How does diet affect osteoporosis?

Is there more to bone health than drinking milk? The answer is a resounding yes. But what is the best diet and lifestyle for strong, healthy bones? And what steps can you take if you’ve been diagnosed with osteopenia or osteoporosis? This article gives simple, practical advice that will keep your bones healthy for life, as well as build stronger bones after an osteoporosis diagnosis.

Let’s take a quick look at your bones. Despite their solid nature, your bones are a dynamic part of your body, being constantly broken down and rebuilt. The entire skeleton is replaced every seven to 10 years in an average adult! 

The process of bone breakdown and renewal, known as bone remodelling, is an intricately balanced system, which, when working well, keeps us strong and robust

When the balance gets out of kilter, with more bone breakdown than renewal, bones become porous and more inclined to fracture following a fall or bump. With so many people in the UK with an osteoporosis diagnosis - over three million according to NHS England - something is upsetting the process of bone remodelling. The question is, what?

As with all chronic disease, there is no one answer. Instead, there are many factors that drive bone loss over the years. Your genetics play a role, as do nutrient deficiencies (calcium, vitamin D, magnesium, boron, other trace minerals) either now or in the past, diets high in fizzy drinks, caffeine, salt and alcohol, chronic low-grade inflammation, certain medications, a low BMI, smoking, a sedentary lifestyle, on-going digestive problems, menopause etc. The list goes on.

Whilst this might seem overwhelming, there is plenty that you can be doing to support your bone health. 

Food and nutrients for stronger bones

Some good general nutrition advice is appropriate as a basis from which to build.

Aim for variety

This includes plenty of vibrant colours from vegetables and fruit, good quality meat and fish, beans and pulses, nuts and seeds, quality olive and other cold pressed oils. Challenge yourself with this, selecting new vegetables during your weekly shop and adding additional ingredients to your favourite soups and casseroles. 

The more variety you can achieve across the day, week and month, the more abundant your nutrient intake will be and the closer you will get to providing your bones with what they need to be healthy and strong. 

If you find yourself restricting your food variety because of the way some foods make you feel, then speak to a nutritional therapist who may be able to help you work out what is causing your discomfort.

Start with veggies

Make vegetables the focus of your meal and start thinking of the meat, fish, eggs, starches etc as the side dishes. You should be aiming for half your plate to be formed of colourful vegetables. This doesn’t have to be fancy or time-consuming: roughly chop a selection of five different vegetables, sauté lightly (add a small amount of water to steam a little if necessary), add some garlic towards the end of cooking, and drizzle with lemon or lime juice, sea salt and a nice peppery olive oil. 

Simple, quick and delicious and paired with a piece of cooked meat or fish or a couple of poached eggs, a perfectly balanced meal.

Calcium and bone health

There is no doubt that calcium plays an important role in the health of our bones. The recommended intake for adult women over 50 years is 1,200mg calcium daily from both diet and supplements. 

If on an average day, you are consuming ½ cup of natural yoghurt (200mg), one milky coffee (300mg), ½ a tin of sardines (150mg) and a good serving of kale (200mg), you are already getting 850mg of calcium in your diet (amounts of calcium may vary from those shown).  

To top up, you may want to consider taking a supplement targeted at bone health and importantly, one that goes beyond the standard calcium/vitamin D that is routinely prescribed. Bone remodelling is complex and needs many more nutrients than calcium and vitamin D to work well.

The role of vitamin D

The primary function that vitamin D plays in bone health is assisting with the absorption of calcium from food. It also plays a direct role in the bone remodelling process and hence it is typically prescribed to people with an osteoporosis diagnosis in a complex with calcium.  

In a nutritional therapy practice, it is routine to test a patient’s vitamin D levels using a simple at-home finger prick test, which makes optimisation of this important vitamin straightforward. The fact that low levels of vitamin D are associated with many other conditions, including lowered immune function, and is easy and cheap to correct, makes this an easy and essential target.

Magnesium is important too

This mineral is important for many body processes, including bone density and the reality is that many of us do not get sufficient levels in our diets. The fact that it is depleted by stress, which is such a large part of modern-day society, makes a focus on intake even more important.

Best sources of magnesium include:

• leafy greens
• nuts and seeds
• beans and pulses
• avocado
• dark chocolate

Experts in the field of bone health suggest that we should be looking at a 2:1 ratio between calcium and magnesium, and it is routinely found in comprehensive bone formulas. 

Vitamin K, boron, manganese, selenium, zinc, copper, essential fatty acids and more have been shown in literature to play a role in bone health. This brings us back to aiming for as varied a diet as is possible and the use of a comprehensive bone formula, as opposed to focusing on the key players only. It is a good idea to seek help from a professional when choosing an appropriate bone formula due to potential interactions with certain medications.

Appropriate exercise

We all know that exercise is good for us. For your bone health, you need to focus on weight bearing exercise, as it is the gentle stress that exercise exerts on bone that maintains bone density. Be careful not to get too carried away however, particularly if you have a diagnosis of brittle bone, as sports that put too much pressure on fragile bone may lead to a fracture.  The best exercises for strong bones are:

• Walking. Look at getting a daily tally of 10,000 steps per day – a pedometer or digital device that counts your steps is useful.
• Weight lifting with slow repetitions.
• Yoga, tai chi and qi gong. All these exercises pull on the tendons attaching muscle to bone and stimulate bone growth.
• Pilates.

Speak to your GP before starting to exercise to seek their advice and think about working with a qualified personal trainer.

Key take-aways

• Get some help to stop smoking. The benefits of this will be felt well beyond your bones.
• Take stock of your alcohol intake. A glass of red wine two or three times a week is fine. Routinely having more is putting your bone health at risk. Seek support if you need to.
• Maximise the variety in your diet, focusing on vegetables, fruits, quality fish and meat, beans and pulses, nuts and seeds. The more colourful and abundant you make your diet, the greater the range of nutrients you get and the happier – and stronger – your bones will be.
• Make every mouthful count. Have a look at what you are about to eat. Is it colourful? Does it have some protein, some good fat? If it is beige in colour and sweet to taste, put it to one side for a moment. These foods tend to be inflammatory, and inflammation is a driver of imbalance in the bone remodelling process. Ask yourself if you are truly hungry. If the answer is yes, have a protein, fat and colourful meal first. Then decide if you still want your original food selection.
• Optimise your vitamin D and omega status. Speak to your GP or nutritional therapist to arrange testing so you can dose appropriately.
• Seek support on appropriate supplementation for your situation. Nutritional therapists are trained in the art and science of supplements and will be able to make safe recommendations, taking into account your diagnosis and any medication you may be taking.
• Exercise appropriately. Seek advice from a professional who will be able to direct you.