Healthy living & bone health

Diet

(Influences and what to do)

Healthy eating

Include in your daily diet:

• cereals
• vegetables
• legumes (lentils, beans)
• fruit
• milk, yoghurt, cheese
• lean meat
• fish
• poultry
• nuts

Calcium

To meet your calcium needs, include in your daily diet:

• 2 serves of dairy foods
• a serve of calcium-rich foods – e.g. broccoli, beans, almonds, tinned salmon or sardines

Vitamin D

To meet your vitamin D needs in order to have normal absorption of calcium, choose foods that are known to have higher levels of vitamin D such as:

• mushrooms
• fish
• liver
• egg yolks

Check the map of Australia for guidelines on the recommended amount of sun exposure based on your location, the season and your skin pigmentation.

Protein and phosphorus

• Protein intake is important for bone development as it provides the necessary building blocks in bones. High protein foods include beef, veal, lamb and pork, chicken and turkey breast, tuna and soy beans.
• Phosphorus is a mineral and nutrient we all need for strong bones and proper cell functioning. Phosphorus is found in milk, grains like rice and oat bran, seeds, bacon and protein rich foods.
• Diets that are very high in protein and phosphorus can disrupt the calcium balance causing the body to take calcium from the bones. If you have an adequate calcium intake, then the effect of high protein and phosphorous is not as significant[1], which means adequate calcium intake is a priority.

Caffeine and salt

• High intake of salt and drinking more than three caffeinated drinks per day can reduce calcium absorption. In addition, people who drink very high quantities of caffeine also tend to eat/drink less calcium rich foods and drinks.
• If you suspect your salt or caffeine levels may be too high, it can be helpful to see a dietitian even for one visit to work out some alternatives

For more detailed information go to Healthy living, Calcium and Vitamin D.

Physical activity & exercise

Weight bearing & high impact activities

Weight bearing exercise, which is exercise done while on your feet so you bear your own weight and support your skeleton, is the key to good bone health. This includes fast paced walking (to have an effect on your bones), running, tennis or dancing. Walking at a fast pace and jogging have been found to help strengthen bone mass – sedate and slow walking may not be as protective of bone[1].

High intensity, rapid impact exercise stimulates bone cell formation. This form of exercise generally refers to weight bearing exercise that involves more load placed through the leg bones and spine, during landing after lifting one's own body weight off the ground. Examples of this include running, skipping, jumping, high impact aerobics and team sports such as netball.

Fifteen minutes of weight bearing exercise, four times per week is helpful for bones. This might include:

• gym resistance training (set by a trained instructor)
• medium impact aerobics
• skipping
• dancing
• jumping exercises

Certain physical activities can increase your risk of fracture, so any exercise activity should first be discussed with your doctor.

Strength training

These activities are also known as resistance exercises. Strength training uses weights of some kind (e.g. machines, dumbbells, ankle or wrist weights) to create resistance, which helps to build muscle mass. It includes activities that use one's own body weight as the load (e.g. push-ups, where load is placed through the arms and shoulders).

Load placed on bone leads to increased bone formation at the site where the load is greatest. The benefit is site specific, so if you are using weights on your legs, it only benefits your leg bones.

Ideally strength training programs should be performed regularly, 2-3 times per week. Strength training is most beneficial when a small number of repetitions (e.g. 8-12) are used, and the weight is progressively increased. As your strength improves, it is best to increase the weight used in the exercise rather than increasing the number of repetitions.

There is evidence to suggest high impact loading and resistance type/strength training activities probably provide the most benefit for improving bone mineral density.

Physiotherapy

A physiotherapist can provide assistance with bone strengthening exercises and fall prevention by addressing:

• posture
• balance
• coordination
• muscle strength

If you have had a fracture, a physiotherapist or exercise physiologist can tailor an exercise program to suit your needs as part of your rehabilitation.

Hydrotherapy

Using warm water activities is particularly beneficial if you need to be careful with exercise. The buoyancy of the water allows for easier movement and less chance of pain. Supervised muscle strengthening exercises can help both rebuild bone and improve balance and posture, thereby assisting in the prevention of falls.

Risky exercises if you might suffer a fracture

If you have osteoporosis it may be best to avoid some of the following exercises:

Source: Everybody's bones: a handbook for the prevention and management of osteoporosis (3rd edition), Osteoporosis Australia, 2001

Activity programs

Before you start

• If you have not been active regularly, see your doctor before you start any exercise or physical activity program
• If you have osteoporosis, see your doctor and seek advice from a physiotherapist or exercise physiologist

Starting your program

• Start slowly and progress gradually
• Choose something you enjoy
• Join a group or a gym
• Wear appropriate footwear such as supportive runners

Keeping your program on track

• Vary your activity
• Get active with a friend – start a walking group, join a line dancing group or take up yoga or Tai Chi
• Pay up front for activities that incur a cost to motivate you to keep going
• Keep an activity diary and schedule your activity at the start of each week
• Match your activity to the weather and seasons – outdoor walking, gardening, Tai Chi for warmer weather and indoor line dancing, gym and yoga for cooler weather
• Listen to your body – if there is any pain, seek professional advice
  

If any pain is experienced during exercises, the exercises should be stopped and if the pain persists you should consult your doctor.

A word on excessive exercise

If you do not have periods, the emphasis of treatment is to restore normal period patterns and this may mean:

• changing training routines
• if you are underweight, making sure you have an adequate intake of calories from a wide variety of foods
• using the oral contraceptive pill to restore oestrogen levels

Smoking & alcohol

Smoking and excessive alcohol are known to have a negative effect on bone health and lead to a significant reduction in bone density. For more information go to smoking or alcohol.

** Currently under review **

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at December 2013.