Set your daughter up for life! Healthy habits and strong bones

Over the next few weeks I’m doing 3 blogs on bone health, covering all age groups. This first blog outlines how bones strengthen in the growing years.

13 going on 30? Getting ready for the years ahead

Bone strength and breaks not something we usually think of until something goes wrong, and the first sign that something is amiss is usually a break from a relatively minor impact or recurrent pain from overload causing a bony stress reaction or fracture.

Do you have daughters, low back or shin pain that won’t go away, or a family history of osteoporosis? If so, read on…

Why is childhood and adolescence critical for bone health?

Bone is living tissue, constantly remodelled or ‘turned over’. Bone mineral density – the amount of bone mineral in bone tissue, and peak bone mass are markers of bone health. Diet, exercise and hormones play a huge part in gaining and maintaining bone strength and how it responds to pressure. Girls gain 80-90% of their peak bone mass by the age of 16, and peak bone mass is achieved by the age of 18.

How can I keep my children’s bones healthy?

Remember skipping, hopscotch, netball and sprinting in a game of chase? These develop your bone strength. Recent research shows that exposure to these higher forces and greater vertical impact forces (e.g. from jumping or hopping) or running faster builds stronger, more resilient bones. Fortunately most kids love challenging themselves to jump higher and further and run faster. As mothers of daughters, teachers and coaches we should be encouraging high impact, weight bearing exercises for the upper and lower body e.g. dance, skipping, football and running. Games such as hockey, netball, basketball, cricket, squash and tennis have the added advantage of building strength in the arms too.

Which food helps bones?

Calcium is an essential component of strong teeth and bones, so dietary intake through dairy foods such as yoghurt, milk and cheese, and green leafy veg such as lettuce, broccoli and spinach, alongside a healthy diet, helps ensure bone strength. Sometimes, kids just don’t want to eat what we would like them to eat, but putting a small amount of a particular veg on their plate or ‘hiding’ dairy food in a dessert means they are a little more likely to comply!

Vitamin D helps regulate calcium and phosphate in the body and therefore key for bone health. Our body creates Vitamin D from direct sunlight on our skin, so short bursts of playing outside without sunscreen help kids get what they need naturally. Of course, this has to be balanced with ‘sun safety’ and avoiding sunburn. As the sun fades in winter, Public Health England have advised parents to consider supplements to top up Vitamin D levels. For official recommendations on Vitamin D intake for children and dietary Vitamin D, see here.

Jumping for joy! Building bones with high impact exercise

When things go amiss in the teenage years

Some girls will have changes in normal hormone levels and regulation, later onset of periods, have lighter, fewer or even no periods as a result of doing a lot of sport, over-exercising, having low body fat or suffering stress. This has a negative impact on the ability to build bone mass, achieve and maintain normal bone mineral density and overcome injury. It’s common amongst female endurance athletes, dancers and in ‘leanness sports’ where low body weight may be considered important, even advantageous. Benefits of weightbearing exercise during adolescence and young adulthood are lost on those with scant or absent periods. They generally have lower bone density and fracture risk increases. Because of the lifelong importance of accruing bone in adolescence and young adulthood, not to mention the impact on general and mental wellbeing, restoring menstrual cycles is essential (Ackerman et al, 2019).

I've seen many girls in their teens and early twenties who had stress fractures and “shin splints” (Medial Tibial Stress Syndrome) which could at least, in part, be attributed to these issues. They healed more slowly and struggled physically and emotionally to overcome the pain, problems and time away from sport or dance.This can affect their bone health both and confidence, both at the time and for the future.

Girls with these changes in normal periods and/or injuries need careful medical, physio, nutritional and psychological management, often in conjunction with empathetic coaches. Prevention with healthy diet and regulating activity is essential but if you suspect this issue affects you or your daughter, see a GP or Sports Physician to help you get correct diagnosis and positive support.

Today is World Osteoporosis Day! Click here to learn more and do a questionnaire to check what your own bone health is like.

References:

Ackerman, K.E. et Al. Oestrogen replacement improves bone mineral density in oligo-amenorrhoeic athletes: a randomised clinical trial Br J Sports Med 2019: 53:4 https://bjsm.bmj.com/content/53/4/229