What to Eat and What to Avoid for Osteoporosis Prevention
It’s easy to forget how much you depend on our bones. But if you’ve ever fractured one, you know better than to take them for granted.
Bone is living tissue, constantly breaking down and rebuilding. If the rate of breakdown exceeds the rate of formation, then bones weaken over time, leading to osteoporosis.
While genetics contributes to osteoporosis risk, physical activity and good nutrition are preventive, says Angel Planells, a registered dietitian in Seattle and spokesperson for the American Academy of Dietetics.
“It’s never too late to improve our bone health, no matter what age we’re at in life,” Planells says.
Nutrition over a lifespan plays a key role in building and maintaining strong bones.
“It’s very important, because if you don’t have certain adequate nutrients, you are going to lose bone, which sets you up for having fractures,” says Joan Lappe, PhD, RN, a professor at the Creighton University Osteoporosis Research Center in Omaha, Nebraska.
Both Planells and Dr. Lappe recommend trying to meet your nutrient needs through diet, adding supplements only if necessary and under the guidance of your doctor.
Although it’s well established that calcium and vitamin D are important for bone health, the effectiveness of taking supplements of these nutrients to prevent fractures is controversial. A 2018 report conducted by the U.S. Preventive Services Task Force concluded there wasn’t enough evidence to recommend calcium and vitamin D supplements for fracture prevention in healthy adults. (This doesn’t apply to people diagnosed with osteoporosis or a vitamin D deficiency.) Calcium and vitamin D supplements can also increase the risk of kidney stones, the report says, so it’s best to discuss your individual risks and benefits with your healthcare provider. The Task Force is in the process of reviewing these findings for potential updates, but it appears as though the recommendations will remain the same.
On the other hand, getting these nutrients from foods means you’re getting a package deal with each food’s other vitamins and minerals, which may also be beneficial for bone health. And emerging research is finding that your overall dietary pattern may be important.
For example, one study concluded that better bone health is associated with eating more fish, fruit, legumes, low-fat dairy products, nuts, poultry, vegetables, and whole grains.
Beyond filling your plate with a variety of foods, it’s worth ensuring that you eat good sources of the most important nutrients for bones: calcium, vitamin D, protein, and flavonols.
“Calcium is critical for bone [health], because it maintains their strength,” says Lappe. The recommended amount for adults is about 1,000 milligrams (mg) of calcium per day or 1,200 mg for women over age 50 and men over age 70.
These are the best food sources of calcium:
Dairy Products A single serving of milk or yogurt provides about 300 mg of calcium.
Calcium-Fortified Juices and Plant-Based Milks These include soy- and plant-based milks, which can contain as much calcium as cow’s milk. (Just be sure to shake the carton well before every pour, Lappe says, because the added calcium can settle at the bottom.)
Canned Salmon and Sardines The calcium is in their soft bones (180 to 325 mg for 3 ounces).
Dark Green Vegetables Options such as collard greens and kale can provide 179 to 266 mg of calcium per cup when cooked. But Lappe cautions that calcium is poorly absorbed from vegetables with high levels of oxalates, such as spinach or rhubarb.
Tally your total calcium intake using this calcium calculator from the International Osteoporosis Foundation.
Vitamin D helps with calcium absorption and bone cells’ function. You can get vitamin D through sun exposure, but during the winter months in the northern half of the United States and Canada, the sun is too low in the sky to provide enough ultraviolet rays, which boost vitamin D levels. So you need to look to food sources and supplements, says Lappe.
Adults should aim for 600 international units (IU) of vitamin D per day or 800 IU for ages 70 and up.
There are only a few good food sources of vitamin D:
Fatty Fish A serving of salmon or rainbow trout can provide about 570 to 645 IU. Lower amounts are found in canned sardines and tuna.
Vitamin D–Fortified Beverages Cow’s milk, plant-based milks, and juice have around 100 IU per serving, but check the label for exact amounts. Some breakfast cereals and yogurts are also fortified.
Egg Yolks, Cheese, Mushrooms, and Beef Liver These foods provide small amounts of vitamin D (20 to 40 IU per serving — read the nutrition facts label for the exact numbers) but can contribute to your total intake over the course of the day.
If you’re worried that you don’t get enough vitamin D from sun exposure and foods, talk with your doctor about taking a supplement.
Minerals such as calcium give bones their hardness, but it’s protein that forms bones’ underlying structural matrix.
For many years, researchers thought that high-protein diets could deplete the calcium in bones, but there is little evidence of this.
Just how much protein is optimal for bone health is still under debate, Lappe says. “I usually just stick with recommended levels, and I don’t think people need protein supplements.”
Most Americans get enough protein, but Planells says it’s common for protein intake to decrease as you get older.
“Your goal should be to get at least 15 grams of protein every time you eat,” he says. Fish, poultry, red meat, dairy products, and eggs are obvious sources. But he also points out that there are more affordable and convenient plant sources, such as beans, nuts, peanut or almond butter, and sunflower seeds.
Certain nutrients and products can interfere with bone health:
Alcohol Limit your intake to no more than one drink per day for women or two drinks per day for men, as heavier drinking habits can contribute to bone loss.
Caffeine Too much caffeine can increase calcium excretion, so limit your intake to two or three cups of caffeinated beverages, such as coffee, each day.
Cola Some research has found that people who drink more soda have poorer bone mineral density. But this effect seems to be limited to cola, which contains both caffeine and phosphoric acid.
Salt Eating too much salt can cause you to excrete more calcium in your urine, which may lead to bone loss in the long term.
Of course, there are other health reasons to watch your salt intake and avoid excessive alcohol, caffeine, and soda intake. It comes back to looking at the big picture and working toward a diet rich in a variety of whole foods to provide bone-building nutrients.
“It’s just kind of a commonsense approach,” says Lappe. “You don’t need to snarf up all kinds of pills or eat a whole bunch of a certain type of food, and you don’t have to give up some of the things you like. Just consume in moderation and you’ll be fine.”
To maintain strong bones and prevent osteoporosis, focus on a balanced diet rich in calcium, vitamin D, protein, and whole foods.
Limiting your intake of alcohol, caffeine, cola, and salt is also best for bone health.
Remember to vary your meals and enjoy a range of nutrient-dense foods to support your bones naturally.
