If you are one of 15.6 million of women in the UK between the ages of 38 to 56 and who are now transitioning into menopause, you’re most likely anxious about the changes that are going to happen to your body, thinking how you can protect yourself to remain in robust health into old age. Women spend a third of their life (between 33% to 41%) in postmenopausal years; thus it is important to know if there are specific strategies you can take for your right health now. One of the biggest worries for women of this transitioning period and in post-menopause is loss of bone density, risk or fractures and development of osteoporosis.
Our human nature is so that most of us tend to address our health conditions once we develop them, and thus with this post I would like to raise awareness for women of all ages: starting to prepare for menopause, albeit might sound counterintuitive, needs to happen in adolescence.
If you are perimenopausal or menopausal, implementing some of these strategies will help you preserve your bone mass now. But if you have a teenage daughter, a younger sister or other young-age female relatives, discussing with them the factors that affect their bone mass formation and maintenance is crucial to prevent bone-related health risks mentioned above. The earlier young girls start optimising their diet and lifestyle the better their body would be prepared for the changes to their health in menopause years.
Key points:
1. Prevention of osteoporosis starts in childhood and adolescence. In women 80 to 90% of bone mass is formed by age 18. Particularly critical ages are between 12 to 16 years, when bone mass development is accompanied by rapid musculoskeletal growth.
2. Bone health is affected by diet, exercise, lifestyle, medications and hormonal status.
3. Exercise is an important modulator for bone health in women of all ages. Strength training in the form of bodyweight exercises and resistance training as well as sports that involve jumping, sprinting and explosive movement are the best for building bone density. Tennis, football and gymnastic are considered the best sports for children and teens for bone mass development.
4. Bone mass has mineral components which are necessary for its healthy maintenance, the most critical are vitamin D3, vitamin C, vitamin K, calcium, magnesium, boron and potassium. Due to a large number of dieting strategies an average woman takes up through her adolescent and young adulthood years, without realising the importance of vitamins and minerals for bone health, key nutrients might be lost on lactose-free, vegan or other dieting protocols.
5. Folate is an essential nutrient for skeletal health maintenance, as together with vitamins B6 and B12 it helps convert homocysteine into beneficial amino acids to prevent high homocysteine (Hcy) levels. Raised homocysteine levels are an independent risk factor for lower bone density and osteoporosis. Main sources of folate in the diet come from green cruciferous vegetables.
6. Consumption of sugar-added foods affects bone health in a variety of ways. Having dysregulated blood sugar levels increases the risk of insulin resistance, which leads to weigh gain and becomes a risk factor for bone health deterioration. Furthermore, high sugar diet can lead to a depletion of several key vitamins and minerals from their cell storage, these are group B vitamins, vitamin C, vitamin D, magnesium, zinc and calcium - critical for bone health.
Thus, the earlier young girls start optimising their diet and lifestyle, the higher chance they will have at preserving healthy bone mass and preventing osteoporosis in menopause years.
2. Bone health is affected by diet, exercise, lifestyle, medications and hormonal status.
3. Exercise is an important modulator for bone health in women of all ages. Strength training in the form of bodyweight exercises and resistance training as well as sports that involve jumping, sprinting and explosive movement are the best for building bone density. Tennis, football and gymnastic are considered the best sports for children and teens for bone mass development.
4. Bone mass has mineral components which are necessary for its healthy maintenance, the most critical are vitamin D3, vitamin C, vitamin K, calcium, magnesium, boron and potassium. Due to a large number of dieting strategies an average woman takes up through her adolescent and young adulthood years, without realising the importance of vitamins and minerals for bone health, key nutrients might be lost on lactose-free, vegan or other dieting protocols.
5. Folate is an essential nutrient for skeletal health maintenance, as together with vitamins B6 and B12 it helps convert homocysteine into beneficial amino acids to prevent high homocysteine (Hcy) levels. Raised homocysteine levels are an independent risk factor for lower bone density and osteoporosis. Main sources of folate in the diet come from green cruciferous vegetables.
6. Consumption of sugar-added foods affects bone health in a variety of ways. Having dysregulated blood sugar levels increases the risk of insulin resistance, which leads to weigh gain and becomes a risk factor for bone health deterioration. Furthermore, high sugar diet can lead to a depletion of several key vitamins and minerals from their cell storage, these are group B vitamins, vitamin C, vitamin D, magnesium, zinc and calcium - critical for bone health.
Thus, the earlier young girls start optimising their diet and lifestyle, the higher chance they will have at preserving healthy bone mass and preventing osteoporosis in menopause years.
The role of exercise for bone mass and Wolff’s law
Exercise plays an important preventive role for bone mass.
Julius Wolff, a German surgeon and anatomist who lived at the end of 19th century, suggested that bone is a dynamic tissue that is in a continuous process of remodelling in response to mechanical stresses and forces placed on it. This has become known as the Wolff’s law.
Bones are living tissues that are constantly adapting to the demands of activity they are subjected to. Such activities as jumping, running, sprinting, and sports like tennis and football are the best for bone mass building and maintenance. The high impacts from these activities create great forces or strains on the bones of the biggest joints - the spine, hips, legs, shoulders, etc. In addition, the rapid changes, burst activities like sprints and changes in direction in tennis and football activate osteoblast cell activity, as they need to constantly adapt to high impacts, thus promoting the creation of new bone structure. The impacts of these forces placed on bones are above what is normally experienced during daily activities, such as walking or cycling. This triggers an active bone-strengthening response.
Julius Wolff, a German surgeon and anatomist who lived at the end of 19th century, suggested that bone is a dynamic tissue that is in a continuous process of remodelling in response to mechanical stresses and forces placed on it. This has become known as the Wolff’s law.
Bones are living tissues that are constantly adapting to the demands of activity they are subjected to. Such activities as jumping, running, sprinting, and sports like tennis and football are the best for bone mass building and maintenance. The high impacts from these activities create great forces or strains on the bones of the biggest joints - the spine, hips, legs, shoulders, etc. In addition, the rapid changes, burst activities like sprints and changes in direction in tennis and football activate osteoblast cell activity, as they need to constantly adapt to high impacts, thus promoting the creation of new bone structure. The impacts of these forces placed on bones are above what is normally experienced during daily activities, such as walking or cycling. This triggers an active bone-strengthening response.
For young females:
Encourage teenage girls to continue playing sports from their childhood into adolescence - football, hockey, tennis, squash, netball, volleyball - are all fantastic for bone maintenance as girls grow. Gymnastics is also a fantastic choice of sports for young females. Through a wide range of high-impact bodyweight movements that involve jumping and tumbling, with the forces sometimes up to 5 to 10 times that of body weight, young and adolescent girls achieve greater bone structure and density compared to their peers who don’t train in gymnastics.
For women over 40:
If you are in perimenopause or menopause, it is a good time to look after your bone structure prophylactically, with the same approaches as to when you were a young girl. Playing tennis, squash and other racket sports is tremendously helpful for bone mass preservation. Try to incorporate jumping and sprinting activities in your weekly training routine - box jumps, short bursts of sprints, tabata training routines are all beneficial for bone maintenance.
Strength training deserves a special focus when it comes to prevention of osteoporosis. Weight bearing exercises, such as squats, press-ups, lunges, deadlifts place higher force on the muscles, joints and tendons compared to the forces one experiences from their daily activities. These create adaptational changes which stimulate osteoblast cell activity to increase bone mass.
Furthermore, strength training serves another preventative role in menopausal women. Balance is affected as we age, increasing the risk of injuries and falls. Strength training incorporates strengthening the tendons and small ligaments that support the bigger joints making you more stable and preventing falls.
Strength training deserves a special focus when it comes to prevention of osteoporosis. Weight bearing exercises, such as squats, press-ups, lunges, deadlifts place higher force on the muscles, joints and tendons compared to the forces one experiences from their daily activities. These create adaptational changes which stimulate osteoblast cell activity to increase bone mass.
Furthermore, strength training serves another preventative role in menopausal women. Balance is affected as we age, increasing the risk of injuries and falls. Strength training incorporates strengthening the tendons and small ligaments that support the bigger joints making you more stable and preventing falls.
Tips for exercise if you’re over 40:
- If you are new to strength training, I highly recommend you choose to work with a professional trainer who can show you the correct form for each exercise. Keeping the right form will help you derive pleasure from the activities and see daily progress as you continue training, whereas bad form can lead to potentially injuring yourself and not coming back to the gym.
- Choose functional training above all other types. Functional training exercises are the ones that mimic the activities in daily life. Functional training are compound exercises, working on multiple muscle groups at once, for example, as we perform squats, we are also training our core muscles and the back, as well as the ankles and calves being supportive for the force placed on the body. Squats are perhaps the best exercise to invest in as you train, I recommend incorporating one type of squat or another each time you train. Regularly performing squats at this time will help you: prevent back injuries, get up the stairs, get out of the car, and so much more, when you’re in your 70s or 80s.
The role of nutrients for bone health
There is a host of important nutrients needed by your body to build and maintain bone mass. Vitamin D3, calcium, collagen, vitamin C, zinc and magnesium are among the main ones.
Collagen
Collagen is the main material in the bone matrix, making up about 90% of the bone structure. Bone formation undergoes a two-step process: osteoblast cells deposit organic ‘soft’ material, into which minerals which later crystallise (for example, calcium, zinc and magnesium) are added to complete the mineralisation and hardening of the bone; this two-way process makes the bone structure into an intricate combination of rigidity, strength but also flexibility.
Collagen is the main part of animal protein with connective tissue, hence by making sure you eat sufficient amount of protein daily you are strengthening your bone tissue. The best sources of collagen in meat are: beef, lamb, chicken, pork, turkey, organ meat; fish - salmon, cod, haddock, whiting, monkfish, herring, sardines, trout, mackerel; seafood - prawns, crayfish, and molluscs.
Collagen is the main part of animal protein with connective tissue, hence by making sure you eat sufficient amount of protein daily you are strengthening your bone tissue. The best sources of collagen in meat are: beef, lamb, chicken, pork, turkey, organ meat; fish - salmon, cod, haddock, whiting, monkfish, herring, sardines, trout, mackerel; seafood - prawns, crayfish, and molluscs.
Vitamin C
This is one of those under-radar vitamins for bone health. We hear a lot about vitamin C when it comes to boosting our immune system and protecting ourselves from winter viruses. However, vitamin C is key for bone development. Vitamin C is a crucial cofactor in collagen protein synthesis, without vitamin C collagen biosynthesis is impaired.
Both young girls and ageing women might lack this crucial vitamin, as the main sources of vitamin C are fruit and vegetables, such as kiwi, peppers, citrus fruit, raspberries, blackberries, radishes, broccoli, Brussel sprouts and other vegetables and fruit. The consumption of fresh fruit and vegetables both in teenage children and in people 50+ is suboptimal in the UK.
Both young girls and ageing women might lack this crucial vitamin, as the main sources of vitamin C are fruit and vegetables, such as kiwi, peppers, citrus fruit, raspberries, blackberries, radishes, broccoli, Brussel sprouts and other vegetables and fruit. The consumption of fresh fruit and vegetables both in teenage children and in people 50+ is suboptimal in the UK.
Vitamin D3 and calcium
There is a very important combination of the hormone D3 (you also know it as vitamin D3) and calcium for bone development, maintenance and regeneration. D3 facilitates calcium absorption from the gut, which then helps calcium to be incorporated into that rigid mineralisation matrix of the bones.
As we age, our natural production of vitamin D3 gets lower, together with the decreased intestinal absorption of calcium. This contributes to bone density loss associated with ageing.
Such conditions as overweight, obesity, having food intolerances, IBS and other gastro issues, having darker skin increase the risk of vitamin D3 deficiency.
Vitamin D3 levels are susceptible to the use of medications, caffeine and sugar, which I will cover later.
We get the mineral calcium from our dietary sources - the main ones are being milk, cheese, yogurt, other dairy, nuts and seeds and animal protein (fish and meat).
If you are on a low-calorie or low-fat diet, your daily intake of calcium foods might be insufficient. Being lactose intolerant or switching to dairy-alternative options should be checked with a qualified nutritionist.
As we age, our natural production of vitamin D3 gets lower, together with the decreased intestinal absorption of calcium. This contributes to bone density loss associated with ageing.
Such conditions as overweight, obesity, having food intolerances, IBS and other gastro issues, having darker skin increase the risk of vitamin D3 deficiency.
Vitamin D3 levels are susceptible to the use of medications, caffeine and sugar, which I will cover later.
We get the mineral calcium from our dietary sources - the main ones are being milk, cheese, yogurt, other dairy, nuts and seeds and animal protein (fish and meat).
If you are on a low-calorie or low-fat diet, your daily intake of calcium foods might be insufficient. Being lactose intolerant or switching to dairy-alternative options should be checked with a qualified nutritionist.
For young females:
There isn’t enough vitamin D quantity that we can obtain from food sources. Vitamin D is present in sardines, salmon, mackerel, herring, butter, some hard cheese. However, the primary source of vitamin D for the human body is its synthesises in the skin from sunshine. One needs to spend 1,5 hours in direct sunlight (between the hours of 10 am and 2 pm) to get enough vitamin D for a week. As we don’t get enough sunshine in the UK in the winter months I strongly recommend supplementing with vitamin D3 during autumn and winter.
For women over 40:
Recommendations for osteoporosis management include a daily vitamin D3 supplement of 1,000 to 2,000 IU and calcium intake of 800–1200 mg (preferably from diet but also supplements, if dietary intake is insufficient).
Check with your doctor what your levels of vitamin D3 and calcium currently are and ask their advice on supplementing.
Check with your doctor what your levels of vitamin D3 and calcium currently are and ask their advice on supplementing.
Magnesium and zinc
After calcium and vitamin D3, magnesium is the next most important mineral for bone mineralisation. Its role in increasing the activity of phosphatase (an enzyme that helps remove phosphate from protein) contributes directly to healthy bone formation. Magnetism deficiency is directly linked to the development of osteoporosis, as lack of magnesium makes the bones porous and brittle.
It is believed that over half of our population are deficient in magnesium. But I don’t advise you run to check your magnesium levels with a blood test. Magnesium is stored intracellularly, the majority of magnesium is located within soft and hard tissues, and most intracellular magnesium is not available for measurement.
Deficiency of magnesium also impacts the activity of parathyroid hormone, which is actively involved in bone tissue synthesis and cellular inflammation.
Magnesium is found in almonds, pumpkin seeds, cashews, some grains, fish, dark chocolate.
Zinc is another essential mineral that is required for bone development and maintenance. Zinc also helps to promote bone regeneration.
It is believed that over half of our population are deficient in magnesium. But I don’t advise you run to check your magnesium levels with a blood test. Magnesium is stored intracellularly, the majority of magnesium is located within soft and hard tissues, and most intracellular magnesium is not available for measurement.
Deficiency of magnesium also impacts the activity of parathyroid hormone, which is actively involved in bone tissue synthesis and cellular inflammation.
Magnesium is found in almonds, pumpkin seeds, cashews, some grains, fish, dark chocolate.
Zinc is another essential mineral that is required for bone development and maintenance. Zinc also helps to promote bone regeneration.
Folate
Folate or vitamin B9 is mainly present in dark leafy vegetables, and it is one of the most important vitamins for bone health. Folate promotes the growth and differentiation of bone cells. Folate also affects the levels of homocysteine in the body. Homocysteine is an amino acid, which as shown by recent research, when it gets to high levels is strongly associated with development of osteoporosis.
There has been a significant decline in folate levels in children and adolescents in the UK since 2008, according to the National Diet and Nutrition Survey (NDNS).
Folate-rich foods are kale, spinach, rocket, Swiss chard, chicory, broccoli, cauliflower, cabbage, bok choy and other green cruciferous vegetables. Make sure you eat 2-3 portions of green cruciferous vegetables every day.
There has been a significant decline in folate levels in children and adolescents in the UK since 2008, according to the National Diet and Nutrition Survey (NDNS).
Folate-rich foods are kale, spinach, rocket, Swiss chard, chicory, broccoli, cauliflower, cabbage, bok choy and other green cruciferous vegetables. Make sure you eat 2-3 portions of green cruciferous vegetables every day.
The role of sugar in bone health
Sugary foods, such as biscuits, pastries, cakes, sweets, chocolate, jams, fruit juice, soft and fizzy drinks contain high amounts of sugar. Sugar provides empty calories for the body; in addition, during its complex metabolic process, sugar requires minerals and vitamins, thus it removes several minerals and vitamins from their storage in their cells. Magnesium, calcium, vitamin C, zinc, vitamin D3 are the ones that are affected.
For young females:
Teenage girls develop 60% of their bone structure during the age of 12 to 16. It is important that their diet is supportive of and enriched with the foods that promote adequate intake of key minerals for bone health. Furthermore, being cautious about sugar intake will prevent the depletion of these critical for bone health elements from their cell storage.
Many teenage girls have a high consumption of sodas, sweets, chocolates and other sugar-added foods. Having a high-sugar diet directly hinders healthy bone structure formation due to the critical minerals lost.
Many teenage girls have a high consumption of sodas, sweets, chocolates and other sugar-added foods. Having a high-sugar diet directly hinders healthy bone structure formation due to the critical minerals lost.
For women over 40:
As women age, they may have a list of medications to address one health condition or another. Although it is not possible to list all medications that affect bone health, the hardest ‘hitters’ on bone health are:
- Acid blockers and proton pump inhibitors (examples, Omeprazole, Lansoprazole, etc.) - their effect on blocking most of acid production results in inhibition of the absorption of vitamin D3, magnesium, calcium and zinc from the intestine, as acid is a vital component of mineral absorption.
- Anti-anxiety, anti-depression drugs (SSRIs) - the exact mechanisms are still being researched, it is currently believed that serotonin is involved in the cell signalling pathway of bone cells, as serotonin receptors are found in all types of bone cells - osteoblasts, osteocytes and osteoclasts.
- Corticosteroids injections/ creams/ medications - decrease the body’s ability to absorb calcium and increase the rate of osteoblasts (bone breaking process), directly increasing the risk of fractures and lower bone density.
Our bone is a living organism, it is constantly developing and regenerating. Support its healthy maintenance with good dietary sources, engage in a variety of bone-strengthening exercises, such as explosive moves, strength-training and racket sports. And final word on the role of sleep: let us remember that sleep is when the body undergoes its active repair and renewal, so good sleep is also your good medicine for healthy bones.
Stay healthy, be joyful!
Love,
Katya
References:
- https://onlinelibrary.wiley.com/doi/10.1111/nbu.12148
- https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1559043/full
- https://assets.publishing.service.gov.uk/media/5ff5a78ee90e0776a8d5615b/CYP_MSBS_Review__1_.pdf
- https://www.sciencedirect.com/science/article/pii/S0167488919301065
- https://www.physio-pedia.com/Wolff's_Law#:~:text=Julius Wolff, a German surgeon,known as "Wolff's Law.”
- https://www.sciencedirect.com/science/article/abs/pii/S0301468124000136#:~:text=Studies on type 1 collagen are crucial for understanding bone,promoting bone health throughout life.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7287917/#:~:text=Zinc is an essential mineral,and regeneration are poorly understood.
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- https://www.nature.com/articles/s41598-024-80471-6