not a problem as the body has a fantastic feedback mechanism which helps to return the pH back to optimal. This mechanism actually involves releasing calcium ions from the bone to neutralise the acid. Where it becomes a problem is when individuals do not have sufficient dietary calcium going back into their diets due to avoidance of dairy. In these cases, the lack of available calcium in the body means it cannot be reabsorbed into the bone, leaving it weakened.


The sex hormones oestrogen and testosterone play a huge part in maintaining optimal bone health. This is also why incidence of Osteoporosis increases so significantly in post menopausal women when oestrogen levels drop.

Sex hormones can be hugely affected by exercise and energy availability. In recent years it has been well documented that in those individuals who restrict their energy intake or who’s training volume exceed their energy intake, significantly affect their production of oestrogen in females and testosterone in males. This is much more easily traced in females as it often results a missed period. Just missing three consecutive periods can be enough for some women to have significant negative effects to their bone health. Amenorrhea in females who are physically very active is often overlooked as a normal phenomenon but it is something that needs to be taken very seriously as it can have severe consequences, including increasing risk of stress fractures.

In males, while not as easy to observe, the same trends have been found; Low-testosterone levels have been associated with low bone mass density in male athletes. In addition, testosterone deficiency in young men is associated with a marked decrease in measures of whole body protein anabolism, decreased strength, decreased fat oxidation, and increased adiposity.

The balance between exercise, energy intake and hormones is critical for optimal bone health.

Top 5 Tips For Maintaining Strong Bone

To ensure that you are looking after your bones, here are our top 5 tips:

  • Ensure that you exercise regularly, including weight bearing options at least 3 times a week.
  • Consider taking a Vitamin D supplement, especially if your levels are below the recommended values for health; for those who are very physically active, the normal acceptable parameters are too low and you should aim for a value of at least 75.
  • Ensure that you are consuming at least 3-4 servings of dairy a day where one serving is the equivalent to:
    • 300ml glass of milk
    • match box size portion of cheese
    • pot (150g) pot of yoghurt
    • 100g cottage cheese
  • Include plenty of fruits and vegetables; potato skins, berries and oranges are high in Vitamin C. While dark green leafy vegetables are high in Vitamin K.
  • Pay specific attention to your diet and overall energy intake if you are some one who trains hard – look out for signs that you might not be getting enough nutrition:
    • In females, changes to menstruation
    • Poor recovery between training sessions
    • Increased fatigue
    • Lack of adaptation and progression from training both physically and with body composition
    • Recurrent injuries, particularly bone related, including stress fractures.

 This article was written by Renee McGregor - Performance Dietician