Maintain Good Bone Density

During the childhood and adolescent years, it is very important to build and maintain bones. In fact, the bones that adults have are in many ways a function of the bones that were built and maintained during the first few decades of life. By age 18, females have acquired up to 90 percent of their peak bone mass; in males, that occurs by age 20. The goal is to have strong bones that will lower the risk of developing the bone loss medical problems known as osteopenia, or the more serious bone loss problem known as osteoporosis. Osteopenia and osteoporosis increase the risk of stress fractures and other types of fractures, especially hip fractures. Hip fractures are serious and may be life-altering or life-threatening.

Exercise needs to become a priority. It actually helps build bones and reduces bone loss. The most effective exercises are the weight-bearing ones such as running, walking, jumping rope, skiing, and stair climbing. Resistance training is similarly useful. And, add still another reason not to smoke: smokers have a harder time absorbing calcium and building bone mass. ¹

In a study published in 2014 in the journal Osteoporosis International, researchers from Madison, Wisconsin, examined the effect of a middle-school-based resistance-training program on the skeletal growth of perimenarcheal females. Forty-five sixth grade females, who were 11 and 12 years old, participated in a seven-month resistance training program as part of their regular physical education classes, held two or three times each week. Every few weeks, the exercise difficulty was increased. The researchers noted that the intervention required a minimal amount of equipment and was easily taught to the new instructors. Meanwhile, the researchers had 23 controls from students in a matched neighboring school. Scans analyzed levels of bone density. The researchers learned that the resistance intervention produced bone gains in the girls. The less mature girls benefited most at the hip, and the more mature girls benefited most at the spine. The researchers concluded that “this program provides an attractive, easily-generalized, public health intervention to minimize the significant morbidity associated with osteoporosis.” ²

In an article published in 2013 in BMC Musculoskeletal Disorders, researchers based in Brazil reviewed 19 studies on the association between physical activity and bone mineral density in young adults. Fourteen of these studies were performed in Europe. Only six studies had more than 200 subjects. Fifteen of the studies focused on the lumbar spine. The researchers found that younger people who participated in “high peak strain” sports, such as team sports, experienced improvements in bone density. That is why, according to the researchers, the promotion of sports in schools is so crucial. The researchers commented that “physical activity may play an important role on reducing the risk of osteoporosis in women.” ³

In a 12-month study published in 2014 in the British Journal of Nutrition, researchers from China wanted to learn more about the association between calcium supplementation and bone density in teens. The researchers recruited 220 teens between the ages of 12 and 14 years. There were almost equal numbers of males and females. The subjects were randomly placed in one of three groups—low calcium, middle calcium, and high calcium. The total supplemental calcium levels were 300, 600, and 900 mg/day for the three different groups, respectively. One hundred and ninety-eight subjects completed the study. The calcium supplementation appeared to have “moderate” effects on the bones of the teens. The researchers commented that their findings “revealed that Ca [calcium] supplementation caused a clinically important decrease in the risk of osteoporosis and fractures.” ⁵

In an article published in 2014 in the journal HORMONES, researchers from Greece discussed some of the bone problems associated with the psychiatric eating disorder known as anorexia nervosa. The researchers noted that people with anorexia have extremely low levels of body fat, and females tend to experience the loss of menstruation. Bone problems in teens and young adults with anorexia are not uncommon. These include impaired linear growth, reductions in bone mineral density, changes in bone turnover, and microarchitectural alterations, and they may lead to an increased risk for bone fractures. In addition, the researchers added that it is difficult to treat bones in patients with anorexia. While there is a need to return to a normal weight, most often that is an exceedingly difficult undertaking, “due to a high propensity for relapse into disordered eating behavior.” The researchers concluded that anorexia clearly has detrimental effects on bones, especially during the teen years when bones should be building strength. “Complete recovery from bone disease is not universal and the increase of fracture risk is prevalent even years after treatment of the disease.” ⁶

In a study published in 2015 in BMC Endocrine Disorders, researchers from Brazil wanted to learn more about the association between intake of low-dose combined oral contraceptives and bone mass density and bone mass content. The cohort consisted of 67 female teens, between the ages of 12 and 19 years, and the study took place over a one-year period of time. Forty-one of the teens used oral contraceptives; 26 did not. Bone density evaluations were conducted at baseline and after one year. Thirty-five users of oral contraceptives completed the study; all of the nonusers finished the study. The researchers determined that the females who used oral contraceptives had lower levels of bone mass acquisition than the nonusers. Since many teens take oral contraceptives to prevent unplanned pregnancies, “new studies are required to establish which estrogenic and progestagenic components and their ideal doses would be safe and adequate for appropriate bone mass acquisition in this age group to favor complete development of the bone mineral capital, a protective factor against osteopenia and/or osteoporosis in later life.” ⁷

In a cross-sectional study published in 2012 in the online journal PLoS ONE, researchers from Helsinki, Finland, noted that vitamin D insufficiency in children may effect calcium absorption, bone mineralization, and bone mass attainment, which may have long-term skeletal consequences. Did Finnish children have adequate amounts of serum vitamin D? To learn more, the researchers established a cohort of 195 Finnish children and teens between the ages of 7 and 19 years. Sixty-two percent were females and 38 percent were males. The vast majority of the teens were physically active. A variety of tests were administered, including measurements of serum vitamin D and evaluations of bone mineral density. The researchers determined that 71 percent of the subjects had insufficient levels of vitamin D. That means that only 29 percent of the children and teens had sufficient vitamin D status. According to the researchers, “vitamin D insufficiency is alarmingly prevalent.” The researchers commented that their findings indicated an “urgent need to increase vitamin D intake to optimize bone health in children.” ⁸

1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, www.niams.nih.gov.

2. Brittney Bernardoni, Jill Thein-Nissenbaum, Joshua Fast et al., “A School-Based Resistance Intervention Improves Skeletal Growth in Adolescent Females,” Osteoporosis International 25, no. 3 (2014): 1025-32.

3. Renata M. Bielemann, Jeovany Martinez-Mesa, and Denise Petrucci Gigante, “Physical Activity During Life Course and Bone Mass: A Systematic Review of Methods and Findings from Cohort Studies with Young Adults,” BMC Musculoskeletal Disorders 14 (2013): 77+.

4. Eszter Völgyi, Arja Lyytikäinen, Frances A. Tylavsky et al., “Long-Term Leisure-Time Physical Activity Has a Positive Effect on Bone Mass Gain in Girls,” Journal of Bone and Mineral Research 25, no. 5 (2010): 1034-41.

5. Xiao-ming Ma, Zhen-wu Huang, Xiao-guang Yang, and Yi-xiang Su, “Calcium Supplementation and Bone Mineral Accretion in Chinese Adolescents Aged 12-14 Years: A 12-Month, Dose-Response, Randomised Intervention Trial,” British Journal of Nutrition 112 (2014): 1510-20.

6. Anastasia D. Dede, George P. Lyritis, and Symeon Tournis, “Bone Disease in Anorexia Nervosa,” HORMONES 13, no. 1 (2014): 38-56.

7. Talita Poi Biason, Tamara Beres Lederer Goldberg, Cilmery Suemi Kurokawa et al., “Low-Dose Combined Oral Contraceptive Use Is Associated with Lower Bone Mineral Content Variation in Adolescents Over a One-Year Period,” BMC Endocrine Disorders 15 (2015): 15+.

8. M. Pekkinen, H. Viljakainen, E. Saarnio et al., “Vitamin D Is a Major Determinant of Bone Mineral Density at School Age,” PLoS ONE 7, no. 7 (2012): e40090.

9. Peng Zhang, Mark Peterson, Grace L. Su, and Stewart C. Wang, “Visceral Adiposity Is Negatively Associated with Bone Density and Muscle Attenuation,” American Journal of Clinical Nutrition 101 (2015): 337-43.