Bone and Joint Health
The following information is from British Nutrition Foundation
British Nutrition Foundation
- Bone and Joint Health

Key points

• Bone is a living tissue and plays a structural role in the body.

• Bone is made up of protein, calcium, phosphorus and a number of other minerals. Calcium is the most abundant mineral in bone.

• It is important to maximise bone mass in order to reduce the risk of osteoporosis in later life. Bone mass is accrued up until the age of 30-35, when peak bone mass is achieved. From the age of about 35 years bone mineral loss exceeds bone mineral formation.

• Excessive loss of bone mineral leads to osteoporosis, a condition that is characterised by increased risk of bone fracture. Osteoporosis may lead to mobility problems and even death.

Bone is living tissue from which substances are constantly being removed and replaced. Bone is made up of a protein matrix, on which hydroxyapatite (a crystalline structure made up of calcium and phosphorus) is deposited. Magnesium, zinc and fluoride are also deposited in the protein matrix, although calcium is the most abundant mineral in bone; and it has been estimated that the average adult skeleton contains 1kg of calcium.  Bone plays a structural role in the body and also serves as a reserve of calcium. Healthy bone is strong and does not break easily. During childhood, adolescence and early adulthood, large amounts of calcium and other substances are added to the bone, strengthening the skeleton as it develops.

Bone is continuously being remodelled, that is old bone tissue is replaced by new. Bone formation and bone resorption (replacement of old bone tissue) take place throughout life, although at different rates at different times. In childhood the process enables the bone to grow; in adulthood the purpose is maintenance. Bone formation and bone resorption are influenced by a variety of factors including diet and physical activity. Bone formation is greater than bone resorption up until the age of 30-35 years, when peak bone mass is reached, the net effect being an increase in bone mass. After this bone resorption occurs at a faster rate than bone formation. The consequence of this is a gradual fall in bone mass as we age; bone mineral and protein are lost slightly more quickly from the age of about 35 years than they are replaced. The amount of calcium in bone gradually decreases. In women, bone loss is accelerated following the menopause, particularly during the first 5 years. This is because the hormone oestrogen (production of which ceases after the menopause) protects bone, and bone formation and loss is influenced by such hormones.

Strong bones that contain plenty of calcium are less likely to become weak and break in old age.

Bone strength is affected by:

    • Genetic factors - some ethnic groups may have stronger bones in general than others
    • Gender - men tend to have a greater bone mass than women
    • Diet - calcium and vitamin D, in particular, are important for strong bones
    • Physical activity - regular exercise (especially weight bearing exercise) is important for strong bones
    • Body weight - heavier people have stronger bones (the bones respond to the weight that they have to carry)
    • Hormones - irregular or loss of menstrual periods can cause bone loss.


Diet is an important factor in forming healthy bones. The mineral calcium is obtained from the diet and deposited in bones and teeth.  99% of calcium present in the body is in bone. An adequate calcium intake at all stages of life (coupled with an active lifestyle) will help ensure that bones are as strong as possible. It is particularly important during childhood, adolescence and early adulthood when bones are developing. The most important sources of calcium in the UK diet are milk and dairy products, with milk and cheese providing 48% of the calcium in the average UK household diet (not including foods consumed outside of the home).

Vitamin D is also important for healthy bones because it is needed for the absorption of calcium from food. Vitamin D is made in skin that is exposed to sunlight. Most people obtain sufficient vitamin D in this way but some groups, such as the housebound or people who wear clothes that cover most of their body, need to be sure that their diets contain enough vitamin D. Few foods contain large quantities of vitamin D. Fish liver oils have very high levels and oily fish, e.g. sardines, mackerel and fresh tuna, are also rich sources. Egg yolk, liver and butter contain smaller amounts of vitamin D. Margarine is fortified by law with vitamin D, and many low fat spreads and some breakfast cereals are also fortified voluntarily, as is skimmed-milk powder.

In May 2003, the FSA’s Expert Group on Vitamins and Minerals (EVM) set a guidance level for vitamin A of 1500µgRE/day for adults, based on evidence that intakes above this level may increase the risk of bone fracture. In 2005, SACN was asked by the Food Standards Agency (FSA) to review the dietary advice on vitamin A in light of findings from the National Diet and Nutrition Survey (NDNS) that 9% of men and 4% of women aged 19-64 years have vitamin A (retinol) intakes above the guidance level of 1500µg/day of retinol equivalents (RE) (Henderson et al., 2003). SACN reported that the findings on vitamin A and bone health published since the EVM report have been inconsistent. The majority of data on the relationship between retinol intake and bone health is derived from epidemiological evidence and suffers from a lack of large-scale observational studies of sufficient duration to observe long-term risk. In addition, many studies reviewed by SACN also include other factors that may affect bone health, such as vitamin D, making drawing conclusions about the association between bone health and retinol more problematic.

The link between bone health and retinol intake originally came to light through publication of US and Swedish data. SACN found that vitamin A intakes in these two countries (derived from national dietary surveys) were different. For example, Sweden had a much higher retinol intake (from food sources) than in the UK or USA; however, different methodologies were used and so the relevance of these differences between countries is difficult to establish. The UK’s latest National Diet and Nutrition Survey (NDNS) indicates that the main sources of retinol are liver, liver products e.g. paté, and supplements containing retinol. Liver consumption has declined since the previous dietary survey in 1986/7, whereas use of supplements containing retinol consumption has increased. Despite this, overall retinol intake is still lower in comparison with the 1986/7 survey.

In light of these findings SACN concluded that the current evidence concerning retinol intake and bone health is insufficient to justify a change in dietary advice to all consumers (i.e. to the general population) regarding consumption of food and supplements containing vitamin A. But as a precaution, SACN advises that regular consumers of liver (once a week or more) do not increase their intakes or take supplements containing retinol. Population subgroups at risk of osteoporosis e.g. post-menopausal women and older people should not consume more than 1500µgRE/day, although intakes should not fall below the RNI.


A deficiency of vitamin D over a long period of time causes rickets in children and osteomalacia in adults. Rickets affects the structure of the growing bone. The bones lack calcium and are weak. The weight of the body causes the bones of the legs to become bent. Osteomalacia causes pain and muscle weakness.


Peak bone mass is reached at the age of about 30-35 years. It is the stage at which the bone is strongest. After this age, bone mass decreases as we get older. Achieving a good peak bone mass is important in reducing the risk of osteoporosis in later life because it means that bones are strong before loss begins.

Peak bone mass is influenced by genetic factors such as build and ethnic group. It can be increased by ensuring that the diet contains adequate amounts of calcium and vitamin D during childhood, adolescence and early adulthood, and by regular activity especially weight-bearing exercise such as brisk walking, running, dancing and climbing stairs.


As a person gets older, some loss of bone mass is normal, but severe loss results in gaps in the structure of bone. The structure of bone is a bit like a solid sponge, with filaments of bone surrounding small holes. As bone tissue is lost, these filaments become thinner and thinner and can eventually disappear, leaving large spaces. This causes the bones to become weak, brittle and to break easily. This condition is known as osteoporosis. Osteoporosis occurs if large amounts of bone are lost, or if the bones are not strong before bone loss begins.

All bones can be affected by osteoporosis but fractures are most common in the wrist, spine and hip. Fractures to the spine lead to the characteristic hunched appearance of some older people. Osteoporosis most frequently affects older women who have gone through the menopause but it can affect men and younger women who have, for example, suffered an eating disorder. It is also occasionally associated with pregnancy. Currently in Britain, 1 in 3 women and 1 in 12 men suffer from osteoporosis. Providing the hormones that the body lacks, as a result of the menopause, can help prevent bone loss in women (known as hormone replacement therapy or HRT).


Regular exercise in which the bones bear some weight, such as jogging, brisk walking or dancing, reduces the risk of osteoporosis. Exercise during childhood and adolescence helps to strengthen developing bones. Being physically active throughout life is also important to keep bones strong.


There are a number of other factors that increase the risk of developing osteoporosis:

    • Smoking and high alcohol intake increase the rate of bone loss and so increase the risk of osteoporosis
    • Osteoporosis is more common in people who are underweight
    • Early menopause increases the risk of osteoporosis.


An adequate intake of calcium is important throughout life. Dairy products such as milk, yogurt and cheese are all good sources of calcium. Together, milk and cheese provide about 48% of calcium in the typical British household diet (not including foods consumed outside of the home). In the UK, white and brown flour (but not wholemeal which already has an adequate amount) must be fortified with calcium, so bread made from these flours is a significant source for many people. Pulses, nuts, dried fruit and green vegetables, such as spring greens, contain calcium. Fish that is eaten with the bones, such as whitebait or canned sardines, are also a good source. In some areas of the country, hard water provides a significant amount of calcium. An additional source of calcium is calcium-rich mineral water.

Some foods may contain significant amounts of calcium but also contain substances that bind to the calcium and reduce the amount that is absorbed by the body. Examples of these substances include phytates in wholegrain cereals and pulses, and oxalate in spinach and rhubarb.

As vegans do not eat dairy products they should take particular care that their diet contains sufficient calcium. In the UK, many soya products, such as tofu and soya drinks, are fortified with calcium and so can be a useful source for vegans.


Diet may also play a role in joint health. N-3 (or omega-3) fatty acid supplements have become popular for the treatment of rheumatoid arthritis. Their proven clinical benefit is modest and the long-term benefits and disadvantages need further evaluation. Fish oils have been shown to alleviate some of the symptoms of rheumatoid arthritis, having beneficial effects on swollen and tender joints, grip strength and motility.

The Food Standards Agency’s current advice on fish consumption is as follows:

    • Girls and women of reproductive age, including pregnant and breastfeeding women should aim to eat between 1 and 2 portions of oily fish per week
    • Women past reproductive age, boys and men should aim to eat between 1 and 4 portions of oily fish per week
    • Exceeding the recommended levels of consumption in the short term would not have deleterious effects on health.

© British Nutrition Foundation, 2004



About Us

NatureStar®-makers of "science based and natural condition specific formulas"
Manufactured in GMP, pharmaceutical FDA registered facility.

Formulas provide at least one month supply of product!
Formulas that address the most pressing health issues!
Value Priced formulas for the discriminating consumer!