Building resilient bones requires far more than taking daily calcium pills. From pairing local small fish with leafy greens to incorporating simple weight-bearing exercises, here is how to craft an actionable, everyday lifestyle plan for lifelong strength.

When we hear the words “strong bones”, most of us immediately think of calcium. There is a problem with this line of thinking. Bone health is much more than calcium. It is a living tissue. Throughout our lives, old bone is continuously broken down, and new tissue is formed. This complex process depends not only on calcium, but also on vitamin D, protein, other micronutrients, physical activity, hormones, body weight and overall nutritional status.

Bangladesh receives abundant sunlight throughout much of the year. Yet, vitamin D deficiency and insufficiency remain surprisingly common. A recent laboratory-based study of adults in Bangladesh found that only 12.2 per cent of participants had sufficient vitamin D; 49.3 per cent were deficient, and another 38.5 per cent were insufficient. Women had a higher prevalence of deficiency than men.

Photo: Collected / rohit choudhari / Unsplash

 

Calcium remains a fundamental nutrient for bone health. However, the question should not simply be, “How much calcium am I taking?” The better question is, “Am I getting enough calcium from an overall balanced diet?”

Milk and yoghurt are familiar calcium sources. But Bangladesh has many other possibilities, such as small fish eaten with their edible bones, appropriate leafy vegetables, and calcium-fortified foods where available, and calcium-containing soy products.

The problem is that dietary calcium intake can be inadequate in some Bangladeshi populations. Research among premenopausal Bangladeshi women has demonstrated low calcium intake and suggested that inadequate intake may compromise bone accretion and increase future osteoporosis risk. This is why calcium supplements should not become a substitute for a nutritious diet.

Photo: Collected / Mathew Schwartz / Unsplash

 

Bone contains an organic matrix in which collagen and other proteins provide an important structural framework. Adequate protein is particularly important during childhood and adolescence, when peak bone mass is being developed, and later in life when muscle and bone loss become increasingly important.

Along with a nutritious diet. bones need mechanical stimulation. Weight-bearing and resistance exercises stimulate bone and muscle. Regular physical activity also improves strength and balance, which can help reduce the risk of falls.

For a healthy adult, brisk walking, stair climbing, resistance exercises, and appropriate sports can all contribute to a bone-friendly lifestyle.

For older adults, balance and strength exercises become particularly important. However, exercise should be individualised. Someone with osteoporosis, a previous fracture or significant musculoskeletal disease may need professional guidance before starting high-impact activity.

Photo: Collected / Ekaterina Kuznetsova / Unsplash

 

Osteoporosis is often regarded as an “old person’s disease.” This is misleading. Bone health is built across the life course. Childhood and adolescence are crucial periods for accumulating bone mass. Research among Bangladeshi women has shown that bone mineral density begins declining relatively early in adulthood and declines more rapidly with advancing age. This means that waiting until the age of 50 or 60 to think about bone health is too late. Healthy eating, adequate protein and calcium, appropriate vitamin D status, physical activity and maintaining a healthy body weight should begin much earlier. This is particularly important for girls and young women because inadequate nutrition during the years when peak bone mass is being established can have consequences decades later.

Women experience accelerated bone loss around menopause because the protective effect of estrogen decreases. Bangladesh-specific research highlights the concern. Women with low body weight, poor nutritional intake, limited physical activity, vitamin D deficiency, early menopause or other clinical risk factors may require additional assessment. And osteoporosis is not exclusively a women’s disease. Men can also develop osteoporosis, particularly with ageing, chronic illness, nutritional deficiencies and certain medications.

So, what does a bone-friendly Bangladeshi diet look like? It does not have to be complicated or expensive.

Include a calcium source regularly: Milk, yoghurt, small fish with edible bones, suitable leafy vegetables and fortified foods can contribute calcium.

Eat adequate protein every day: Include fish, eggs, dairy, poultry, lean meat, dal, beans, soy, nuts and seeds according to individual needs.

Pay attention to vitamin D: Safe, appropriate sunlight exposure and vitamin-D-containing foods can contribute to maintaining vitamin D status. Individuals with deficiency may require supplementation under medical supervision.

Eat plenty of vegetables and fruits: A varied diet supplies magnesium, vitamin K, potassium and other micronutrients and bioactive compounds involved in overall musculoskeletal health.

Stay physically active: Combine weight-bearing activity with muscle-strengthening and balance exercises where appropriate.

Maintain a healthy body weight: Being underweight is associated with poorer bone health, while obesity can also create musculoskeletal and mobility problems.

 

​The author is the Chief Clinical Dietitian and Head of the Department, Dietetics and Nutrition Department, Continental Hospital PLC