Osteoporosis Diet & Nutrition

Calcium is the most abundant mineral in the body and is definitely a “major” mineral within us. And for good reason. Without calcium, we couldn’t build (or maintain) our bones or teeth.

Almost 99% of the calcium in our bodies serves as the key structural component in our skeleton, where it’s also used as a calcium “bank account” from which withdrawals can be made to release calcium into our bloodstream should a drop in blood levels occur.

The National Health and Nutrition Examination Survey (NHANES), a program of studies designed to assess the health and nutritional status of adults and children in the United States, shows that Americans of all ages are not getting anywhere near enough calcium from the foods we eat.²³

And the two age groups most likely to be getting insufficient calcium from their diet are the two age groups who need calcium most:

• Children 9-18 years. This age group is supposed to be getting 1,300 milligrams/day, but is actually getting only 935 mg/day — or about 70% of what they need to produce their adult teeth and supply their growing bones.
• Women over age 40. Women aged 40-70+ are supposed to be getting 1,000 – 1,200 milligrams/day, but their average dietary intake is only 882 milligrams/day – just a little more than half the amount of calcium women are supposed to be getting to maintain a healthy skeleton, especially as we go through perimenopause and menopause. Average dietary calcium intake in women aged 60 and older is even lower: 842 milligrams/day.

Calcium supplementation to make up for these deficits is extremely important!

For more on the most abundant mineral in your body, check out our calcium overview, calcium benefits, and calcium-rich foods pages.

Did you know that as many as 80% of Americans are magnesium deficient? Deficiency of this mineral affects bone building, osteoblastic and osteoclastic activity, osteopenia, bone fragility, and alters calcium metabolism.

Calcium and magnesium work together in many cellular activities and need to be in balance for optimal function. Without magnesium, calcium may not be fully utilized and absorption problems may occur.

Ultimately, magnesium is needed for calcium absorption. Studies have shown that magnesium keeps calcium dissolved in the blood and without it, would leave deposits in the kidney, causing calcification of arteries and bone joints.²⁴

It’s also one of the most critical minerals for getting calcium to the bones — because it affects calcium metabolism and the hormones that regulate it. The ratio of calcium to magnesium that is recommended is 2:1, calcium: magnesium.

For more on this might mineral, check out our magnesium overview, magnesium benefits and magnesium-rich foods pages.

Boron is a trace mineral that boasts many bone health benefits such as:

• • It helps you keep vitamin D around longer and use it more effectively to build bone.
  • It prevents inflammation, greatly lowering levels of key inflammatory markers, including C-reactive protein (CRP). High levels of C-reactive protein significantly increase your risk for fracture!
  • It’s been shown to reduce menopausal symptoms.
  • It increases your ability to absorb and utilize magnesium, boosting all of magnesium’s beneficial effects.
  • And it has no safety issues. The UL (upper limit) for boron is 20 milligrams per day and the good news is, you need nowhere near that.

In addition to these benefits, it also lessens the amount of urinary calcium excretion. Back in 1985, when the US Department of Agriculture conducted a study in which postmenopausal women took boron daily, the women’s daily loss of calcium in their urine dropped by 44%!²⁵

Yes, this study was conducted way back in 1985, but don’t let that fool you. The science is still relevant today as the study was extremely well done (gold standard) and still rings true.

Furthermore, boron was helpful in preventing calcium loss in women who were low in magnesium. And even in women with adequate levels of magnesium, boron further improved their calcium retention. What does this mean for your bones? It means that boron increases your ability to not only hold on to more calcium, but also increases magnesium absorption.

In turn, this reduces bone demineralization, which is a process that reduces the amount of mineral substances in your bone. So boron combats that, keeping more minerals where they belong – in your bones where they can reduce your fracture risk!

For more on this crucial trace mineral, check out our boron overview, boron benefits, and boron-rich foods pages.

Manganese is critical for bone because it’s required for the production of chondroitin sulfate, which plays a key role in the first steps in bone formation. And it’s the co-factor for an antioxidant enzyme called mitochondrial superoxide dismutase (MnSOD), which is so critical for life that animals bred to lack MnSOD die almost immediately.²⁹

Bone mineralization cannot start without manganese due to this trace mineral’s essential role in our production of chondroitin sulfate.³⁰ Chondroitin sulfate in partnership with the osteocalcin (vitamin K2-dependent bone-mineralizing enzyme) forms the extracellular matrix, which makes up connective tissues like tendons, ligaments, bone, skin and cartilage. Like glucosamine, chondroitin sulfate has also been used as a dietary supplement for osteoarthritis.³¹

In addition to giving cartilage its elastic properties, chondroitin sulfate is also thought to have an anti-inflammatory effect, which can help reduce pain and swelling associated with osteoarthritis.³²

In humans, manganese insufficiency promotes low bone mineral density and osteoporosis, and low MnSOD activity increases risk for osteoporosis – and cancer, diabetes, cardiovascular disease, and Alzheimer’s disease.

Research conducted in Belgium showed that women with osteoporosis were found to have significantly lower blood levels of manganese compared to healthy controls.³³ Those with osteoporosis also had lower trabecular bone volume and lower bone mineral density. (Trabecular bone is the interior, more metabolically active portion of our bones. If your bones were M&Ms, trabecular bone would be the soft chocolate center. Cortical bone, the hard exterior, would be the thin candy shell.)

Other research found that men fed a diet lacking in manganese became manganese deficient in just 39 days. And their blood levels of calcium increased significantly too, indicating that manganese deficiency hindered calcium deposition into bone and/or increased calcium withdrawal from their bones.

For more on manganese, check out our manganese overview page.

Strontium is a common mineral that is naturally found in your bones. It has a unique benefit as it provides dual activity in your bones. Strontium inhibits bone resorption while simultaneously stimulating bone building. No other drug or natural substance is known to provide this dual effect!

While there has been some controversy over strontium’s safety, it has all stemmed from the particular drug form of strontium, strontium ranelate, which has been shown to increase blood clot risk, cardiovascular events and more. (Strontium ranelate has never been approved in the U.S. and is now significantly restricted in Europe). The good news is, natural strontium in the form of strontium citrate, is safe and highly beneficial ─ and freely available.

Experts now believe strontium is, “an essential trace mineral necessary for the optimal normal development and accretion of peak bone mass, and the sustained health of our bones.”³⁸

For more on strontium, check out our dedicated strontium overview, strontium-rich foods and strontium benefits pages.

Vanadium is categorized as an ultra-trace element because it’s found in such low concentrations in foods and biological tissues. In humans, the average body content of vanadium ranges from just 100 micrograms to 1 milligram.³⁹

Almost all the vanadium we consume via food or supplements is excreted, but the tiny amount that we keep has significant beneficial effects on our bones – impacts that are just now being confirmed in the current research.⁴⁰ But why is it important to your bones?

For several reasons actually:

• • Promotes bone-building cells. Vanadium stimulates growth of unique stem cells that turn into osteoblasts ─ your bone-building cells! Vanadium also acts as a growth factor that produces more of these bone-building cells, too.
  • Helps bones absorb minerals. Vanadium stimulates a special enzyme called bone alkaline phosphatase, which is crucial in drawing calcium and other minerals into bone.⁴¹
  • Increases organic bone material. Vanadium increases type-1 collagen production. Type-1 collagen is an elastic protein making up the organic part of bone. It’s also the most common form of collagen in the body!

It should come as no surprise that not having enough zinc adversely affects health in numerous ways. Impairing physical growth (including that of our bones), and disrupting healthy bone remodeling, immune function, thyroid function, reproductive function, and brain-sensory functions (like taste and smell).

When zinc intake is inadequate, zinc is no longer available for its many important biological roles in bone. Zinc plays a critical role in collagen formation, promotes the proliferation of our bone-building cells, the osteoblasts, and is required for osteoblasts’ creation of the bone matrix and its calcification.⁴² In other words, we cannot effectively build bone without zinc.⁴³

Zinc’s role in bone is both structural because bone mineral is composed of hydroxyapatite crystals, which contain zinc, and formative because zinc is required for osteoblasts’ activity. Plus zinc promotes bone mineralization through its role as a cofactor for the bone-building enzyme, bone alkaline phosphatase.

Although our focus is the importance of vitamin D for your bones’ health, you’ll be happy to know that getting enough vitamin D3 is associated with lower risk of not just osteoporosis, but cancer, diabetes, obesity, cognitive decline, rheumatoid arthritis, and multiple sclerosis.

The three most important of vitamin D’s beneficial effects on your bones are that it:

• • Enables active calcium absorption. Without adequate vitamin D, you will absorb only 10–15% of the calcium you consume, whether from your diet or from a calcium supplement. Why?
    
    Calcium is absorbed both actively and passively in our intestines. Active absorption occurs in the first two sections of the small intestine, the duodenum and the jejunum, and accounts for almost all (85-90%) of all the calcium absorbed. Passive absorption takes place in the final portion of the small intestine, the ileum, but accounts for only a minor fraction of the calcium absorbed. Active absorption of calcium doesn’t happen without the help of vitamin D.
    
    Vitamin D in its fully activated form of 1,25-D that attaches to vitamin D receptors in cells in the lining the small intestine.⁴⁴ 1,25-D binding stimulates these cells to produce and secrete special calcium-binding proteins, collectively called “calbindin,” which collect calcium and transport it across the intestinal lining into the bloodstream.
    
    
  • Improves muscle strength and repair. The latest research is reporting numerous ways that muscle mass and bone mass are linked with vitamin D.⁴⁵ For instance, vitamin D increases the formation and development of new muscle cells and helps regulate how quickly our muscles heal and regenerate after injury.⁴⁶ Vitamin D deficiency causes loss of muscle along with bone, and is a key reason why sarcopenia (muscle wasting) is typically present along with osteoporosis.⁴⁷
    
    
  • Lessens inflammation. Vitamin D can improve immune function and lessen inflammation by helping to prevent excessive activation of osteoclasts, the cells that break down bone.

For more on vitamin D, check out our Vitamin D overview, vitamin D benefits, and vitamin D rich-foods pages.

Vitamin C is a water-soluble vitamin that must be obtained from our diets as human are unable to make it ourselves. Also known as ascorbic acid, this vitamin benefits your bones by lessening inflammation, restoring the antioxidant glutathione, and promoting collagen formation.

It has been extensively studied for its importance for bone health, particularly in men and women over the age of 60. The majority of studies have reported a significant beneficial effect of vitamin C on the risk of fracture and bone mineral density. Read more on vitamin C in our Ultimate Guide.

There are eight B vitamins and while they work as a team, each also plays its own role within your body.

Now, recent human research have shown that five B vitamins, B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B9 (folate) and B12 (cobalamin)⁶⁴ all play major roles in supporting the health of your bones, too.⁶³

Vitamin B2 – Riboflavin: Riboflavin is important for preventing free radical damage, contributing to growth, boosting energy levels and maintaining healthy blood cells.⁶⁵  

Riboflavin is also required for the reactions through which iodine is recycled to produce more thyroid hormones.⁶⁶ A lack of adequate riboflavin increases risk of hypothyroidism⁶⁷, which promotes bone loss.⁶⁸

The current U.S. RDI is 1.3 mg/day for male adults and 1.1 mg/day for female adults.⁶⁹ The top food sources of riboflavin are dark leafy green vegetables like spinach and beet greens, asparagus, cremini mushrooms and almonds.

In addition, the biggest contributors of B2 in Western populations are fortified milk and dairy products. Food fortification is the process of adding micronutrients like vitamins and trace minerals to foods.

Vitamin B3 – Niacin: Niacin is required for the production of nitric oxide, which relaxes blood vessels, lowers blood pressure and improves blood flow and nutrient delivery to cells. Current research has confirmed that a healthy blood supply is crucial for healthy bones.

Bone receives up to 10% of cardiac output, which is the volume of blood being pumped by the heart.⁷⁰ The process of bone turnover and formation requires lots of nutrients and are delivered by the bloodstream.

The U.S. RDI for niacin is 16 mg/day for men and 14 mg/day for women.⁷¹ The top food sources of niacin are yellowfin tuna, pasture-raised chicken and turkey, and wild-caught Alaskan salmon.

Vitamin B6 – Pyridoxine: Vitamin B6 includes three pyridines: pyridoxine, pyridoxal and pyridoxamine, and their 5′-phosphorylated derivatives.⁷² Pyridoxine is important for major functions such as memory, blood flow, and energy expenditure.

It also helps your body maintain a healthy nervous system and can create antibodies that your immune system uses to protect you! Once vitamin B6 is converted with the help of riboflavin into its active form, it increases your cells’ ability to absorb magnesium. In other words, your ability to absorb magnesium depends on both riboflavin and vitamin B6.

The current U.S. RDI is 1.7 mg/day for men and 1.5 mg/day for women over 50.⁷³ The top food sources of vitamin B6 include pasture-raised turkey, grass-fed beef, sweet potatoes, sunflower seeds, and bananas.

Vitamin B9 – Folate: Folate plays a crucial role in the process of DNA, RNA, proteins and phospholipids.⁷⁴

The U.S. RDI for folate is 400 mcg for both adult women and men.⁷⁵ The top food sources of folate include asparagus, artichokes, spinach, mustard greens, pinto beans, and free-range eggs.

This is the one B vitamins where deficiency is rare so the key takeaway is to eat folate-rich foods. And if you are taking a vitamin B complex (typically delivers all eight B vitamins) supplement, make sure it contains folate and not folic acid. Folic acid does not equal folate.

Vitamin B12 – Cobalamin: Cobalamin plays important roles in the processing of fats, proteins and carbohydrates in your body. It’s also needed for energy production.

Mild to moderate deficiency in vitamin B12 can be found in 20% of the elderly population and can lead to impaired cognition.⁶³ This can be attributed to poor absorption and gastrointestinal issues. Deficiency in vitamin B12 can also result in pernicious anemia – this is a condition that causes numbness of extremities, general weakness, and pallor (unhealthy pale appearance.) In fact, vitamin B12 was first revealed to be related to fractures and osteoporosis in patients with pernicious anemia.⁷⁶

The mechanisms on how vitamin B12 impacts your bones is still unclear, however, the link has been confirmed in research. The Framingham Osteoporosis Study looked at vitamin B12 levels and bone health indicators in 2,576 women and men from 30-87 years old.⁷⁷ Bone mineral density was measured by a DEXA at the hip and spine and plasma vitamin B12 was measured. Both men and women with lower concentrations of vitamin B12 had lower bone mineral density than those with vitamin B12 above the concentration cut-off. The differences were significant for women at the spine and for men at most hip sites.

Additional studies⁷⁸ support that vitamin B12 may preserve bone mineral density⁷⁹ and reduce fracture risk.⁸⁰ However, further research is needed to discover the specific mechanisms between vitamin B12, bone mineral density, and fracture risk.  

The U.S. RDI is 2.4 mcg per day for adults 50 years or older.⁸¹ The top food sources of vitamin B12 are in animal sources and include sardines, wild-caught Alaskan salmon, shrimp, scallops, grass-fed lamb and beef, and yogurt.

Unfortunately, the RDI recommendations do not take into account that deficiencies of all B vitamins are frequently seen in the U.S. population overall and increase dramatically with age. There are also commonly used drugs that deplete B vitamins, further increasing needs.

For instance, proton pump inhibitors (PPIs) and drugs to treat peptic ulcers can interfere with vitamin B12 absorption. While anticonvulsants and oral contraceptives can deplete vitamin B6. They also negatively impact your bones. For more on, check out our top post on Common Prescription Drugs That Cause Bone Loss.

When all five B vitamins are present, they enable two essential metabolic processes (the folate and methylation cycles) to function properly. But they all must be present to work properly and support the health of your bones in the following ways:

• • Support healthy thyroid function
  • Support blood flow and the delivery of nutrients and oxygen to bone
  • Improve magnesium absorption
  • Increase production of glutathione (which is the body’s premier antioxidant)
  • Contribute to energy production
  • Prevent increases of highly inflammatory compounds that destroy bones
  • Regenerate vitamin K

The omega-3 essential fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), defend your bones against osteoporosis by lowering inflammation through many different mechanisms.⁸² Chronic inflammation has been shown to be a major contributor to osteoporosis.⁸³

In addition to providing your bones with all the nutrients they require to rebuild, lowering inflammation is the most important action you can take to prevent or reverse osteoporosis. Why?

Lowering inflammation is essential to prevent osteoporosis because chronic low grade inflammation continuously activates osteoclasts, the specialized cells that break down bone.

EPA and DHA are found in highest amounts in animal foods such as anchovies, salmon, mackerel, and sardines. Can we get enough of the omega-3s, EPA and DHA, we need to maintain healthy muscles and bones from fish? While it’s possible, it’s not practical.

To ensure optimal intake of EPA and DHA, we still need to take a supplement. Here’s why…

The only good dietary sources of EPA and DHA are wild caught cold water fatty fish, such as sardines, salmon, sablefish, halibut and tuna. It’s important to specify that the fish be “wild caught” because the amount of EPA and DHA in fish is highly dependent on the fish or animal’s diet. Wild fish eat algae, sea plants, and other smaller fish that are rich in omega-3s, so they produce and store EPA and DHA in their tissue.

Authorities recommend optimal health benefits provided by omega-3s are associated with intakes of from 2-4 grams of EPA and DHA per day. You’d need to consume at least two 3-ounce portions of the fish that are low in mercury every day to safely provide enough EPA and DHA to beneficially impact the health of your bones. That’s a lot of fish! So again, to ensure you’re getting optimal amounts of EPA/DHA you need to supplement with a high-quality fish oil.

One thing to note is that this recommendation does not consider omega 6 fatty acids (omega 6s). To talk about omega 3s without talking about omega 6s is irresponsible. Why?

Because balance is key. While optimal amounts of omega 3s are important, you have to take your omega 6 fatty acid intake into consideration, too. Without doing so, you’d be doing a disservice to your health. Why?

Omega 6 fatty acids are pro inflammatory, while omega 3 fatty acids are anti inflammatory. Authorities say that the optimal omega 6 to omega 3 ratio is 2:1. However, the ratio found today in Western diets is closer to 16:1!⁸⁴

So making sure you’re balancing these two types of omega fatty acids is crucial to your bones and overall health. For more, check out our post on The Modern Omega 6 to Omega 3 Ratio and How To Fix It.

Black olives, particularly Lucques olives produced in southern France, seem to have a higher levels of polyphenols (compounds in plants packed with antioxidants) than green olives.

One study compared the osteoporosis-preventing effects of these black Lucques olives and green olives in a 6-month rat study.⁹³ It found that black Lucque olives significantly prevented the decrease in bone density in the inflamed rat group, but this was not seen with green olives. In other words, black Lucque olives were far superior in osteoporosis-preventing effects compared to green olives, which could be attributed to the higher polyphenol levels.

One potential issue with olives, especially those that are well cured, is the salt content. So while olives may osteoporosis-preventing effects, limiting your salty olive intake in favor of the oil itself may be better way to go.