We tend to think of osteoporosis as a disease of old age. Really, though, the seeds of the disease process are sewn many years earlier, when our bodies are doing the bulk of their bone-building work.
Of the 10 million people in the United States who have osteoporosis, some 8 million are women, according to the National Osteoporosis Foundation (NOF). Another 34 million people have such low bone density that they’re at risk for developing the disease.
Osteoporosis causes the bones to lose their substance over time, becoming more porous, fragile, and subject to fracture. Of course, we can’t feel that they’re weakening until one of them breaks. Osteoporosis doesn’t hurt, but a broken bone sure does.
The disease also is responsible for stealing inches from a person’s height as she (or he) gets older. And it can cause a rounded upper back—the so-called dowager’s hump—and stooped posture over time, as the softening bone of the spinal vertebrae develops tiny fractures. These breaks can cause a considerable amount of back pain.
Getting the right nutrients is extremely important for building and maintaining strong bones, especially if you have or are at risk for osteoporosis. Before we get into the individual vitamins and minerals, let’s take a closer look at how the body makes bone in the first place.
Bone is a living, dynamic substance—not just the tough “scaffolding” that gives you shape and holds you upright. Even before you were born, certain of your body’s cells were busy building bone up and tearing it down. That’s right: The creation and destruction of bone goes on constantly over the course of your lifetime.
Cells known as osteoblasts use calcium (with the help of vitamin D) to form the strong yet porous material that makes up bone. At the same time, other cells called osteoclasts are busy removing the calcium and deconstructing the bone. Building up, tearing down—it seems a bit counterproductive, doesn’t it? But think of it this way: If your skeleton, once constructed, had remained static, you never would have achieved your adult height.
As you can imagine, then, your diet—especially the amounts of calcium, vitamin D, and other key nutrients in your diet—has a major impact on your bone density. So, too, does physical activity. When you engage in exercise, particularly weight-bearing exercise like walking, dancing, and weight lifting, your osteoblasts work overtime to add bone to your bank.
What’s more, the younger you were when you started paying attention to these lifestyle factors, the better off your bones will be. You see, you had already acquired between 85 and 95 percent of your bone mass by the time you turned 18 if you’re female, 20 if you’re male. So how strong and solid your bones are now was pretty much determined by what you ate and how active you were through your teens. That’s significant, because as you get older, the bone-building osteoblasts aren’t quite as productive as they once were. Meanwhile, the osteoclasts’ efforts to deconstruct bone seem to pick up steam.
If you have a good, strong skeleton by then, you can afford to lose some bone without significantly undermining your bone health. If you don’t, however, you’re far more likely to develop osteoporosis. So does this mean it’s too late for a healthy diet and regular exercise to do your bones any good? Not at all!
“You want to try to minimize any further loss,” says Miriam Nelson, PhD, director of the Center for Physical Activity and Nutrition and associate professor of nutrition at the Friedman School of Science and Policy at Tufts University in Boston. “Bones are not static!”
According to Dr. Nelson—who’s also the author of Strong Women Stay Young the important thing to remember is that building strong bones requires many different nutrients in the right amounts. Besides calcium and vitamin D, these include (but are not limited to) vitamin C and other antioxidants, vitamin K, and magnesium. The best way to shore up your nutritional defense against osteoporosis, Dr. Nelson says, is to eat a healthy, balanced diet featuring a variety of fruits and vegetables, whole grains, and good quality protein from fish, lean meats, and poultry.
In 2006, findings from the statewide Utah Study of Nutrition and Bone Health reinforced the importance of an antioxidant-rich diet for bone health. Researchers analyzed the diets of 1,215 people who had suffered osteoporosis-related hip fractures and compared them to the diets of a similar group of 1,349 people who had not experienced fractures. The researchers found significant differences between the two groups in terms of dietary intake of beta-carotene, vitamin E, and selenium. The apparent protective effect of these antioxidants was even more pronounced in people with a history of smoking. The Daily Value for vitamin E is currently set at just 30 International Units, and there is no Daily Value for selenium. You can get adequate amounts of both in a multivitamin. If you already have osteoporosis, there’s one nutrient that you should be wary of, and that’s vitamin A. “We need less and less as we get older,” Dr. Nelson says. Indeed, studies have shown that excess vitamin A can harm our bones over time. Dr. Nelson suggests avoiding any breakfast cereals that are fortified with vitamin A. The same rule applies for multivitamins (though beta-carotene, a precursor to vitamin A, is okay).
Be aware, too, that while your body definitely needs some protein, following a high-protein diet could be bad for your bones. Studies have shown that people who get more than 30 percent of their calories from protein tend to have fragile bones.
On the other hand, calcium and vitamin D are must-haves for bone health. Dr. Nelson isn’t a big fan of supplements generally, but these are two nutrients for which she makes an exception because getting adequate amounts from food sources alone can be a challenge. They’re especially important if you’re already on medication for osteoporosis, because these drugs need calcium and vitamin D to do their job. Otherwise, you may as well flush them down the toilet, because that’s essentially where they’ll be going.
While we’re on the subject of medication, be aware that corticosteroids can pull calcium and vitamin D from your bones, which may contribute to osteoporosis, Dr. Nelson says. If you’re taking one of these medications for any reason, you should talk with your doctor about getting extra calcium and vitamin D, because your need for both nutrients will go up.
Here’s an overview of the individual nutrients that can help strengthen your bones.
Your bones are actually made of the essential mineral calcium. If you were somehow to withdraw all of the calcium from your bones at once, you’d collapse to the floor like a jellyfish out of water. How much calcium should you be getting? Between 1,000 and 1,200 milligrams a day is a good benchmark, Dr. Nelson says. This amount is your total for both foods and supplements, which means that if you’re eating a lot of calcium-rich foods, you’ll need to adjust your supplement dosage accordingly. Good sources of calcium include milk, cheese, yogurt, tofu, canned salmon and sardines (with bones), spinach, kale, and broccoli.
Among supplements, any form of calcium will do the trick, though calcium citrate tends to be better absorbed, Dr. Nelson says. It also tends to cause less gas and gastrointestinal discomfort.
Too much calcium can contribute to kidney stones. If you have a history of stones, be sure to talk with your doctor before beginning calcium supplementation.
The mineral magnesium forms a part of bone structure albeit a small part. It helps keep bones from becoming brittle. The Daily Value for magnesium is 400 milligrams. Good food sources of magnesium include nuts, peanut butter, halibut, yogurt, potatoes, beans, lentils, and oatmeal.
The antioxidant vitamin C helps keep bones strong, according to Dr. Nelson. A variety of fruits and vegetables—including oranges, pineapples, cantaloupe, strawberries, and peppers—provide a healthy dose of vitamin C. The Daily Value for vitamin C is set at 60 milligrams.
Your skin naturally makes vitamin D when exposed to sunlight. But this process becomes less efficient as you get older, Dr. Nelson explains.
In 2005, researcher Michael Holick, MD, PhD, of Boston University School of Medicine, and his colleagues launched a study to determine the prevalence of vitamin D deficiency among women past menopause who were receiving therapy to prevent or treat osteoporosis. Blood tests revealed that more than half of the women had low levels of the nutrient, which is so important for building and maintaining bone strength.
Dr. Nelson suggests aiming for 400 to 800 IU of vitamin D per day. Achieving this range with foods alone can be a challenge; as mentioned earlier, you may need a supplement to make up the difference.
Good food sources of vitamin K include cauliflower, broccoli, and leafy green vegetables such as spinach and kale. Vitamin K is required for bone formation. A number of population studies have shown a connection between vitamin K intake and strong bones. In a study published in 2000, researchers at Tufts University in Boston analyzed nutritional data from the Framingham Heart study. They looked at the diets of 888 older men and women and found that those in the bottom quarter for the amount of vitamin K consumed had a 65 percent greater chance of hip fracture than those in the top quarter. Those who were consuming the least amount of vitamin K in their diets were getting about 50 micrograms, while those getting the most were taking in about 250 micrograms.
If you have osteoporosis, you should be under the care of a physician. It’s best to consult him or her before you begin taking any supplements. You might want to consider a multivitamin, just to make sure all your neutritional bases are covered. However, you should not take a multivitamin containing vitamin A if you have osteoporosis or are at risk for the disease. Also avoid breakfast cereals fortified with the vitamin. Finally, steer clear of high-protein diets and protein supplements, which can weaken bone.
Calcium* |
1,000 to 1,200 milligrams |
Magnesium |
400 milligrams |
Vitamin C |
60 milligrams |
Vitamin D |
400 to 800 IU |
Vitamin K |
250 micrograms |
*If you have a history of kidney stones, be sure to discuss calcium supplementation with your doctor.