Dietary and lifestyle choices—especially in childhood—play a huge role in whether someone reaches their full skeletal potential.
In the first installment of our special series "Stronger Bones at Every Age," we explore how the choices we make in childhood can set the stage for lifelong bone health. We’ll look at the critical roles of calcium, protein, and physical activity—and share practical tips for helping kids build strong, resilient bones from the very start.
"Stronger Bones at Every Age" is a special limited series made possible in part by the National Cattlemen's Beef Association, a contractor to the Beef Checkoff. This series is dedicated to providing the same evidence-based, unbiased information you've come to expect from the Nutrition Diva, reflecting the editorial integrity and professional expertise of our host.
For more information on the topics discussed in this episode, visit https://www.quickanddirtytips.com/bones.
You can also find citations for the entire series at https://www.quickanddirtytips.com/bones#citations.
Hello I’m Monica Reinagel, host of the Nutrition Diva podcast and I want to welcome you to the first in a special series of bonus episodes on bone health that we will be releasing throughout the month of May, which is Osteoporosis Awareness month. These episodes, which will publish each Monday in May, will be in addition to our usual Nutrition Diva episodes that publish each Wednesday. And the entire series, once complete, will also be available on our website at https://quickanddirtytips.com/bones.
We are grateful to the National Cattlemen’s Beef Association for helping to make this special series possible. The NCBA is a contractor to the beef checkoff program. For those of you who may not be familiar with this USDA-authorized program, the Beef Checkoff collects revenue from all U.S. beef producers and with those dollars they fund research into human nutrition, food safety, environmental impacts, and other topics, and they also support efforts (such as this one) to make that information more available to the scientific community, consumers, healthcare professionals, food service industry, and so on.
Sponsored episodes are not something that we do very often on this show and so I want to take a moment to clarify that the information I’m sharing in this series reflects my own independent assessment of the evidence, professional experience and judgment. Just like every other episode, my goal here is to provide you with balanced, accurate, and useful information.
For any of you who may be registered dietitians, this special podcast series has been approved by the Commission on Dietetic Registration for 1.5 hours of continuing education credits. At the end of the series, you will be able to access those credits (as well as the episodes themselves) by going to the Beef Nutrition Education Hub at https://beefnutritioneducation.org.
If you are not a dietitian, however, this series is still very much meant for you as well! Over the course of the month, we are going to be looking at bone health as it unfolds through the lifespan. Each episode will focus on a specific phase of life, exploring both the opportunities that each life stage offers in terms of building or preserving strong bones, as well as some of the common challenges that may undermine bone health.
We’ll be looking at diet and nutrition, obviously, but also other aspects of lifestyle that impact bone health. And we’ll end each episode with some key takeaways for how to optimize bone health at every stage of life. In this first episode we’ll be focusing on children.
We don’t usually think of childhood as having much connection to osteoporosis. But the foundations for a strong, resilient skeleton are largely laid during these early years. In fact, by the end of adolescence, most of us will have acquired up to 90% of our peak bone mass.
Genetics certainly influence how much bone mass a person is capable of achieving, but dietary and lifestyle choices—especially in childhood—play a huge role in whether someone reaches their full skeletal potential.
Throughout life, our bones are constantly being remodeled—old or damaged bone tissue is broken down and replaced with new tissue. But in children, whose bones are growing rapidly, both in length and in density, the rate of bone formation dramatically outpaces the rate of bone breakdown (or, resorption), resulting in net bone gain. This remodeling also helps bones adapt to mechanical stress, improving their structure and strength, and ensures that the skeleton keeps up with the body's rapid growth.
What all of this means is that bone tissue is much more metabolically active during childhood than it is later in life–which means that nutrition and movement during this phase have an outsized impact on lifelong bone health. In other words, this is a once-in-a-lifetime window of opportunity that we don’t want to miss.
Just as in adults, weight-bearing exercise (walking, running, jumping, skipping, etc.) is one of the things that helps build strong bones in kids. So, encouraging kids to be active in their play and other routines, getting them off the couch and away from their screens, is absolutely a priority. But let’s turn our attention to the nutrition part of this story.
When we think about building strong bones, calcium usually gets top billing—and for good reason. Calcium is the most abundant mineral in the body, and nearly all of it is stored in our bones and teeth. During childhood, when bones are growing in size and density, the demand for calcium is at its highest.
The recommended dietary allowance—or RDA—for calcium changes throughout childhood, ranging from about 700 milligrams per day for toddlers to 1300 milligrams for tweens, which is the equivalent of two to four servings of calcium-rich foods each day. These might include milk or fortified plant milks, yogurt, cheese, tofu, or leafy greens like collards and bok choy.
But calcium doesn’t work alone. To be absorbed and used effectively by the body, calcium depends on vitamin D—which is primarily produced in the skin with sunlight exposure, but also found in fatty fish, eggs, and fortified foods (including most dairy products).
Another critical nutrient that you may not associate with bone health is protein. About half the volume of bone is actually made up of protein, which provides the scaffolding onto which calcium and other minerals are deposited.
The RDA for protein is based on body weight and ranges between 15 grams/day (for a 30-pound toddler) to 47 grams/day for a 120 pound pre-teen. However, the RDA is based on the minimum required to prevent deficiency. Newer research suggests that higher protein intakes—above the RDA—may support better bone development, especially when combined with adequate calcium intake.
Here with some additional insight is Dr. Taylor Wallace, a professor of nutrition at both Tufts and George Washington Universities. He previously served as a senior staff member at the National Osteoporosis Foundation, where he spearheaded a number of research initiatives. Here’s what he had to say about this important phase of bone development.
Dr. Wallace: As a father of an 8-year-old little boy myself, his bone health is always at the top of my mind. About one third of kids will experience a bone fracture by the time they reach their teenage years, especially if they're engaged in sports activity. During childhood bones are constantly remodeling to expand and lengthen, which makes them increasingly vulnerable to fractures. A diet rich in nutrients like calcium and protein work together best when combined with exercise and under conditions of vitamin D adequacy. This can help ensure your child's bones are strong and flexible enough to withstand all those playground and soccer "accidents" without breaking.
For most children, aiming for 30 to 70 grams of protein per day—depending on age, size, and activity level—is a good ballpark
So what does that look like?
Of course, protein-rich foods provide other nutrients that contribute to bone health, as well. Dairy products and fortified plant milks provide calcium. The peanut butter sandwich provides magnesium and phosphorus. Lean beef is a particularly good source of iron and zinc—two minerals that are essential for healthy growth and development, including the formation and maintenance of bone.
But we also need to take protein quality into account. Animal-based protein sources like meat, dairy, eggs, and fish are high-quality, complete proteins, providing all the essential amino acids in ratios that allow them to be used efficiently in the body. Those who are relying exclusively or primarily on plant-based proteins like beans, nuts, and seeds may need to take in more total protein to get the same benefits. Ironically, plant-based diets tend to be lower in protein than those that include animal products. And because the RDA for protein is, arguably, on the low end of what’s needed for optimal growth and nutrition, protein quality will be even more important for those who are consuming something closer to that minimum recommended amount.
The bottom line here, is that a lot goes into strong bones beyond just calcium. And building our kids’ diets from nutrient-dense foods is the ideal way to provide a broad range of nutritional support.
Of course, laying out what kids should be eating in order to build strong bones is one thing. But here in the real world–where we are dealing with things like picky eaters, busy schedules, food insecurity, or dietary restrictions–reality doesn’t always match the ideal.
Let’s start with younger children—those in the 2 to 8-year-old range. Roughly 30–40% of children in this age group are not meeting the recommended intake for calcium, according to national dietary surveys. For many families, juice is a factor in this equation. While it is marketed to parents as a healthy beverage choice, it can displace more nutrient-rich options like milk or fortified plant-based milk, which are a key source of calcium for this age group.
And then, as kids move into the tween years, things get a bit worse. National data show that more than 50% of adolescents—and nearly 70% of teen girls—fail to meet the minimum recommended intake for calcium.
Meanwhile, most young children are consuming enough protein to meet the RDA—but remember, the RDA is meant to prevent deficiency and not necessarily to optimize bone growth. When we look at the higher end of the recommended range for protein, some children may not be getting quite enough, particularly those who are picky eaters or following strictly plant-based diets.
On a more positive note, certain foods and dietary patterns are linked with better overall nutrient adequacy–and bone health—in this population. For example:
I think what these statistics show is the importance of a balanced diet in providing all the necessary nutrients needed for growth. For example, studies have found that protein-rich diets are associated with higher bone mineral density in kids—but only when calcium intake is also sufficient (at least 1000 mg/per day). Similarly, greater intake of fruits and vegetables has been associated with higher bone mineral density in preteens–especially when combined with adequate calcium.
So, obviously, nutrients work in concert and not in isolation. And similarly, good nutrition works in concert with other lifestyle factors like physical activity and adequate sleep to lay the foundation for strong bones.
WIth that in mind, let me offer a few takeaways from this exploration of how we can help our kids lay the foundation for a lifetime of bone health.
Thanks again to NCBA for their help in making this special series possible. I hope you’ll tune in next week for the next installment of our special series, where we will be focusing on the bone-building opportunities and challenges that we face during the teen and young adult years.
If you’re interested in exploring some of the research that I cited today, there is a complete list of scientific references for this series. You can find that at https://quickanddirtytips.com/bones
If you’re a new listener who has joined us for this special series, I hope you’ll also subscribe to our regular weekly podcast, where we take a closer look at the latest nutrition news, research, and trends, sort fact from fiction, and answer your food and nutrition questions!
Nutrition Diva is a Quick and Dirty Tips podcast. Steve Riekeberg is our audio engineer, Brannan Goetschius provides script editing. Holly Hutchings is the Digital Operations Specialist and Morgan Christianson heads up Podcast Operations & Advertising. We also get indispensable support from Nat Hoopes. Thanks to all of them and thanks to you for listening!