Bone development with age

As we age, our focus on bone health grows.The link between ageing and an increased risk of developing bone conditions, such as osteoporosis, highlights the importance of learning about bone health and how we can maintain healthy bones.
 
But from what we know about human bones and how they develop throughout a lifetime, it pays to be aware of them and what keeps them healthy at other life stages too. It’s crucial to recognise that bone health isn’t just relevant in older ages - how well we look after our bones in the earlier part of our lives     makes a significant difference to how healthy they stay during our later years.
 
Once we stop growing, it’s easy to think of our bones as a part of our body that will simply stay the same forever. But the fact is that our bones stay active throughout our life with old bone dissolving and new bone forming constantly (a process called remodelling).      
 

How many bones are in the human body?

The adult human body is made up of around 206 bones.
 

• Bones are made of two types of bone tissue: cortical bone, a strong, dense type of bone found on the outer surface of bones (cortical bone makes up about 80 per cent of your skeleton); and trabecular bone, the interior part of most bones that has a spongy, honeycomb-like structure (not all bones have trabecular tissue, some are made up entirely of cortical bone such as the small bones of the wrists, hands and feet)

• Bone minerals – including calcium and phosphorus – make up 65 per cent of bone tissue, providing it with strength and hardness (i)

• Most of the rest of your bone tissue is made up of collagen

• Peak bone mass is your maximum bone size and strength. This is largely determined by your genes, though other factors including diet, exercise and other lifestyle factors can play a key role in bone development 

• People who achieve a high peak bone mass in the early part of their life are better protected against bone conditions such as osteoporosis as they age      

• Men naturally have a higher peak bone mass than women, who also have smaller bones than men

• After you reach your peak bone mass you gradually start to lose bone density – this is because you start to make less new bone tissue than you lose

• While some bone loss is inevitable, two of the things you can do to avoid severe bone loss as you get older is to make sure you get the right nutrition for your bones and to exercise regularly (other things include giving up smoking, maintaining a healthy weight and drinking alcohol in moderation)

 

Building bone density: children and teenagers

This stage is often called the bone-building years, when bones are developing towards their peak mass. It’s the most important time for bone health, as this is when the foundation for healthy bones can be set.
 
During childhood and adolescence, bones undergo a continuous process of growth and strengthening as new bone formation outpaces old bone removal.  The adolescent years are a particularly important period for bone health. That’s because the amount of bone mineral gained during adolescence can often equal the amount lost throughout the rest of your life (ii). According to the International Osteoporosis Foundation, the bone tissue accumulated when girls are aged 11 - 13 approximately equals the amount of bone they lose during the 30 years following menopause (iii).
 
Babies’ bones grow rapidly then slow down a little at around two years of age, with another big growth spurt starting again during puberty. The speed of bone build-up in the spine and hip increases by approximately five times in girls aged 11 - 14 years and boys aged 13 - 17 years. Bone mass is the same in both girls and boys from birth to puberty, but during puberty it increases more in boys than in girls, mostly because boys have a longer period of rapid bone growth than girls (iii).
 

How much calcium per day? 

To keep bones growing, children and teenagers need a good supply of bone-health nutrients in their diet, including calcium, vitamin D and protein. The American Academy of Orthopaedic Surgeons, for instance, claims half of total body calcium stores in adult women and up to two thirds of calcium stores in adult men are made during puberty (iv). The need for calcium also increases as a child gets older. British Dietetic Association guidelines state children and teenagers need the following amounts daily (v):

 

Age Group	Recommended Calcium Intake (mg)
Babies aged one year or younger	525mg
Children aged one to three years	350mg
Children aged four to six years	450mg
Children aged seven to 10 years	550mg
Adolescent girls (11 - 18 years)	800mg
Adolescent boys (11 - 18 years)	1000mg

 

What food contains calcium?

Calcium-rich foods include milk, natural yoghurt, hard cheese, fish, kale, sesame seeds, dried figs, tofu and calcium-fortified foods such as breakfast cereals. Calcium supplements designed for children are also available for those who don’t get enough through diet alone.
 

Young bones and vitamin D

Even if a child gets plenty of calcium, not getting enough vitamin D can interfere with their bone development, since vitamin D helps the human body absorb calcium. Children, like adults, get most of their vitamin D when their skin is exposed to sunshine as there are relatively few foods that contain good amounts of it (examples include oily fish, fortified foods, egg yolks, meat and offal). However, according to the International Osteoporosis Association, low levels of vitamin D in children have been reported in studies worldwide, partly because children and young people are increasingly leading indoor lifestyles and partly because of the widespread use of sunscreen (iii).
 

How much vitamin D per day?

Here in the UK, the Department of Health and Social Care recommends that (vi):
 

• All babies from birth to one year of age should take a daily supplement all year round containing 8.5 - 10 micrograms of vitamin D if they’re breastfed or having less than 500ml of vitamin D-enriched infant formula

• Children aged one to four years old should have a daily supplement containing 10 micrograms of vitamin throughout the year too

 
Meanwhile, older children, teenagers and adults are advised to take a 10 microgram supplement of vitamin D during the autumn and winter months. Those who don’t spend much time outdoors,  wear clothes or use sunscreen that covers most of their skin when they’re out, as well as those with dark skin, are advised to take vitamin D supplements throughout the year.
 

Osteoporosis

Most people reach peak bone mass during late adolescence or in their early to mid 20s (one study suggests 90 per cent of bone mass is achieved by the age of 20 (vii)). During your later 20s and your 30s you may no longer be forming new bone as rapidly as you did before, but your bones will usually remain at their maximum strength and bone density. As we approach our late 30s (if you’re a woman) and  early 40s (if you’re a man), bone density will usually start to decline – and it keeps declining until the end of your life.
 
However, just because your bones are at their peak mass during your 20s you can still develop a bone condition such as osteoporosis at this age if your particular peak mass is still too low. This highlights how important it is to be aware of bone health at any age, and to make healthy choices such as eating a nutritious, balanced diet with plenty of bone-health nutrients and staying physically active.
 

Osteoporosis in pregnancy 

Bone density can suffer during pregnancy, as a woman’s body transfers bone minerals including calcium to her developing baby and stores them for breastfeeding. One review of studies indicates that (viii):
 

• An estimated bone density loss of between one and nine per cent happens between before conception to immediately after the birth

• Up to eight per cent of bone mass can be lost during breastfeeding because calcium is transferred through breast milk

 
Some women also develop pregnancy-associated osteoporosis, which means their bones can break easily around the time they give birth or during the following eight to 12 weeks. While this condition is rare, we still don’t know what causes it. According to the Royal Osteoporosis Society, one of the reasons experts think this might happen is that pregnancy may trigger a sudden and unusual reaction in previously healthy bones (ix). It’s also thought that normal levels of bone loss during pregnancy might lead to further bone loss in some women who already have quite weak bones.
 
The good news, however, is that bone density usually returns to normal in the months after childbirth and after weaning. Experts also believe breastfeeding doesn’t seem to increase the risk of osteoporosis in the long term (x).
 

Vitamin D and Osteoporosis 

Eating a healthy and varied diet during pregnancy is important, as it helps make sure you’re getting all the nutrients your body needs – including bone health nutrients such as calcium. The NHS also says pregnant women should take a daily vitamin D supplement to help keep their bones healthy.
 
Vitamin D supplements are widely available, including vitamin D3 (the recommended form) in tablet and veggie-friendly drops. Vegan vitamin D3 supplements sourced from lichen rather than the fat of lamb’s wool are also available these days. On the other hand you may want to consider taking a specially formulated pregnancy multi-vitamin and mineral supplement that contains safe levels of a range of nutrients – including vitamin D – to make doubly sure you’re getting the nutrients your body needs, every day during your pregnancy.
 

Bone health in menopause 

Once you reach your 40s, your bones are still constantly being remodelled. But before this age all the old bone was replaced with new bone, when you’re in your 40s and beyond less of the old removed bone is replaced. This makes it even more important that you get plenty of bone health nutrients in your diet and stay active, since exercise is crucial for minimising bone loss – plus it helps prevent mid-life weight gain (the ideal weight for your bones is a normal weight, since being underweight or obese has been linked with bone problems – read our article Bone health: why weight matters to find out more).
 
Bone health, however, becomes a more pressing concern for women in their 40s and 50s, since this is when most women experience menopause. According to the NHS, perimenopause (which marks the start of menopausal symptoms) and menopause usually happen between the ages of 45 and 55 years – the average age for a woman to reach menopause in the UK is 51 (xi).
 
At this time, women’s bodies start producing smaller amounts of oestrogen and other hormones that control their menstrual cycles. This drop in oestrogen – a hormone that’s essential for protecting bones – is often accompanied by rapid bone loss. Indeed, experts reckon in the 10 years after menopause women can lose 40 per cent of their trabecular bone tissue and 10 percent of their cortical bone tissue, the result of which is weaker bones and an increased risk of fractures (iv). 

How to improve bone density during menopause

There’s nothing you can do to prevent the natural loss of oestrogen if you’re a woman in your 40s or 50s, but you can do other things to keep bone loss to a minimum, such as:
 

• Increasing your intake of foods that contain bone health nutrients 

• Managing your weight

• Staying active (see Natural support for your bones, below).

 
Men, on the other hand, can experience low testosterone levels during middle adulthood, which increases their risk of losing bone mass. But this is usually far less severe than the hormone changes women experience during menopause, which probably explains why osteoporosis tends to be more common in women at this age than men.
 
Nevertheless, according to the National Osteoporosis Foundation up to one in four men over the age of 50 will break a bone because they have osteoporosis. Men of this age are also more likely to break a bone due to osteoporosis than they are to develop prostate cancer (xii). Other risk factors that affect osteoporosis risk in men – and women – of all ages include taking steroid medicines for a long period of time, being inactive, smoking and drinking too much alcohol.
 

Bone health: later life

People aged 60 and older continue to lose bone mass, but taking preventative measures such as eating a healthy and nutritious diet, taking bone health supplements and having an active life may help slow the rate of bone thinning as well as reduce the risk of osteoporosis-related fractures (fragility fractures). This is important for women, but particularly important for men since bone loss in men usually speeds up when men reach their 70s (xiii).
 

Vitamin D for the elderly

Older adults may also become deficient in vitamin D if they are housebound or don’t get outdoors very often, which suggests taking a vitamin D supplement all year round is particularly important at this stage.
 
It may also be a good idea for people in this age group to make sure they get plenty of protein – since protein is important for maintaining bone mass – either in their diet or by taking supplements (read on to find out more about protein and how it may help improve bone health in older people).
 

Elderly fall prevention

Fall prevention is also crucial at this age, since falling can result in a debilitating fracture and potentially the loss of independence or worse – according to the National Institute for Health and Care Excellence (NICE), about 10 percent of people with a hip fracture die within a month, and about a third within 12 months (the average age of a person in the UK with hip fracture is 77) (xiv). Regular physical activity can keep older people fitter, and their muscles stronger and more flexible, all of which may help prevent the likelihood of them having a fall.
 

Exercise for bone density

Experts often encourage regular activity as a way of preventing or reducing bone density decline, but why? One reason is it can help you manage your weight and keep it in a normal range, which is ideal for your bones. But another reason is that a certain type of activity, called weight-bearing activity, has a direct effect on bone density.
 

Weight-bearing exercises

Weight-bearing activity is any kind of exercise where your feet and legs support your whole body weight (cycling and swimming, for instance, are not examples of weight-bearing activity). According to the organisation American Bone Health, weight slightly compresses the bone matrix and triggers the cells to take in more calcium and other minerals, which increases bone density (xv).
 
Here in the UK, the Royal Osteoporosis Society says the most effective way to keep your bones strong through exercise is to combine weight-bearing exercise with impact (exercise that involves being on your feet and adding an additional force or jolt through your skeleton through jumping or skipping, for instance) as well as muscle strengthening exercise (xvi):
 

• Low-impact activities include walking, marching and stair climbing.

• Moderate-impact activities include skipping, hopping, jogging, running, team and racket sports and Highland dancing.

• High-impact activities – the most effective for improving bone density – include star jumps, tuck jumps, track events, volleyball and basketball.

 
Muscle strengthening exercise, on the other hand includes moves such as squats, lunges, leg presses, chest presses, dead lifts and bicep curls.
Exercise is also important for bone growth in children. According to the International Osteoporosis Foundation, young bones respond even more to exercise than adult bones, with children and adolescents who exercise regularly showing significant increases in bone mass (iii).
If you’re new to exercise or you haven’t been very active lately, start slowly and build up your fitness levels gradually. Always speak to your GP before starting any new exercise regime if you have a medical condition.
 

Food to strengthen bones 

Having a diet rich in foods containing certain nutrients is essential for good bone health. Getting enough calcium is essential, as it’s largely the calcium stored in your bones that gives them their strength. Try eating plenty of foods such as milk and other dairy foods, foods fortified with calcium, fish that includes edible bones and green leafy vegetables such as kale for a calcium boost.
 
Calcium supplements are also widely available, including single supplements, multivitamin and mineral formulas and multi-nutrient products designed specifically for bone health.
 
Make sure you’re also getting plenty of vitamin D to allow your body to absorb more calcium from your food or supplements. And don’t skimp on the protein when it comes to meal times either. This is important at any age but particularly for older people, since studies suggest bone mineral density may be positively linked with protein intake and eating less protein may increase your risk of having a fall (xvii).
 
Foods high in protein include animal foods such as meat, dairy foods, eggs and fish. Meanwhile vegetable sources include soya products, nuts, seeds, grains, beans and lentils. You can also boost your protein intake by drinking protein shakes or adding protein powders to your meals – these can be convenient for those who struggle to get enough protein through food alone.
 
There are, however, several other nutrients you need if you want to get serious about improving or maintaining your bone health and minimising the natural decline in density that happens as we age:
 

Vitamin K

Probably best known for its role in blood clotting, vitamin K is fast becoming a bone health must-have as we now know it’s needed for making important bone proteins. Vitamin K also works alongside calcium and vitamin D to keep your bones strong: while vitamin D helps your body absorb calcium, vitamin K helps calcium to get where it’s needed (that is, into your bones and teeth instead of your soft tissues where it can cause problems). Clinical evidence for the role of vitamin K in human (rather than animal) bone health is still at a relatively early stage, but some studies have linked poor bone health with low vitamin K levels (xviii), with others have found the amount of vitamin K in people’s diet and their bone mineral density are related (xix).
 
Researchers who have analysed some of the data from the large-scale Nurses Health Study also claim women who consume at least 110 micrograms of vitamin K each day are 30 per cent less likely to break their hip than those who eat less (xx). The researchers claim low intakes of vitamin K may increase the risk of hip fracture in women. And scientists analysing information from another large-scale study – the Framingham Heart Study – have found a link between vitamin K intake and the risk of hip fracture, not just in women but in men too (xxi).
 
Vitamin K is found in plant foods such as leafy greens as well as in animal-sourced foods and fermented foods. Find out more about vitamin K and the foods that contain it in Bone health: the importance of vitamin K. [ADD LINK WHEN PUBLISHED] You can also get vitamin K in supplement form singly or as part of a good multivitamin and mineral supplement or a multi-nutrient bone health supplement.
 

Magnesium

This is important for bone health because – like calcium – it helps keep bones hard and rigid. Indeed, 70 per cent of the magnesium in your body is stored in your bones and teeth. Magnesium also helps convert vitamin D into the form that boosts calcium absorption in the body. Many people, however, may not be getting enough magnesium in their diet (sources include nuts, seeds, green leafy veg, whole grains, beans and lentils).
 
If you’re looking for a magnesium supplement, choose a form of magnesium that’s absorbed more readily than others, such as magnesium citrate.
 

Zinc  

Researchers have shown zinc is another mineral that plays an essential role in bone metabolism and mineralisation (xxii). Other scientists claim zinc is an essential mineral required for normal skeletal growth, and that it may also be involved in promoting bone remodelling (xxiii). Like magnesium, the citrate form of zinc in supplements is thought to be better absorbed by the body than other forms. You can also try getting more zinc-rich foods in your diet such as dairy foods, shellfish, meat, bread and wheatgerm.
 

Vitamin C  

Healthy bones need collagen, which means they need vitamin C as it contributes to normal collagen formation. More recently, however, researchers have discovered vitamin C has other functions that may help keep bones strong too. Some have claimed the ways in which vitamin C affect how our genes work are central to bone formation, and that it may help prevent common bone-degenerating conditions (xxiv). Vitamin C is found in a wide variety of fruit and vegetables, but a good-quality supplement can help make sure you’re getting the amount you need every day.
 

Soya isoflavones

Also called phytoestrogens, soya isoflavones are plant chemicals that may help with menopause symptoms because of the way they bind to the same receptors as oestrogen made by the body, thereby mimicking the effects of oestrogen. This explains why many women take soya isoflavone supplements to help relieve menopause symptoms. Some studies, however, suggest soya isoflavones may have bone benefits too, with one review and meta-analysis of randomised controlled trials concluding they are effective in slowing down bone loss after menopause (xxv). To choose a good-quality soya isoflavone supplement, look for one that provides a tried and tested dose – 50mg is often the dose used in clinical trials. Also choose one that has 50mg of isoflavones, rather than 50mg of soya extract (isoflavones are only part of the extract).
 

Want to find out more?

To find out lots more information about maintaining good bone health at any age, visit the bone health section of our pharmacy health library. If you’re affected by osteoporosis, find out more about your condition by reading Osteoporosis Symptoms. There’s further help and support available from the Royal Osteoporosis Society, including a list of local support groups located around the UK.
 

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