I know this is not a sexy subject. Regarding our bodies, we are generally more concerned with issues of the flesh. Moreover, opinions on how to treat osteoporosis or osteopenia are, dare I say it, fractured.  

I'm going to focus in this article on bone health for midlife women - a time when we become more vulnerable due to hormonal shifts. (I've created a comprehensive programme for women (nutrition, movement and mindset) that does all this for you - The Midlife Reset; check it out). 

However, the truth is the density of our bones goes back to childhood. So, as many of you are likely to be parenting growing children, let's review that first.

The growth years 

Our maximum bone size and strength is called peak bone mass. Genes play a significant role in how much peak bone we have. For example, the actual size and structure of a person's skeleton are determined, for the most part, by genetic factors. However, although our genes largely determine peak bone mass, lifestyle factors — such as diet and exercise — can influence whether we reach our full bone mass potential. 

The critical point here is that there's a limited window of time in which we can influence peak bone mass. As a parent, you can focus on ensuring bone-supporting nutrition during years of rapid growth - childhood, adolescence, and early adulthood. 

Naturally, parental nutrition advice will always say that you must ensure your child gets an excellent overall diet (good luck with that). You can indeed get calcium from green vegetables, plant-based milk and a wide range of healthy foods, and this can be sufficient under the right conditions. Unfortunately, however, during adolescence and early adulthood, we often reject healthy eating and make choices that decrease peak bone mass, such as smoking, poor nutrition, inactivity, excessive dieting, and excessive alcohol intake!

I chose a more pragmatic approach. As the parent of a teenage girl (sorry, young woman) who inherited my aforementioned grandmother's build of tiny (but fierce), I've always driven home the need for her smaller bones to get adequate calcium. So, despite not tolerating cow's milk, she managed goat's milk until her little brother came along and told her it was icky (it's not), and then we switched to lactose-free. I was leaning into dairy just as everyone was all over plant milk. I was also concerned about over-training when she was a young gymnast, so I was relieved when she opted to give up that highly demanding sport. 

So, when it comes to your children, please do your best on their overall diet but add the safety net of calcium-rich dairy products where possible during growth years. 

Bone health in midlife, menopause and beyond 

Your turn. You will reach your peak - bone mass terms - between 25 and 30. By the time we reach age 40, we slowly begin to lose bone mass. If you got a higher peak bone mass when you were young, you would be better protected against osteoporosis and related fractures later in life. 

Bones keep you mobile and upright, but they are also your body's main reservoirs of calcium. Your body maintains vital blood levels of calcium within a narrow range. If you're not getting calcium from the diet, your body pulls it from your bones to sustain other survival functions, such as maintaining a regular heart rhythm. So the calcium problem is really about how to get enough, but not too much, and how to ensure you don't lose it. 

The hormonal changes of peri-menopause and menopause are when oestrogen and other sex hormone levels fall, triggering a loss of minerals in bone tissue. On average, we also live longer and tend to have smaller bones than men, so the impact is more marked. 

Bone formation and bone resorption are influenced by physical activity and diet. However, in midlife, we can become more sedentary, and an inactive lifestyle leads to bone wastage.

Exercise strategies that protect bone health in midlife 

It is no secret that regular exercise is necessary to remain healthy and keep your bones strong, and one of the most effective forms of training for this is weight training or resistance training. Weight training stimulates osteoblasts, the bone cells that encourage bone growth. High-intensity exercise has a similar effect, so plyometric-style HIIT moves are also great to incorporate into your workout regime. As a Pilates teacher, I support my bone health - and fitness - with a series of Pilates exercises coupled with a short dose of HIIT two or three times a week. For HIIT, I use an approach known as 'Tabata - 8 x 20-second blasts of HIIT (such as running on the spot or burpees) with 10 seconds rest between each burst.

What to eat to support bone health

Although milk and cheese are high in calcium, they often accompany excess stimulants such as coffee, alcohol or tea and a lack of bone-building minerals such as magnesium, boron, zinc and silica.   

Increasing calcium intake through calcium-rich dairy foods is not wrong in itself, but you need to focus on a broader spectrum of factors concerning bone health. These include reducing sodium (salt) and getting adequate sun exposure to boost vitamin D levels or supplement vitamin D. 

I am a fan of using fermented milk products like yogurt or kefir instead of drinking milk itself. There are many reasons for this that I'll outline shortly, but let me first highlight some research from Sweden (published in the BMJ) that showed that a high level of drinking milk (three glasses or so each day) seemed to correlate with an increased incidence of fractures, not less. As ever, a moderate path is needed. Also worth mentioning that high fat dairy products like some cheeses and ice cream and fortified soy products have a vastly different nutrient composition than milk and low fat or skim dairy products lack most or all of milk’s healthy fats. 

So, let's focus instead on natural, plain yoghurt and kefir. These provide calcium, phosphorus, and protein, all nutrients influencing bone growth and bone loss. The probiotics can modulate intestinal calcium absorption and bone metabolism.

Moderating animal protein intake is another area that needs attention. A study published in the American Journal of Clinical Nutrition found that women who ate most of their protein from animal sources had three times the rate of bone loss and 3.7 times the rate of hip fractures as women who ate most of their protein from vegetable sources. The study concluded that an increase in vegetable protein intake and a decrease in animal protein intake might decrease bone loss and the risk of hip fracture. Excessive animal protein would mean more than two servings a day, a typical serving being the size of the palm of your hand.

Another study published in the American Journal of Clinical Nutrition (2000) looked at all aspects of diet and bone health and found that high consumption of fruits and vegetables positively affected bone health and that dairy consumption did not. 

Again, I've done all this hard work for you in the The Midlife Reset menus. 

How to asses your bone health 

You can't see your bones, and bone density checks usually don't happen until some damage is already there. So basically, the only real clue is unexpectedly getting a broken bone without significant trauma. Prevention is the best bet. Suppose you have risk factors such as a history of anorexia, over-exercising, or a medical condition such as coeliac disease (which reduces the body's ability to absorb calcium). In that case, it might be beneficial to go for a bone check involving bone density scanning.