Osteoporosis develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture)(1).
Losing bone density is a normal part of ageing, but some people lose bone much faster than normal.
Women lose bone rapidly in the first few years after the menopause(2). They are also more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45)(3).
And if you have a vegan and vegetarian diet, you can be at a higher risk of developing it too, as plant-based diets often lack certain nutrients essential nutrients for bone health, like calcium, vitamin D, and protein (4)(5), which are crucial for maintaining strong bones.
Here are the things that you can do that have to help keep your bones strong and healthy and help prevent osteoporosis . We've listed them in order of importance for potential significant improvements.
Calcium is a crucial mineral for strong bones. Adults should aim to consume around 700 mg of calcium daily(6). Dairy products, such as milk, cheese, and yoghurt, are excellent sources of calcium. Non-dairy sources include leafy green vegetables, nuts, seeds, and calcium-fortified foods, such as breakfast cereals and plant-based milk alternatives(7). It’s important to note that organic planet-based milks and cereals are not fortified with additional vitamins and minerals.
Vitamin D helps the body absorb calcium and is essential for healthy bones(8). Sun exposure, eating oily fish, and fortified foods can provide vitamin D, but it is challenging to get enough during the winter months. Public Health England recommends that adults in the UK take a daily 10 microgram vitamin D supplement between October and March(10).
Engaging in weight-bearing exercises, muscle-strengthening activities, and balance training can improve bone density and reduce the risk of falls and fractures(11)(12).
Former Chief Medical Officer Dame Sally Davies makes simple recommendations: “Instead of catching the lift a floor or two walk up, carry your shopping, get off the bus a few stops early, see what you can do in your normal life so it's not a burden.”
“A lot of admissions into hospital emergency rooms are because of falls and if people had stayed fit and developed their muscle strength and balance, they would have maintained their independence and stopped those falls”
Activities like walking, dancing, yoga, and tai chi are particularly beneficial for bone health (13).
Angela Rippon demonstrates a simple exercise that can help.
Maintaining a healthy body weight is crucial for overall health, including bone health(14).
Being underweight or overweight can increase the risk of fractures and osteoporosis(15).
Adopting a balanced diet and engaging in regular physical activity can help keep your weight within a healthy range
Excessive alcohol consumption and smoking negatively impacts bone health, increasing the risk of osteoporosis(16)(17) by:
Impaired calcium absorption
Affecting bone-forming cells called osteoblasts, reducing their ability to create new bone tissue.
Can disrupt the balance of hormones, such as estrogen and testosterone, that play a crucial role in maintaining bone health.
Nicotine reduced blood supply to bones, and in addition, for women, smoking has been shown to cause earlier menopause, resulting in a more rapid decline in estrogen levels, which are essential for bone health,
Limiting alcohol intake to no more than 14 units per week and quitting smoking can help protect your bones
Bone broth is rich in nutrients that support bone health, such as collagen, calcium, and magnesium(18). Incorporating bone broth into your diet can provide these nutrients and contribute to overall bone health. Try having a cup of bone broth a few times a week, or use it as a base for soups and stews.
Magnesium and vitamin K play essential roles in maintaining bone health(19)(20). Magnesium is involved in bone formation, while vitamin K helps with calcium regulation(21).
Good sources of magnesium include dark chocolate, nuts, seeds, whole grains, and leafy green vegetables. Vitamin K can be found in leafy greens, broccoli, and Brussels(22).
Omega-3 fatty acids have been shown to have a positive effect on bone health by enhancing calcium absorption and reducing inflammation(23). Sources include fatty fish like salmon, mackerel, and sardines, as well as nuts and seeds like walnuts and flaxseeds(24).
This is especially important for plant-base diets. Protein is essential for maintaining bone health(25). Research has shown that adequate protein intake can help improve bone mineral density and reduce fracture risk(26). Aim to include a variety of protein sources in your diet, such as lean meats, poultry, fish, eggs, dairy products, beans, and legumes(27).
The recommended daily protein intake for adult women is approximately 45-50 grams, while for adult men, it's around 55-60 grams(28). These values may vary depending on individual factors such as age, sex, and activity level.
Phytonutrients, such as flavonoids and carotenoids, are found in “rainbow foods”, the colourful fruits and vegetables, such a blueberries, red peppers, and green salad leaves(29). They have been shown to support bone health by reducing inflammation and oxidative stress(30).
This is for general information only, and if you’ve already been diagnosed with osteoporosis, please check with your GP first for appropriate diet or exercise routines specifically tailored to your needs.
References:
[1] National Osteoporosis Foundation. (n.d.). What is Osteoporosis and What Causes It? Retrieved from https://www.nof.org/patients/what-is-osteoporosis/
[2] Sözen, T., Özışık, L., & Başaran, N. Ç. (2017). An overview and management of osteoporosis. European journal of rheumatology, 4(1), 46–56. https://doi.org/10.5152/eurjrheum.2016.048
[3] National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2018). Osteoporosis in Men. Retrieved from https://www.bones.nih.gov/health-info/bone/osteoporosis/men
[4] Davey, G. K., Spencer, E. A., Appleby, P. N., Allen, N. E., Knox, K. H., & Key, T. J. (2003). EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public health nutrition, 6(3), 259-268.
[5] Mangels, A. R. (2006). Bone nutrients for vegetarians. The American journal of clinical nutrition, 100(suppl_1), 469S-475S.
[6] National Health Service. (2018). Calcium. Retrieved from https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/
[7] Weaver, C. M. (2014). Calcium supplementation: is protecting against osteoporosis counter to protecting against cardiovascular disease?. Current osteoporosis reports, 12(2), 211-218.
[8] Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.
[9] Lanham-New, S. A. (2006). Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment. Proceedings of the Nutrition Society, 67(2), 163-176.
[10] Public Health England. (2016). PHE publishes new advice on vitamin D. Retrieved from https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d
[11] Howe, T. E., Shea, B., Dawson, L. J., Downie, F., Murray, A., Ross, C., ... & Creed, G. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD000333.pub2
[12] National Osteoporosis Foundation. (n.d.). Exercise for Strong Bones. Retrieved from https://www.nof.org/patients/fracturesfall-prevention/exercisesafe-movement/osteoporosis-exercise-for-strong-bones/
[13] Kanis, J. A., Johansson, H., Oden, A., De Laet, C., Johnell, O., Eisman, J. A., ... & Tenenhouse, A. (2005). A meta-analysis of prior corticosteroid use and fracture risk. Journal of Bone and Mineral Research, 20(6), 893-899.
[14] Compston, J. E., Watts, N. B., Chapurlat, R., Cooper, C., Boonen, S., Greenspan, S., ... & Silverman, S. (2011). Obesity is not protective against fracture in postmenopausal women: GLOW. The American journal of medicine, 124(11), 1043-1050.
[15] National Health Service. (2019). Obesity. Retrieved from https://www.nhs.uk/conditions/obesity/
[16] Kanis, J. A., Johnell, O., Oden, A., Johansson, H., De Laet, C., Eisman, J. A., ... & Tenenhouse, A. (2005). Smoking and fracture risk: a meta-analysis. Osteoporosis International, 16(2), 155-162.
[17] Abrahamsen, B., & Vestergaard, P. (2005). Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997-2006. Osteoporosis International, 21(3), 373-380.
[18] Schnitzler, C. M. (1993). Bone quality: a determinant for certain risk factors for bone fragility. Calcified tissue international, 53(1), S27-S31.
[19] Rizzoli, R., & Bonjour, J. P. (1999). Determinants of peak bone mass and mechanisms of bone loss. Osteoporosis International, 9(1), S17-S23.
[20] Rizzoli, R. (2014). Dairy products, yogurts, and bone health. The American journal of clinical nutrition, 99(5), 1256S-1262S.
[21] Orchard, T. S., Larson, J. C., Alghothani, N., Bout-Tabaku, S., Cauley, J. A., Chen, Z., ... & LaCroix, A. Z. (2014). Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study. The American journal of clinical nutrition, 99(4), 926-933.
[22] Booth, S. L., Broe, K. E., Gagnon, D. R., Tucker, K. L., Hannan, M. T., McLean, R. R., ... & Kiel, D. P. (2003). Vitamin K intake and bone mineral density in women and men. The American journal of clinical nutrition, 77(2), 512-516
[23] Salari Sharif, P., Asalforoush, M., Ameri, F., Larijani, B., & Abdollahi, M. (2010). The effect of n-3 fatty acids on bone biomarkers in Iranian postmenopausal osteoporotic women: a randomized clinical trial. Age, 32(2), 179-186.
[24] Bonjour, J. P., Gueguen, L., Palacios, C., Shearer, M. J., & Weaver, C. M. (2009). Minerals and vitamins in bone health: the potential value of dietary enhancement. British Journal of Nutrition, 101(11), 1581-1596.
[25] Kerstetter, J. E., Kenny, A. M., & Insogna, K. L. (2011). Dietary protein and skeletal health: a review of recent human research. Current Opinion in Lipidology, 22(1), 16-20.
[26] Mangano, K. M., Sahni, S., & Kiel, D. P. (2014). Dietary protein is beneficial to bone health under conditions of adequate calcium intake: an update on clinical research. Current Opinion in Clinical Nutrition & Metabolic Care, 17(1), 69-74.
[27] Weaver, C. M. (2015). Diet, gut microbiome, and bone health. Current Osteoporosis Reports, 13(2), 125-130.
[28] Heaney, R. P., & Layman, D. K. (2008). Amount and type of protein influences bone health. The American Journal of Clinical Nutrition, 87(5), 1567S-1570S.
[29] Byberg, L., Bellavia, A., Larsson, S. C., Orsini, N., Wolk, A., & Michaëlsson, K. (2018). Mediterranean diet and hip fracture in Swedish men and women. Journal of Bone and Mineral Research, 33(12), 2178-2185.
[30] Shen, C. L., von Bergen, V., Chyu, M. C., Jenkins, M. R., Mo, H., & Chen, C. H. (2012). Fruits and dietary phytochemicals in bone protection. Nutrition Research, 32(12), 897-910.
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