Better Bone Health – Your Complete Guide from A to Z

Curious about improving your bone health?

You’re in the right place.  

This guide isn’t just for those with osteoporosis; it’s for anyone looking to understand and improve the health of their bones. We’ll keep it down-to-earth as we explore a wide range of factors that contribute to better bone health, from the basics of alignment to the nitty-gritty of Z-scores.

So, let’s begin this journey towards better bone health together.  It’s an important one, after all breaking a bone has a significant impact on your ability to take care of yourself. You need a strong skeleton to navigate your day and live life to the fullest.

Osteoporosis, is a condition where bones lose strength and become more likely to break.  This currently affects 3.5 million people in the UK; 1 in 2 women and 1 in 5 men over 50 will suffer a fracture as a result of poor bone health ^[1].

My lovely Nana had osteoporosis, so I’m keen to share as much as I can and encourage everyone to do what they can to help their bones. Keep in mind that I’ll be dedicating a separate blog post to the specific ways Pilates can play a crucial role in improving bone health. So, stay tuned for that too.

 

Our alphabetical journey begins with becoming more aware of the health of your bones…

 

Alignment for Ease of Movement (A): Alignment of your spine and limbs as you move is key to exercising safely and effectively.  Awareness of your alignment can also help you manage posture-related pain.  It’s no surprise it’s one of the fundamentals of Pilates.

Balancing for Better Bone Health (B): Improving your balance reduces your risk of falling, less risk of falling means fewer fractures.  Balance is a key element to bone health.  Everyone can improve their balance with practice and challenge!  For something to try at home, Clock Yourself is a useful resource for working on balance, cognition and improving reaction times ^[2].

Calcium Choices (C): Calcium is one of the minerals that provide strength for the collagen framework of our bones. While yoghurt (soya or dairy) is a good source, there are lots of plant-based foods that are rich in calcium too ^[3].  Make easy switches to increase calcium absorption – tahini instead of peanut butter, rocket or watercress instead of spinach (oxalates in spinach hinder the absorption of calcium).

Diving into DEXA Scans (D): A Dual Energy X-ray Absorptiometry (DEXA) scan is used to measure bone density and it has lower radiation than normal X-Rays. A DEXA scan looks at two sites in the body where bone loss associated with osteoporosis typically starts, the hip and the spine.  Our aim is to maintain bone density so the structure of your bone remains as strong as possible through life.

Exercise – The Backbone of Bone Health (E): Inactivity promotes bone loss! To stimulate our bones, we need to do more, not less! We need weight-bearing exercises, resistance exercises, balance exercises, Pilates, and cardiovascular exercises to promote bone health. With osteoporosis/osteopenia it’s critical to find someone who understands these conditions and is qualified to teach you safely (I have a Level 3 certificate in Designing Pilates Programmes for Bone Health.) [4].

 

Osteoporosis is termed a silent condition, meaning you often may not know you have it until you fracture, a DEXA scan could confirm the diagnosis, but there may be other clues…

 

Fragility Fractures – A Wake-Up Call (F): Fall dramatically from a height and you may expect a broken bone, but if you fracture from something less impactful (for example, closing the boot of a car or hanging washing out for instance) it may be a red flag indicating changes in your bony architecture. The wrist, hip and spine are common sites of fracture.

Genetics and Lifestyle (G): It’s thought our genes regulate our peak bone density and rate of bone loss. However, there’s certainly an interplay between genetics and lifestyle factors in bone health– diet and exercise habits, smoking, chronic illnesses, digestive issues, eating disorders and, for women, a history of irregular periods or early menopause.

Hormones and Your Bones (H): It’s complicated! Parathyroid hormone triggers the release of calcium from bones, while calcitonin (produced by the thyroid) stops this release. Oestrogen stops the production of parathyroid hormone, so during and post-menopause there’s a decline in bone density.  It’s even more important to take care of your bone health at this time.

 

Your lifestyle has a big impact on your health and even more so through mid-life. Small positive changes can help your bone health, here are a few more ideas…

 

Impact, Intensity and the Surprise Factor (I): Bone responds to intensity, rather than duration, it needs a surprise here and there! Doing the same walk on the same surface/same incline/same distance/same effort means your bones don’t get the signal to regenerate. Add in something different and add some impact!

Joy, Stress and the Adrenals (J): Stress can influence your bone health by influencing your adrenal glands. Cortisol (one of the hormones released by the adrenals) can interfere with vitamin D and digestion – essentially blocking calcium absorption. Noticing stress and understanding its impact on our health can be a starting point for making changes.

The Powerful Vitamin K (K): It’s fat-soluble and needed to manufacture osteocalcin, a bone protein that helps to harden calcium within bone. Good sources include green leafy veg, cauliflower, broccoli, cabbage, lettuce, wholegrains and soya^[5]. Did you know, another form of vitamin K is synthesised by friendly bacteria in the gut? Variety is key!

Lifting Weights – the Muscle-Bone Connection (L): Your muscles contracts to lift a weight, pulling on the bone and stimulating bone growth. The more powerful the muscle, the more powerful the stimulation of the bone. The weight you choose needs to be something that feels challenging but still manageable, a ‘manageable challenge’.  You also want to keep perfect posture while lifting it!

Menopause and Beyond (M): For all genders, bone loss increases as part of ageing and rapidly for women in the first few years after menopause. Early menopause, either medical or natural, is a risk factor for osteoporosis. Lifestyle choices, including regular physical activity, can help minimise this decline in bone density post-menopause.

Nutrition Essentials (N): A varied diet is key to getting the nutrients we need ^[5].

Key minerals needed for bone health	boron, calcium, copper, magnesium, potassium, silicon and zinc
Key vitamins needed for bone heath	vitamins D, K, B6, B9, B12, C & E

You can’t see inside your bones, so it’s easy for ‘improve bone health’ to drop off your to-do list, but your bones are alive, they need looking after! Start by understanding your risk factors for osteoporosis and how the right kind of exercise can help your bones…

 

Osteoblasts and Their Role (O): Bone is a living tissue! There’s dynamic interplay between osteoblast cells that build bone, and osteoclast cells that remove the bone.  Osteoclasts, remove worn-out bone, allowing osteoblasts to replace it. This bone remodelling is critical for bone strength and is stimulated by exercise.  Bone development by osteoblasts is influenced by oestrogen (in women) and testosterone (in men).

Pilates (and Posture and Practice and Patience) (P): So where does Pilates fit in? Attention to the detail of the exercises means that Pilates fits the bill perfectly in terms of improving bone health safely. I keep a close eye on your alignment in class and give you the tools to recognise great alignment in your body! Working on this is a great way to improve your posture, avoid a forward flexed position and manage posture-related pain. There are tweaks we can make to your regular Pilates exercises to further help bone health.  I’ll cover these in more detail in my next blog. Practice and patience are required with bone health, it’s not a quick fix!

The Quest for Quality (Q): Precision of movement is critical, especially when working on your posture and challenging yourself with additional weight. Quality over quantity is described brilliantly with a great Joseph Pilates quote:

Concentrate on the correct movement each time you exercise, lest you do them improperly and thus lose all the vital benefits.

In your quest for quality, find a level of exercise that challenges you where you can also keep good posture and alignment at the same time.

Ostoeporosis Risk Factors (R): Some risk factors you cannot change.  But there are some you can, for example, low body weight, smoking, drinking too much alcohol, slip’s trips and falls. It’s important to understand your risk factors of breaking a bone so you can focus on making positive changes. It’s never too late to make improvements.  The Royal Osteoporosis Society has a risk checker, like a questionnaire and the advice and practical tips are tailored to your answers ^[1][6].

Strong, Steady and Straight (S): These are the recommendations I follow for our classes, tweaking Pilates exercises to make them even more effective at promoting bone health.

Strong – for bone health, using weight-bearing and muscle-strengthening exercises.

Steady – to reduce falls, use balance and muscle-strengthening exercises again.

Straight – to practice techniques for moving and lifting while strengthening back muscles to improve posture and endurance ^[7].

 

Finally, let’s understand how your bone health is categorised after a scan and find a few more ideas for empowering you on your bone health journey…

 

T-scores and Bone Density (T): When you have a bone density scan of your spine and hip, one of your results will be a T-score. This is the difference between your bone density and that of a healthy 25-year-old at average peak bone density. If diagnosed with osteoporosis in one area, it is assumed that all bones are osteoporotic.

T-score	Description of Bone Density
Between 0 and -1	Normal bone density
Between -1 and -2.5	Low bone density (osteopenia)
Less than -2.5	Osteoporosis

Normal bone density is a T-score between zero (no difference) and -1, while low bone density is a score between T= -1 and T=-2.5. A T-score of less than -2.5 is diagnosed as osteoporosis.

UV Light, Vitamin D and Sunlight (U and V): Good levels of Vitamin D are needed for you to absorb calcium from food or supplements. We get some vitamin D from our diet but the most important source is produced in our skin when exposed to sunlight (UV light). The UV light converts a substance in our skin to pre-vitamin D, which is then converted to the active form of vitamin D (calcitriol) in our liver and kidneys. During winter months, a supplement can be useful. Vitamin D also plays an important role in bone metabolism (regulating the bone-building osteoblasts) and our immune system ^[3].

Weight-Bearing Exercise for Bone Health (W): Moving your body against gravity in other words weight-bearing exercise is helpful for those sites that are vulnerable to fracture, helping to preserve bone density.  For example, walking, hiking, jogging, climbing stairs, dancing, playing tennis. Build up gradually and remember bone responds to change, so keep things varied!

X-Ray for Broken Bones (X): While an ordinary X-ray is used to see if you’ve broken a bone, a different type of X-ray is used to measure the density of your bone. A DEXA scan is recommended to assess your bone health and check for osteopenia or osteoporosis (see DEXA, T-scores and Z-scores).

YOU, yes YOU (Y): Yes, it’s in capitals!  Yes, it’s important!  You are important and taking care of your bone health starts with YOU. Do what you can in terms of lifestyle (for example, a healthy diet, giving up smoking). Find an effective exercise that you enjoy!  You know what you enjoy most, what you can fit in and what you’re going to stick to!  If you need someone to talk to about getting started, please get in touch.

Age-matched Z-scores (Z): Another result listed on your bone density scan (DEXA) report.  This time your bone density is age-matched, meaning it’s compared to women/men within the same age range as you.

 

From alignment and balance to genetic factors and the impact of menopause, we covered many essentials of bone health. Remember that your bone health is mostly within your control, and simple lifestyle changes can make a difference (together with medication where appropriate). Wherever you are on your journey to better bone health, I hope this has provided valuable insight and inspires you to be proactive.

 

If you’re interested in joining a small group dedicated to improving bone health in a safe, challenging and fun class, I’d love to hear from you. I teach small Healthy Bones and Balance Classes online, you can get in touch here to see if our classes are a good fit for you.  If you’ve enjoyed this blog, join my newsletter by signing up below for more valuable tips and insights delivered straight to your inbox.