Which food selection for a patient with osteoporosis who is trying to improve calcium?

Osteoporosis is a condition characterized by low bone mass and the breakdown of bone tissue. When you have osteoporosis, your bones become weaker (1, 2).

This condition is more common in women and elderly people. In fact, a 2021 review reported that the worldwide prevalence of osteoporosis in women was 23.1%, while the prevalence of osteoporosis among men was found to be 11.7% (3).

Additional risk factors for this condition include being being smaller or thinner than average, smoking and drinking excessively, and having a family history of osteoporosis (4, 5).

Because osteoporosis weakens the bones, those with osteoporosis are more at risk for fractures, including fractures of the vertebra, wrist, and hip.

Fortunately, there are ways to improve bone mineral density and reduce fracture risk when you have osteoporosis as well as steps to take to reduce your risk of developing osteoporosis in the first place.

In this article, we’ll share diet tips to help promote bone health when living with osteoporosis.

Whether you already have osteoporosis or want to reduce your risk of developing osteoporosis, there are certain dietary tips to be aware of.

For example, not getting enough of the following nutrients could put you at risk for low bone mineral density and osteoporosis.

Protein

Protein makes up about 50% of your bone volume and ⅓ of your bone mass, so taking in optimal amounts of protein on a daily basis is incredibly important for bone health (6).

Studies show that suboptimal protein intake increases the risk for low bone mineral density and that older adults following higher protein diets tend to have higher bone mineral density and lower fracture risk (7).

Because of this, some osteoporosis experts recommend a protein intake between 1.0–1.2 grams per kg (.45-.54 grams per pound) per day, which is much higher than the current Recommended Dietary Allowance (RDA) of .8 grams per kg of body weight (0.36 grams per pound) (6).

Calcium

Your body requires calcium to maintain healthy bones, which are constantly being remolded. Calcium is needed to form new bone tissue.

For this reason, it’s important to get recommended amounts of calcium in your diet when you’re living with osteoporosis (8).

However, this doesn’t necessarily mean through calcium supplements. Even though calcium is essential for bone health, it’s recommended to get your calcium through foods whenever possible. This is because some studies have linked high-dose calcium supplements to an increased risk of heart disease (9, 10, 11).

While some people may require calcium supplements to treat osteoporosis, others may be able to get enough calcium through foods like yogurt, cheese, dark leafy greens, beans, nuts, and seeds.

If you’re unsure whether or not you should be supplementing with calcium, ask your healthcare provider who manages your osteoporosis for advice.

Vitamin D

Without enough vitamin D, your body can’t absorb calcium properly. Because of this, it’s critical to maintain optimal vitamin D levels. Unfortunately, vitamin D insufficiency and deficiency are extremely common. In fact, about 50% of the world’s population has insufficient vitamin D levels (12).

Having low vitamin D levels can increase your risk of low bone mineral density and osteoporosis. For those with low or deficient vitamin D levels, supplementation may be necessary. This is because vitamin D is only concentrated in a few food sources, like fatty fish.

Your healthcare provider can test your vitamin D levels and then recommend an appropriate vitamin D supplement based on your level of insufficiency or deficiency, if needed.

Keeping in mind that some people may require vitamin D injections in order to increase their vitamin D level to a healthy range (13).

Other nutrients

In addition to protein, calcium, and vitamin D, there are a number of nutrients needed to maintain healthy bones, which may play a role in reducing the risk of developing low bone mineral density and osteoporosis.

Keep in mind that you may need to supplement with some of the following nutrients if your diet doesn’t provide adequate amounts.

• Magnesium: Your body needs magnesium to maintain bone health and not getting enough in your diet could increase your risk of developing osteoporosis. Also, your ability to maintain healthy magnesium levels declines with age. Studies show that magnesium supplements help increase bone mineral density and decrease fracture risk in older women. Magnesium can be found in foods like beans and vegetables (14, 15).
• Vitamin K: Vitamin K is necessary for the function of proteins involved in bone formation and maintenance. Low dietary vitamin K intake is associated with higher fracture risk. Vitamin K1 is found in green leafy vegetables like spinach and kale, and vegetable oils while vitamin K2 is concentrated in animal products like cheese and chicken as well as fermented foods (16).
• Vitamin C: Vitamin C is an important antioxidant and may help prevent bone breakdown. Having low levels of vitamin C is linked to reduced bone mineral density, so consuming vitamin C-rich foods is important for those with osteoporosis. Foods rich in vitamin C include citrus fruits, berries, peppers, and broccoli (17).
• Zinc: Zinc is needed for proper bone growth and maintenance and also promotes bone regeneration. Low levels of zinc have been associated with post-menopausal osteoporosis. Sources of zinc include seafood, nuts, poultry, and lentils. What’s more, zinc supplementation may help maintain bone mineral density and speed healing after fractures (18, 19).

The minerals potassium, boron, silicon, selenium, iron, and manganese are also needed for bone health (20).

Additionally, some research suggests that supplementing with omega-3s and collagen could be helpful for people with low bone mineral density and osteoporosis (21, 22, 23).

As you can see, there are a number of nutrients involved with bone health. Following a nutritious, well-rounded diet is the best way to ensure you’re getting optimal amounts of protein, vitamins, minerals, and other important compounds on a daily basis.

Research suggests that while certain diets may increase the risk of osteoporosis, other dietary patters could help protect against osteoporosis development and improve bone mineral density and overall health in people living with osteoporosis.

The Mediterranean diet is a way of eating that’s rich in whole foods like vegetables, fruits, beans, nuts, and fish. Studies show that a Mediterranean-style diet could help protect against fracture and osteoporosis risk and help maintain healthy bone and muscle mass (6).

The Mediterranean diet is high in bone-protective compounds like polyphenol antioxidants as well as bone-supportive nutrients like magnesium and calcium.

Maintaining sufficient protein could also be helpful for people living with osteoporosis and those who want to support overall bone health.

For example, a 2021 study in 2,160 older adults found that those with the highest dietary protein intake had up to 6% higher bone mineral density in their hips and lower spine compared to older adults with low protein intake (24).

Plus, the older adults who ate the most protein had a reduced risk of vertebral fractures compared to the low protein group (24).

Keep in mind that while following a nutrient-rich diet like a well-balanced Mediterranean diet can help support bone health and protect against osteoporosis, you may still need to supplement with certain nutrients, like vitamin D and magnesium, in order to maintain optimal levels.

Other dietary patterns, including well-planned Asian or all-vegetarian diets may be effective in helping to prevent osteoporosis or fractures (6).

A healthcare provider like your doctor who manages your osteoporosis can perform testing to identify potential insufficiencies and deficiencies in certain nutrients and can recommend appropriate treatment if needed.

A dietitian can also recommend helpful supplements and dietary patterns to support your health and improve your bone mineral density.

Diets high in ultra-processed foods, added sugar, and excessive salt could harm bone health and increase the risk of bone diseases like osteoporosis.

The Western diet is a dietary pattern characterized by high intakes of ultra-processed foods, sweetened beverages, fried foods, processed meats, and refined grains. This way of eating is linked to lower bone mineral density and a higher risk of osteoporosis and fractures (6).

This eating pattern contributes to weight gain and obesity, which can negatively impact bone health by reducing bone formation.

The high fat and sodium content of the Western diet can reduce calcium absorption and increase bone loss. What’s more, the Western diet causes an acidic environment in the body, which may cause bone breakdown ( 6).

A high intake of added sugar from sugary foods and beverages like ice cream and soda can also contribute to osteoporosis by increasing calcium loss through the urine and interfering with calcium homeostasis (25).

Consuming sugary soda is especially harmful to bone health because soda is high in sugar and phosphoric acid additives, which can inhibit bone mineralization (6).

Although some study findings suggest caffeine consumption may be harmful to bone health, not all studies have found a negative association. Therefore, more research is needed (26).

Here is a 5-day healthy eating plan for people with osteoporosis. This menu is high in protein and nutrient-rich foods like vegetables, beans, and seeds, which help promote bone health.

Keep in mind that this meal plan only covers basic meals and doesn’t list serving sizes. This is because your calorie needs depend on your activity level, body size, gender, age, and more.

If you’re unsure of how many calories you should be consuming, consider making an appointment with a registered dietitian. They can help you develop an eating plan that’s specific to your health needs and weight goals.

Breakfast

• whole eggs scrambled with spinach and zucchini served with sliced avocado and a cup of mixed berries

Lunch

• a Mediterranean quinoa bowl made with chickpeas, roasted red peppers, feta, cucumbers, olives, tomatoes, artichokes, and red onions

Dinner

• roasted salmon served with mashed sweet potatoes and garlicky broccoli

Breakfast

• a parfait made with full-fat unsweetened Greek yogurt, diced apples, pumpkin seeds, and unsweetened almond butter drizzled with honey and sprinkled with cinnamon

Lunch

• lentil soup served with a large green salad topped with an olive oil and lemon juice-based vinaigrette

Dinner

• turkey burgers served with a Greek salad made with cucumber, feta, cherry tomatoes, and red onion and roasted herbed potato wedges

Breakfast

• cottage cheese topped with almond butter, chia seeds, and blueberries.

Lunch

• veggie and grilled shrimp kabobs served over quinoa

Dinner

• burrito bowl made with chicken, sautéed vegetables, salsa, guacamole, shredded cheese, black beans, and brown rice

Breakfast

• a smoothie made with unsweetened milk of choice, frozen berries, ground flax, unsweetened peanut butter, and unsweetened vanilla protein powder

Lunch

• a large salad made with mixed greens, sunflower seeds, goat cheese, chopped vegetables of your choice, and grilled chicken or grilled shrimp served with whole grain crackers and hummus

Dinner

• sweet potato and lentil coconut curry served over brown rice

Breakfast

• roasted vegetable buddha bowl topped with jammy eggs

Lunch

• creamy sesame brown rice noodles topped with chopped peanuts and fresh herbs

Dinner

• Chicken chili topped with a dollop of Greek yogurt and sliced avocado plus a green salad

Osteoporosis is a bone condition that impacts millions of people worldwide.

Whether you already have osteoporosis or are trying to reduce your risk of developing osteoporosis, following a diet rich in nutrients essential for healthy bones and low in foods and beverages that may harm your skeletal system is key.

In general, a diet high in protein and bone-protective nutrients like calcium and vitamin D, as well as magnesium and vitamin C, and low in foods and beverages like fast food and soda is best for bone health.

If you’d like to develop a bone health-promoting diet that’s specific to your health needs, consider working with a registered dietitian.