Bone health

Debbie Hawkins, Registered Nurse at AXA Health

Understanding bone health

15 March 2024

Bones play a number of essential roles within the body. They provide structure, protect vital organs, store calcium, anchor our muscles and allow both good blood flow and nerve health.

And while some may think bones are hard, lifeless and purely structural, they’re actually living tissue. They need the same kind of attention, nourishment and ongoing care that we give to our muscles and joints.

Bones are constantly changing and developing as we get older. Bone tissue is broken down and rebuilt, so to ensure good bone health, it’s important to know how best to look after them throughout our lives.

Bone changes over time

As with many body parts and bodily processes, the bones change over time. This means the way we look after them also changes as we get older.

Childhood and teenage years

As we grow, the process of bone renewal – which is called bone remodelling or bone turnover – is faster than at other stage in our lives. This allows for rapid bone growth as the skeleton needs to increase in size, density and strength as we grow up.

Young adulthood

Our bones tend to stop growing in length when we’re between the ages of 16 and 18. But our bone density – which is the total amount of bone tissue there is – continues to slowly increase into our late 20s.

Early to mid-30s

Until around the age of 35, the total amount of bone tissue we have tends to stay the same. During this time, bone turnover becomes steadier and we’ll usually have a fairly even balance between the amount of bone that’s broken down and the amount that’s generated.

Late 30s and onward

As we move from mid to late-30s, bone turnover slows and the amount of tissue that’s removed and the amount that is rebuilt becomes less and less balanced. That means more of our bone tissue is removed, so the overall bone density starts to diminish.

From the outside, your bones won't look any different, but inside, the structure of the bones becomes gradually thinner and weaker.

Older age

As we continue to get older, the more bone tissue we lose. From the age of around 50 to 60, the rate of bone breakdown significantly exceeds bone formation, which means they become weaker.

This is why we’re more likely to develop osteoporosis – a condition where your bones lose strength – and suffer with broken bones after the age of 50.

While ageing is inevitable, there are measures you can take to build bone density or slow down their deterioration, no matter what stage of life you’re at.

>Our article on keeping active over 60 highlights how to help keep you active, safely.

What factors can affect bone health?

Bones are living tissue. They naturally break down and are then rebuilt by cells called osteoblasts, so we need to look after our bones in a similar way as we do with our muscles. Diet, exercise and lifestyle factors all play a part in keeping them healthy.

Here are just a few things that can affect the health of our bones.

Calcium – a diet that’s low in calcium can contribute to low bone density and early bone loss. Adults need 700mg of calcium a day1 and it’s possible to get it all from dairy products, leafy greens, soya beans and nuts.

Vitamin D – helps the body absorb calcium. Adults need 10 micrograms of vitamin D per day.1 While in the summer we can get vitamin D from the sun, it’s difficult to get enough of it from diet alone, so some experts recommend taking supplements, particularly during the winter months. 

>Read more about Vitamin D deficiency

Exercise – just as we need to exercise to strengthen our muscles, your bones need regular exercise to help them stay strong and healthy. Weight-bearing and muscle-strengthening exercises are particularly important as they can stimulate bone production by getting our osteoblasts firing. As we get older, it’s also a good idea to focus on balance and stability to help avoid falls.

Body weight – both obesity and being extremely underweight can have a negative impact on bone health. If you have a smaller body frame, your bones will have less mass to draw upon as you get older. While obesity can alter hormones, affect how our bodies absorb calcium and make it more difficult to perform the kinds of exercises our bones need.

Tobacco and alcohol consumption – smoking has been found to directly impact bone density by affecting how bone-building cells operate.2 Alcohol meanwhile can prevent the body from absorbing calcium and, over time, can weaken the bones.

Hormones – hormones and hormonal changes can impact bone health. Too much of the thyroid hormone, for example, can cause bone loss. And, in men, low testosterone levels can have the same effect.

Women are particularly susceptible to losing bone mass when they reach menopause due to decreasing levels of oestrogen. This hormonal change actually means that osteoporosis is more common in women. In 2021, around 21.9% of women over the age of 50 were estimated to have osteoporosis, compared to only 6.7% of men.3

Medications – certain medications and steroids can also impact our bone health. Some affect how the body absorbs calcium while others can cause hormonal imbalances, such as breast cancer medications that inhibit oestrogen production in women.

Eating disorders or diseases – any disorder or disease that restricts food intake can affect our bone health if they mean the bones don’t get enough of the right nutrients. For example, coeliac disease can affect calcium absorption, which can lead to weakening of the bones.

One of the main risks of poor bone health is osteoporosis. This is a common health condition, which involves the bones weakening so much that they’re more fragile and likely to break.

For more information on osteoporosis, as well as helpful tips on how to maintain bone health, check out our guide to Osteoporosis and bone health.

Bones of contention

There are a number of myths surrounding the bones, osteoporosis and general bone health. We’ve put together a list of the most common, along with the truth behind the misconception.

MYTH 1: You NEED dairy in your diet

It’s true that you need calcium in your diet. And it’s true that dairy products are a great source of calcium. But there are plenty of other places you can get calcium from, such as broccoli, cabbage, soya beans, tofu, nuts or anything made with fortified flour.

There are also a number of plant-based drinks with added calcium, so dairy products aren’t the only place to get your calcium from.

MYTH 2: A bone fracture is less serious than a broken bone

There are many different degrees of bone damage, but both fractures and breaks involve a bone being broken apart. They may be treated differently and have different recovery times, but both are ultimately caused by the same weakening of the bones. Breaks and fractures both need immediate medical attention and should therefore be treated as equally serious issues.

MYTH 3: Bones don’t change once they’re fully developed

As mentioned, bones are constantly being regenerated and they continue to change throughout our lives. And we can stimulate these changes ourselves, particularly through exercise.

Weight-bearing exercise can put the bones under a moderate amount of stress, which causes the cells responsible for generating bone mass – osteoblasts – to react and boost bone strength in the areas where it might be needed.

MYTH 4: Osteoporosis is a painful condition

Osteoporosis causes loss of bone mass, which means the bones can be significantly weakened. But the condition itself isn’t painful. Osteoporosis can go unnoticed for years, eating away at the bones with no noticeable symptoms.

It’s usually only when a bone breaks or becomes fractured that people suffer pain as a result of osteoporosis. So, if you’re over the age of 50 or think you may be at risk, it’s worth speaking to a GP about getting a bone density test. This can help detect or prevent osteoporosis early, instead of finding out the hard way.

MYTH 5: Only older people need to worry about osteoporosis or weakened bones

It’s true that our bone density and strength steadily decline after the age of around 50. But osteoporosis can affect younger people. People with a family history of the disease are particularly at risk, as well as people who smoke, drink heavily, don’t exercise, have a vitamin D deficiency or are underweight. Early menopause (before the age of 45) is also a common cause for developing osteoporosis.

And, of course, bone strength, length and density are built during childhood and into our 20s. So, while those under the age of 30 may not be worried about osteoporosis, bone health should be a priority for all age groups.

MYTH 6: For strong bones, I just need calcium

Calcium is vital, but it’s not the only thing your bones need to stay strong. First of all, you need vitamin D to help absorb the calcium. And you also need a range of other nutrients, including potassium, magnesium, vitamin K and various B vitamins. And, of course, exercise also plays a big part. So while you do need calcium, it’s not the only ingredient for strong and healthy bones.

The bottom line

While it’s easy to associate weakened bones and osteoporosis with ageing, bone health is something we need to think about throughout our lives – from promoting and building bone mass in our early years to slowing down their deterioration as we get older.

Diet, exercise and lifestyle choices all play a vital role at every stage of our development.


Food for healthy bones - NHS

Bone health and falls - NHS Inform

Epidemiology, Burden, and Treatment of Osteoporosis in the United Kingdom - International Osteoporosis Foundation