Osteoporosis, Bone Health And Eating Disorders
- Talia Cecchele
- 19 minutes ago
- 6 min read
Written by Talia Cecchele, Highly Specialist Dietitian and TCN Founder
Before we get into the link between nutritional science and bone health, it is important to understand what osteoporosis is and the risk factors for development.
What Is Osteoporosis?
Osteoporosis is a condition that affects bone strength, making bones more fragile and increasing the risk of fractures. It is characterised by reduced bone mineral density and changes in the internal structure of bone.
The bones most commonly affected include the spine, hips and wrists.
While osteoporosis is often associated with aging, particularly after menopause, it can develop at any age, especially when the body is not receiving enough energy or essential nutrients like calcium to support bone health.
Risk Factors for Osteoporosis
There are several factors that can increase the risk of developing osteoporosis (1):
Hormonal changes
Estrogen is one of the most important hormones for bone health. When estrogen levels are low, such as during menopause or when menstrual cycles stop (amenorrhoea), bone loss can occur more rapidly.
Low energy availability (under-eating)
When the body is not receiving enough energy, it adapts by conserving resources and slowing down metabolic processes. One way it does this is by reducing hormone production, including estrogen. Over time, this can negatively impact bone health. Low energy availability is an important factor in RED-S (Relative Energy Deficiency in Sport)
Amenorrhoea (loss of menstrual cycle)
Missing periods is a key warning sign that the body is under stress. It often reflects low estrogen levels, which are essential for maintaining bone density.
Therefore missing your period has a significant impact on bone health. Missing periods should be taken seriously because it is not normal for them to be irregular or absent.
Excessive exercise without adequate fuelling
Exercise is beneficial for bone health but when it is not supported by enough nutrition and recovery, it can place stress on the body and contribute to hormonal disruption and bone loss. See our blog on Unhealthy Exercise in Eating Disorders.
Genetics
Bone density is influenced by genetics, meaning some individuals may naturally have a lower baseline. However, lifestyle and behaviours still play a significant role in bone health.
Nutrition
Restrictive eating can impact bone health, both through a reduction in energy intake (which can lead to a reduction in bone formation as the body conserves energy) and also inadequate intake of essential nutrients including calcium, vitamin D and phosphate.
Is Osteoporosis Different To Osteopenia?
People often get confused between osteoporosis and osteopenia. Osteopenia is the stage before osteoporosis which is characterised by a lower than average bone density for your age, yet not low enough to be classified as osteoporosis.
The main difference between the two is the severity of bone loss. Although osteopenia is characterised by bone loss that is less severe than that of osteoporosis, the risk of fractures is still elevated compared to normal bone.
Bone loss is measured through a DEXA (dual-energy X-ray absorptiometry) scan, which measures bone mineral density. However, it’s important to note that a DEXA scan does not show the full picture of bone health, it measures density, but not bone structure (microarchitecture), which also influences bone strength.
Is Osteoporosis Reversible?
The short answer is yes, the long answer is it depends on many factors and the changes a person is able to make.
Bone is constantly being broken down and replaced. If bone health is linked to modifiable factors such as nutrition, exercise and hormone disruption, with the right lifestyle changes, bone health can improve. This may or may not “reverse” the t-scores and z-scores which categorise osteoporosis, osteopenia and normal bone health, but any improvement is going to be beneficial.
You can listen to Talia and Dr Nicky Keay on the Food Is Food podcast where they discuss bone health and hormones in the context of disordered eating and eating disorders.
The Effects Of Nutrition On Bone Health And Hormones
Calcium
Calcium is the most abundant mineral that makes up our bones, followed by magnesium. With 99% of calcium in our body being used by our bones and teeth, this mineral is essential (2) for bone and teeth health.
Calcium is found in higher amounts in dairy products (cheese, yoghurt and milk), small fish (due to eating the bones) and in smaller amounts in some plant foods such as spinach, kale, broccoli and legumes. Calcium is readily added to foods such as plant based alternative milks (soya, oat etc) and cereals, making it an achievable mineral to consume even when following a dairy-free or vegan diet.
We always encourage a food first approach with calcium, however if you are struggling to eat enough, we encourage you to see a registered dietitian or your GP to talk about supplementation options.
Our bodies use calcium continuously, so we must consume calcium regularly in our diet. The recommended daily allowance (RDA) for calcium is dependent on age and sex (3):
1000mg per day for adults, aged 19 to 50 years of age
1200mg per day for women aged over 50 years of age (due to the menopause)
1200mg per day for men once over 70 years of age
It is important to note that for individuals with an eating disorder and/or osteoporosis, recommended calcium intake is higher than the RDA. Individuals should aim to consume 4 serves of dairy foods (or equivalent) a day.
Vitamin D
Vitamin D works alongside calcium to promote good bone health. They work as a team, because vitamin D increases our absorption of calcium, which we know is integral for strong, healthy bones.
Vitamin D also improves the function of muscles, which can help your balance and decrease the likelihood of falling and suffering a bone fracture. It is advised that for those living in colder, less sunny climates supplement vitamin D with 10ug (micrograms) daily between the months of October and April (4).
You can read our blog on vitamin D for more information about sources of vitamin D and supplementation.
If your Vitamin D levels are low and you are under a healthy weight, in recovery from an eating disorder or have osteoporosis, you might be recommended to take a higher Vitamin D dose (20ug-25ug).
Phosphorous & Vitamin K
Phosphorus works with calcium and vitamin D in your body to keep your bones healthy and strong. Phosphorus is found in protein rich foods like dairy, meat, fish, eggs, legumes/pulses, wholegrains and seeds.
Vitamin K is another important nutrient, which helps activate proteins like Osteocalcin to improve bone mineralisation (the process of minerals being deposited to strengthen bones). Vitamin K is found in green leafy vegetables, vegetable oils (it is a fat soluble vitamin), soy, egg yolk and some meats. We need approximately 60-90ug of Vitamin K per day.
Energy & Protein
Adequate energy and protein intake are important for bone health. Without enough fuel, the body reduces hormone production, which directly impacts bones. Aiming for approximately 1.2g/kg/d - 1.6g/kg/d of protein is recommended.
What Is The Role of Exercise In Bone Health?
Exercise can support bone health, but it matters how it is being approached. Bones respond positively to mechanical loading (such as strength training and weight-bearing exercise). However, if exercise is not being fuelled appropriately, this can have a negative impact on bone health.
It is important to consider:
Exercise in the context of adequate fuel
Intensity of exercise and whether this needs to be reduced to support recovery
An individual approach and working with an exercise physiologist, physiotherapist, dietitian and/or a medical professional such as an endocrinologist is important.
What about HRT (Hormone Replacement Therapy)?
Hormone Replacement Therapy (HRT) may be recommended in certain situations, particularly when:
Periods have stopped due to low energy availability
Bone health is compromised
There is a delay in restoring natural hormone function
HRT works by providing estrogen (alongside progesterone), which can help protect bone health while recovery is ongoing.
It’s important to note that the combined oral contraceptive pill is not the same as HRT and is not recommended for improving bone health in this context.
Please speak to your GP and/or endocrinologist to find out if HRT is appropriate for you.
Eating Disorder Recovery, Bone Health And Osteoporosis
It is so important that you know that you have not “ruined” your bones. There is always hope that you can improve your bone health.
Restoring energy balance (eating enough, especially to support activity levels)
Supporting hormone health and getting your period back
Adjusting exercise so that it is appropriate for you
Returning to a healthy weight
Need Dietetic Support?
If you need support in your recovery, we offer 1:1 nutrition counselling at the TCN Clinic to help you overcome food rules and build a more positive relationship with food. You can find out more about how we can support you here
Talia Cecchele
TCN Director and Lead Specialist Dietitian
References:
(1) MedicineNet. Osteoporosis Risk Factors. Available at https://www.medicinenet.com/script/main/art.asp?articlekey=20363
(2) Calcium, I., Ross, A., Taylor, C., Yaktine, A. and Valle, H., 2021. Overview of Calcium. Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK56060
(3) Ods.od.nih.gov. Office of Dietary Supplements - Calcium. Available at: https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional
(4) nhs.uk. Vitamins and minerals - Vitamin D. Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d
Talia Cecchele Nutrition (TCN) is a virtual clinic with a team of registered dietitians specialising in eating disorders and disordered eating. Our services include 1:1 consultations, group meal support and group programs to support you to break free from food rules and chronic dieting and find food freedom. Talia and her team work by incorporating a compassion-led, non-diet and weight inclusive. To enquire about a private consultation please fill out a contact form.
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