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All About The Bones

Parents' Guide to Building Better Bones

Most parents recognize the need to encourage healthy eating habits in their children, and they have heard that calcium is important for building healthy bones. But did you know that keeping salt and animal protein intake low and fruit and vegetable intake high is every bit as important? Did you know that scientists are doubtful that drinking more milk has any significant benefit for growing bones?

In this fact sheet, nutritionists and doctors with the Physicians Committee for Responsible Medicine (PCRM) aim to set the record straight and help parents sort through the hype about calcium, milk, and bone health.For Starters

Most children have no problem developing normal healthy bones. In fact, children in Japan, China, and other countries consume much lower levels of calcium than their North American peers and still develop strong, healthy bones. That's because the human body is an efficient regulator of bone growth.

Just like our hair, skin, and lungs, bone is a living tissue that is constantly being built, broken down, and made anew. Throughout life, bones are taking up and releasing calcium and other minerals, a cycle that is influenced by a variety of factors, including diet, exercise habits, hormones, genetics, and certain diseases. According to two recent reviews of bone health in childhood, the largest influence on this cycle is genetics, accounting for 60 to 80 percent of the differences, with hormones related to growth and puberty second in importance.1,2

Children generally build bone at a slightly higher pace than they break it down. After adolescence, this cycle begins to shift a little so that bone building and breakdown generally keep pace with each other. Later in life, this bone-remodeling cycle tends to head in the reverse direction—with more bone being broken down than is rebuilt. Of course, the extent of this weakening can range from barely noticeable to a serious condition called osteoporosis, depending on many lifestyle and dietary habits.

The minerals in a child's skeleton are completely replaced (or recycled) about five times between childhood and her or his 55th birthday.3 Focusing on those actions that promote bone building and those that decrease bone breakdown will effectively improve bone health.Promoting Bone Building

Bones are a matrix of collagen (the same material used for building joints and other body tissues), water, calcium, phosphorus, magnesium, and other minerals. Special cells are responsible for making new bone. Here are the most important steps your child can take to help keep these bone-building cells busy:

  • Get moving! Play and exercise every day.

  • Eat a diet rich in fruits and vegetables.

  • Get vitamin D from the sun or from supplements.

  • Get calcium from plant foods and fortified products.

Exercise Exercise gives bones a reason to live. When bones are put to work, especially in weight-bearing activities such as running, soccer, basketball, and weightlifting, they respond by becoming stronger and denser. Engaging in physical activity may be the most influential thing your child can do to promote adolescent bone health. A recent study published in the medical journal Pediatrics found that sedentary teens had lower bone density by age 18 than those who engaged in regular physical activity.4

In a study of women 45 years and older, those who exercised four or more times per week as teenagers were only one-fourth as likely to fracture a hip as those who exercised once or not at all each week.5 Encouraging your children to get away from the computer or up off the couch to enjoy more active pursuits is great way to help them build healthy bones.

Fruits and Vegetables Will a glass of orange juice, a crunchy salad, or a bowl of vegetarian chili help grow strong bones? Absolutely. Increasingly, research is pointing to diets rich in fruits and vegetables for promoting bone health. A study published in the American Journal of Clinical Nutrition shows that higher intakes of fruits and vegetables throughout the teen years improve bone density in adulthood.6 An array of nutrients—vitamin C, vitamin K, potassium, and magnesium—found abundantly in fruits, vegetables, and other plant foods, have been shown to promote bone health.6-8

Vitamin C from citrus fruits, tomatoes, peppers, and other fruits and vegetables is essential for making collagen, the connective tissue that minerals cling to when bone is formed.

Vitamin K is thought to stimulate bone formation. It is found most abundantly in dark leafy greens like kale and spinach, but is also readily available in beans, soy products, and some fruits and vegetables.

Potassium decreases the loss of calcium from the body and increases the rate of bone building. Oranges, bananas, potatoes, and many other fruits, vegetables, and beans are all rich sources of potassium.

Magnesium, like calcium, is an important bone mineral. Studies have shown higher magnesium intakes to be associated with stronger bones. “Beans and greens”—legumes and green leafy vegetables—are excellent sources of magnesium.

Fruits and vegetables are also important for what they don't do. Some foods—especially cheeses, meats, fish, and some grains—make the blood more acidic when digested and metabolized.9 These foods add to the body's “acid load.” When this happens, bone minerals, especially calcium, are often pulled from the bones to neutralize these acids.10 Diets high in fruits and vegetables actually tip the acid-base scales in the opposite direction and make it easier for bones to hold onto their calcium.9

Vitamin D Vitamin D is a hormone produced by sunlight on the skin. It controls your body's use of calcium and is an important player in bone building.11 A lack of adequate vitamin D results in rickets, a serious childhood bone problem. Avoiding rickets is as easy as getting a short daylight walk on most days or having a bowl of cereal with fortified soy or rice milk for breakfast. About 15 minutes of sunlight each day normally produces all the vitamin D your child needs. If your family gets little or no sun exposure, you can include any common multivitamin or a serving of a vitamin D-fortified food in your daily routine. Consuming too much causes problems, so be sure not to overdo it.

Calcium from Plant Sources Children and adults lose calcium from the body every day, so we need to replenish it. Healthful calcium sources are “beans and greens.” Broccoli, Brussels sprouts, collards, kale, mustard greens, turnip greens, and others are loaded with highly absorbable calcium and a host of other important nutrients. While these foods have a smaller amount of calcium per serving compared to dairy products, they have more calcium per calorie, and the calcium they contain is absorbed nearly twice as well as the calcium in cow's milk.12

One cup of cooked kale, for example, has the same amount of absorbable calcium (100 milligrams) as one cup of cow's milk with less than half the calories. Beans are a good source of calcium, too. Choose from baked beans, chickpeas, tofu, or other bean products, and you will find a taste to please every palate. Just a few ounces of tofu, a bowl of vegetable chili or creamy Broccoli Potato Soup will provide your child with another healthful helping of absorbable calcium.

If you are looking for a concentrated calcium source, calcium-fortified orange and apple juices as well as enriched soy and rice milks contain 300 milligrams or more of calcium per cup in a hig