Osteoporosis and Diet

Data from the Rotterdam Study, a prospective study of 14,926 people 45 or older who have been followed since 1990, show that a diet based on vegetables, fruits, dairy, fish and poultry is associated with:
• markedly reduced risk for fractures,
• higher bone density on X ray, and
• stronger bones characterized by a higher bending strength (American Journal of Clinical Nutrition, Dec 22, 2016, and Eur J Nutr, Aug 24, 2016).
Diets that included a lot of sweets, processed meats or alcohol were associated with increased risk for fracture and weaker, more unstable bones, independent of bone density.

The Women’s Health Initiative showed that an inflammatory diet is associated with increased hip fracture rates in women ages 50 to 63 and an anti-inflammatory diet is associated with less bone density loss in this same group of postmenopausal women (J Bone Miner Res, Dec 26, 2016). Anti-inflammatory foods include fruits, vegetables, whole grains, beans, seeds and nuts, while pro-inflammatory foods include processed meats, sugar-added foods, sugared drinks and fried foods. See Anti-Inflammatory and Pro-Inflammatory Foods. Another study showed that risk for osteoporosis of the spine and hip are reduced by eating lots of fruits, vegetables, and cereals and reducing alcohol and red meat (Open Journal of Epidemiology, May 2013;3(2):79-84).

Sugar-Added Foods and Drinks: High blood sugar levels in non-diabetics weaken bone matrices and increase fracture risk long before bones lose calcium to have an abnormally low bone density test (Journal of Clinical Endocrinology & Metabolism, published online December 21, 2016). That means that a high blood-sugar level (insulin resistance) itself weakens bones to increase a diabetic’s risk for bone fractures, even if the person has a normal bone density test. Young people who are not diabetic but have high blood sugar levels after meals have smaller and weaker bones than non-diabetics who do not have high rises in blood sugar after meals. Foods that cause a high rise in blood sugar include sugar-added foods, all sugared drinks, and red meat (blocks insulin receptors).

Protein: Several earlier studies suggested that eating a high-protein diet makes the blood acidic to increase calcium loss through the kidneys to weaken bones (J Nutr. 1998;128:1051–53). Other studies show that a low-protein diet, particularly in people over 60, weakens bones (Int J Vitam Nutr Res, 2011;81(2-3):134-42). The general feeling today is that a reasonable intake of protein (1.5 g /kg/d) does not weaken bones (Am J Clin Nutr, 2003;78(suppl):S584–92), and that taking extra protein does not strengthen bones.

Thirty-six weeks of whey protein supplements or a high-protein diet did not make bones stronger or denser (The Journal of Nutrition, December 21, 2016;146(2):). Older people can meet their needs for protein by eating lots of nuts and whole grains and some animal protein such as fish or poultry.

Calcium: Calcium pills, even with extra vitamin D, are not likely to strengthen bones; see Calcium Pills Do Not Prevent Fractures. However, lack of calcium weakens bones, so you should eat foods rich in calcium, such as leafy green vegetables, seafood, whole grains and beans. Acid-forming foods such as meat, fish and eggs, have been shown to increase calcium loss through the kidneys. Alkaline-forming foods (plants) help your kidneys retain calcium (J Nutr, 2003;133(suppl):S850–1).

Exercise: Everything that causes you to lose muscle size and strength also causes you to lose bone size and strength (Am J Clin Nutr, May 2008;87(5):1567S-1570S). Anything that enlarges muscles also makes bones larger and stronger.

My Recommendations
With aging, all men and women on the typical Western diet are at increased risk for osteoporosis and broken bones (Am J Physiol Renal Physiol, 2003;284:F32–40). To prevent or slow the progression of osteoporosis, everyone should try to strengthen their bones by:
• eating a diet rich in fruits and vegetables,
• restricting processed meats and meat from mammals, sugar-added foods and all sugared drinks including fruit juices,
• restricting alcohol,
• trying to exercise regularly against increasing resistance, and
• keeping blood levels of hydroxy vitamin D above 30 ng/ml.

Checked 4/4/22