We can often underestimate the importance of our bone health, with our bones providing important roles in movement, support, muscle function and strength throughout our lives. 

Here Laurann O’Reilly, owner of Nutrition by Laurann explains everything you need to know about maintaining your bone health including risk factors, diagnosis and prevention of bone related conditions as well as practical dietary strategies for optimising your bone health

From the moment we are conceived we are setting down the foundations of our bone health. Our growth from infancy through to puberty is the prime opportunity to ensure that bone foundation is strong and that it carry us through adulthood and into old age. 

- Bone Related Illnesses: Whilst there are numerous bone related conditions here are the two major ones to be aware of 

1) Osteoporosis – The Irish Osteoporosis Society (IOS) define osteoporosis as “a disease that affects the inside of your bones, making them fragile.  Osteoporosis causes large holes to develop inside bone, which is why they break easily. No one feels bone loss and this is why Osteoporosis is known as the Silent disease.” Often perceived as something that occurs in older individuals, this is not always the case (see risk factors below). 

2) Osteopenia – The IOS describe Osteopenia as “the early stages of Osteoporosis” and state that “it is essential that a plan is put in place to prevent further bone loss and Osteoporosis developing”. According to Michele O’Brien of The IOS, “research shows that the majority of breakages occur in the moderate to marked Osteopenia range, which is why it is so important that your causes of bone loss are investigated and addressed as part of your bone health plan”.

- Bone Health Statistics in Ireland – According to The IOS “Osteoporosis is considered a silent condition and is estimated to affect 200 million people globally”.  Data from The Irish Hip Fracture Databases states that “Ireland has the sixth highest rate of hip fracture in the world” and “in Ireland alone, nearly 7 out of 10 hip fractures happen to women”. Many of which are preventative. 

- Diagnosis – According to the IOS, measurement of Bone Mineral Density via a DXA (Dual Energy X-ray Absorptiometry) scan is “the most precise, non-invasive and widely used method” for assessing our bone health. 

- Risk factors – Whilst there are numerous risk factors which can contribute to bone related illnesses here are some of the main ones to be aware of 

1) Genetics: Plays a major role and The IOS discuss how the bone the mineral density of most populations is accounted for by genetic factors (approximately 70%). Should this apply to you then it’s important to take the correct lifestyle and dietary approaches listed below. 

2) Menopause: During menopause a women’s oestrogen levels decline and oestrogen plays an important role in regulating calcium absorption in our body which makes one more vulnerable bone related issues. Approximately 1 in 3 women over the age of 50 will break a bone due to osteoporosis. For this reason it’s important to both monitor your bone health as well as following the right lifestyle and dietary strategies during this time. 

3) Reduced Activity/Immobility: Inactivity, or prolonged immobility (especially bed or wheelchair bound) for more than six weeks or long term, especially in childhood when bone is being laid down. So again, it’s important to meet the nutrition requirements for calcium and vitamin D in this situation (see below).

4) Nutrition & Lifestyle: According to The IOS, the following or a combination of can increase one’s risk of osteoporosis, high fibre (above 40g/day), too much protein in the diet, high caffeine consumption, excessive alcohol intake (>7 pints or 14 units per weed for women & >11 pints or 21 units per week for men), smoking, excessive exercise (particularly with inadequate caloric intake), too much psychological stress and high amounts of physical stress.

5) Certain Medications & Treatments: The IOS discuss how certain medications such as steroids, particularly long-term steroid use has been proven to reduce bone mineral density, so it’s important to monitor your bone health if this applies to you. 

NOTE: Please consult with your pharmacist or GP if you are concerned or to check if your medication applies. 

You can take the first step in knowing your risk today by taking the simple bone risk test on www.irishosteoporosis.ie. From there, you will be given advice on the next steps for you to take. Please note that you can always talk to your G.P. about any concerns you may have.

- Prevention of Bone Related Issues: Prevention is key when it comes to bone related conditions through lifestyle factors, health screening and nutrition. According to Professor Moira O Brien of The IOS “most fractures can be prevented and osteoporosis unlike many diseases is treatable”.

1) In Pregnancy: The prevention of Osteoporosis should start in utero (during pregnancy). The Food Safety Authority of Ireland (FSAI) state that “calcium is important to protect maternal bone during pregnancy, as well as to support foetal bone growth and development”. It’s important to ensure that you are meeting the minimum requirements of Vitamin D and calcium during this time (see recommended amounts below).

2) Exercise: Daily weight bearing exercise is recommended as this can help to reduce but a person’s risk of bone loss. The recommendation is that all children should be encouraged to participate in weight bearing physical activity for a minimum of 60 minutes per day. Weight bearing activities are those that your bones are supporting your body weight. Children especially just prior to puberty around 8-12 years of age (depending on hormone levels) can build up the strength of their bones, which will reduce their risk of bone loss as they age.

Examples for children:  include walking, running, skipping, jumping, tennis, dancing, hockey, football. 

Examples for adults: include walking, jogging, running, stair climbing and dancing. 

3) Health Screening: If you have any of the risk factors above, if you have had previous breaks or fractures or if you are concerned about your bone health, please consult your GP who can arrange for you to get your DEXA scan done, this can also be done through private health care providers. 

4) Nutrition – Plays an important role in the prevention and maintenance of our bone health throughout our lives

Vitamin D – Most of us are aware that our bodies produce Vitamin D through the exposure of our skin to the sun. However, there are many factors which can affect this such as our Irish weather, clothing, sun cream, wearing make-up as well as a lack of opportunity for sun exposure, with many of us working, studying or being indoors due to lack of mobility or illness.  As a result, it’s important that that we all meet the daily requirement of Vitamin D throughout life, not only for bone health but their overall health, as Vitamin D is essential for the absorption of calcium, maintaining healthy respiratory and immune systems and for reducing your risk of fracturing bones. Food sources include: Oily fish (such as salmon, sardines, herring and mackerel), lean red meat, liver, egg yolks and fortified foods (such fortified milks or spreads and breakfast cereals). It’s also been recommended that we take a Vitamin D supplement all year round, here are the requirements. 

- How Much Vitamin D Do We Need?

Babies 0-1 years breast fed or formula fed = 5µ/200 IU per day

Children 1-18 years = 10µ/400 IU per day

19+ years pregnant and/or breastfeeding = 20-30µ/800-1000 IU per day

Women & men 19-49 years = 10-20µ/400-800 IU per day

Women & men 50+ years = 20-30µ/800-1000 IU per day

Sources: HSE 2011, FSAI 2011, FSAI 2020 

Calcium – It’s important to consume adequate amounts of calcium through our diet as it plays an important role in the building but also maintaining our bone health. 

- How Much Calcium Do We Need?

0-1 years = N/A

1-3 years = 450 mg per day

4-10 years = 800 mg per day

11-18 years = 1200 mg per day

Pregnant/or Breastfeeding = 1200 mg per day

Women & men 19-64 years = 800 mg per day

Women & men 65+ = 800 mg per day

Sources: INDI 2015, FSAI 2020

- Dietary Sources of Calcium

200ml Skimmed Milk = 44mg

200ml Full Fat Milk = 240mg

200ml Goats Milk = 200mg

Calcium Enriched Soya Milk = 188mg

30g Cheddar Cheese = 221.4mg

30g Feta Cheese = 28.8mg

1 Pot Glenisk Full Fat Bio Natural Yogurt = 189mg

1 Pot Glenisk Low Fat Bio Vanilla Yogurt = 153mg

120g Salmon = 18mg

80g Broccoli = 37.6mg

30g Almonds = 12mg

30g Brazil Nuts = 51mg

30g Hazelnuts = 12mg

1 Tablespoon Chia Seeds = 95mg

High Quality Protein - Is essential for healthy bones. Not many people are aware, but protein makes up roughly 50% of the volume of bone and about one-third of its mass. As the bone protein matrix undergoes continuous damage and repair, an adequate supply of amino acids (protein building blocks) are needed to support the formation and maintenance of bone throughout our lives. We should aim to fit in a combination of the following in our diets to meet this need. 

- Animal Based Protein Sources: Poultry, fish, lean beef or pork, yogurt, milk, eggs and low-fat cheeses

- Plant Based Protein Sources: Nuts (such as almonds, pistachios, cashew and hazelnuts), seeds (such as chia, flaxseed, sunflower and pumpkin), beans, lentils and grains such as (wholegrain/brown rice, wheat, spelt and oats). 

5) Get Gluten Checked: If you’re in irritable bowl (IBS) sufferer, it may check to see if you have symptoms of gluten sensitivity, as it can impair your ability to absorb important vitamins and minerals such as calcium and vitamin D which can affect your bone health.

 You can also take the Coeliac Society of Ireland assessment here (it is recommended that if you are under the age of 16 to do so with a parent, carer or guardian) https://www.isitcoeliacdisease.ie/overview or contact your GP if you suspect you have symptoms. 

6) Hydration: It is very important that everyone drinks fluids, especially water to prevent dehydration and constipation. As little as 2% decrease in brain hydration can result in short term memory loss and prolonged dehydration can result in a lack of mental clarity, sometimes referred to as ‘brain fog’ resulting in a higher chance of falls or injury.

- Where To Get Support: It can often be confusing to know where to go if you are concerned if you or your loved ones may have a bone related condition however you can contact The Irish Osteoporosis Society (IOS) who are the National experts in Osteoporosis at 01 637 5050, email them at info@irishosteoporosis.ie and you can also access valuable and helpful material via their website www. Irishosteoporosis.ie

Bone Health Recipe - Easy Chocolate Mousse  

Healthy Treat or Dessert – 4 Servings (247mg Calcium/portion)

Ingredients

For The pudding

• 4 Tablespoons of Low-Fat Milk 
• 100g Dark Chocolate (+70% Cocoa)
• 500ml Greek Yogurt
• 1 Tablespoon Honey
• 1 tsp Vanilla extract 

For The Topping 

• 2 Mandarin Oranges, peeled and segmented 

Directions

1) Bring a saucepan half filled with water to the boil and place a heat proof bowl on top 

2) Add the chocolate to the bowl, followed by the milk and stir to combine as the chocolate begins to melt

3) Once the chocolate and milk have fully combined, add the honey and vanilla and stir 

4) Spoon the Greek yogurt into a large bowl, pour the chocolate mixture on top and stir fully to combine

5) Transfer to small serving bowls/ramekins and place in the fridge to chill and set for 2 hours

6) Serve with a teaspoon of Greek yogurt and top with the Mandarin segments