Bone-Appetit! Eating Healthy to Boost Bone Health

Osteoporosis is a condition that causes our bones to thin and lose their strength. When bones become weaker, fractures can occur, even with minimal trauma. Every year in the United States, osteoporosis causes about two million broken bones. One in every two women and up to one in every four men will break a bone in their lifetime due to osteoporosis¹. If you are among those diagnosed with osteoporosis, have a family history, or are at high risk, making bone-healthy lifestyle choices can help you keep your bones strong for life.

As women grow older, their risk for osteoporosis increases, particularly those with a family history of the condition. While these risk factors for osteoporosis cannot be changed, there are some key lifestyle steps you can take to prevent or slow down the bone loss that leads to osteoporosis²:

• Follow a healthy eating plan that includes calcium-rich foods.
• Take calcium and vitamin D supplements as needed.
• Stay active. Engage in physical activity for at least 30 minutes daily, including aerobic exercise, strength training, and balance exercises.
• Take precautions to prevent falls. If you have weak bones, falling can easily cause a fracture. Many factors can lead to a fall: poor balance, weak muscles, foot or joint pain, poor vision, alcohol use, some medications, and hazards in the home. Engage in activities that help improve your strength and balance to help prevent falls.
• If you’re a smoker, talk with your primary care provider or your diabetes care and education specialist about quitting.
• If you choose to drink alcohol, don’t drink too much. (Limit yourself to no more than one to two drinks per day).

Our bones store most of the calcium in our bodies. Our bodies need calcium to build new bones and help our muscles, nerves, and cells work properly. Your body gets the calcium it needs from food or supplements that contain calcium, or by taking calcium from your bones. If the calcium taken from the bones is not replaced, your body will make less new bone, and over time, your bones will get weaker. Bones need nutrients so they can continue to grow. A bone-healthy eating plan can be a good strategy to prevent ongoing bone loss and should be part of an overall healthy lifestyle that includes various types of physical activity. A calcium-rich eating plan is important to maintain optimal bone health and prevent osteoporosis. Vitamin D is also helpful for the body to absorb calcium and deposit it into bones².

Top Tips for Eating to Promote Healthy Bones:

1. Eat more vegetables, fruits, and whole grains.

Research shows that eating more vegetables and fruits will improve bone health. These foods are generally lower in calories and fat, and they are high in fiber and essential vitamins and minerals. They also contain special plant nutrients called phytochemicals that can protect against various diseases, including osteoporosis. Aim to eat four or more servings of vegetables and three servings of fruit each day. Fruits and vegetables are excellent sources of magnesium and potassium, as well as vitamins C, K, and A; all play a role in maintaining bone health. Leafy greens and other nutrient-rich plant foods are also good for your bones.

While beans contain calcium, magnesium, fiber, and other nutrients, they are also high in substances called phytates. Phytates interfere with your body’s ability to absorb the calcium that is contained in beans. You can reduce the phytate level by soaking dry beans in water for several hours before cooking them in fresh water.

You should aim to eat four servings of grains daily, with at least half being whole grains. Whole grains contain more nutrients, especially magnesium and fiber, than the more processed refined grains do. Wheat bran (like beans) contains high levels of phytates, which can prevent your body from absorbing calcium. However, unlike beans, 100% wheat bran also appears to reduce the absorption of calcium in other foods eaten at the same time. This means if you have milk and 100% wheat bran cereal together, your body can absorb some of the calcium from the milk but not all. The wheat bran in other foods like bread is in smaller quantities and thus will likely have less impact on calcium absorption. If you take calcium supplements, it is best to take them two or more hours before or after eating 100% wheat bran cereal.

2. Choose healthy sources of protein and fat.

Protein is important for bone health because it’s a major part of bone tissue and plays a role in maintaining bone. Protein should account for 25% to 35% of your total daily calories, a minimum of 60 grams of protein per day. Check with your healthcare team for the recommended amount of protein for your needs². Many older women do not consume enough protein each day, which may be harmful to bones that are already at risk. The best choices include plant proteins, such as beans and nuts, as well as fish, skinless poultry, and lean cuts of meat. Plant proteins are rich in vitamins, minerals, and estrogen-like plant compounds that help preserve bone. Low-fat dairy products, including milk and plain yogurt, are other good sources of protein and are also rich in calcium, which benefits bone health. On the flip side, too much protein can interfere with bone health. High-protein eating plans that contain multiple servings of meat and protein with each meal can cause the body to lose calcium.

You need some fat intake for your body to function properly. The best choices are monounsaturated fats, such as those found in olive oil, nuts, and seeds. Cold-water fish also provide essential omega-3 fatty acids. Try to limit saturated fats (including animal fats), which have been shown to be harmful to overall health and to bone health in adults.

3. Get plenty of calcium and vitamin D.

Calcium is critical to bone health. This mineral is a key building block of bone, and it helps prevent bone loss and osteoporotic fractures in older people. Although the recommended daily intake for adults generally ranges from 1,000 to 1,200 milligrams, the typical eating plan provides much less. Try to eat more foods that are high in calcium, such as dairy products like milk, yogurt, and cheese. For example, one 8-ounce serving of milk contains about 300 milligrams of calcium. Calcium is also found in dark green leafy vegetables such as kale and broccoli. Some foods, such as spinach, rhubarb, beet greens, and certain beans, are high in oxalates. Your body does not absorb calcium well from foods high in oxalates. These foods contain other healthy nutrients but should not be counted as sources of calcium. Some foods, such as plant-based milk, some juices, and even some cereals, may be fortified with calcium³.

If you are unable to consistently get enough calcium in the foods you eat, a calcium supplement may be recommended. Check the label to find out what type of calcium the supplement has. Take calcium citrate with or without food. Take calcium carbonate with food. The acid the stomach makes while eating helps the body absorb calcium carbonate. It’s best to take calcium in smaller doses (500 milligrams or less at a time). To take 1,000 mg of calcium a day, split it into two or more doses over the day.

Calcium supplements and many prescription medications do not mix well. This includes antibiotics, bisphosphonates, and high blood pressure medicines. Ask a pharmacist or member of your healthcare team what medicines shouldn’t be taken with calcium supplements. For people who take calcium supplements and multivitamins, it’s best to take them at different times of the day. Calcium can affect how the body absorbs the nutrients iron, zinc, and magnesium. It is best not to take a calcium supplement at the same time as a meal that’s high in iron. Foods high in iron include lean meat and seafood, nuts, beans, vegetables, and grains that have iron added to them.

In the United States, most people do not consume enough vitamin D to meet recommended intakes. Some vitamin D can be made in the body with sun exposure. Still, many people have low vitamin D status. Some kinds of fish, including trout, salmon, tuna, and mackerel, can provide some of the vitamin D we need each day. Most of the vitamin D that Americans get from food comes from fortified foods. Most milk and some yogurts in the United States are fortified with vitamin D. Some ready-to-eat breakfast cereals and orange juice may be fortified with vitamin D. Some multivitamin and mineral supplements contain vitamin D. Research shows that vitamin D3 (both liquid and capsule) is more effective than vitamin D2 at increasing blood levels of vitamin D. Always talk to your healthcare provider before starting to take supplements⁴.

4. Limit sugar, salt, and phosphate additives.

Limit your intake of processed foods and beverages, such as soft drinks. Phosphorus is used as an additive in many processed foods and too much phosphorus in your eating plan can interfere with how much calcium is absorbed through your small intestine. Foods that contain sugars added during processing generally provide a lot of calories, additives, and preservatives.

While more research will help us better understand the link between soft drinks and bone health, we know that carbonation in soft drinks is not harmful to bone health. The caffeine and phosphorus often found in colas may contribute to bone loss. Phosphorus is listed as an ingredient in colas and other processed foods as “phosphate” or “phosphoric acid.” The harm to bones may be caused when people choose soft drinks over milk and calcium-fortified beverages.

Eating foods that have a lot of sodium causes your body to lose calcium and can lead to bone loss. Try to limit processed foods, high-sodium canned foods, and salt added to the foods you eat each day. To learn if a food is high in sodium, look at the Nutrition Facts label. If it lists 20% or more for the % Daily Value, it is high in sodium. Aim to get no more than 2,300 mg of sodium per day (about the amount in 1 teaspoon of salt).

5. Limit alcohol and caffeine consumption.

Consuming more than one or two alcoholic drinks per day can contribute to bone loss and reduce your body’s ability to absorb calcium. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink per day for women of all ages and men older than 65, and up to two drinks a day for men 65 and younger. Drinking alcohol with meals will slow calcium absorption, as well.

Caffeine can slightly increase calcium loss during urination. But much of its potentially harmful effect stems from substituting caffeinated beverages for milk and other healthy drinks. Moderate caffeine consumption of two to three cups of coffee per day will not be harmful if you consume adequate calcium. Calcium and vitamin D are sometimes added to juices, breakfast foods, plant-based milks, and even breads.

Keep Learning!

The Bone Health and Osteoporosis Foundation provides a comprehensive table of bone-healthy foods and their nutrients at their website: https://www.bonehealthandosteoporosis.org/preventing-fractures/nutrition-for-bone-health/nutrients/³

To learn more about osteoporosis and ways to boost bone health with healthy foods and an active lifestyle, visit these websites for trustworthy information:

• Bone Health and Osteoporosis Foundation: https://www.bonehealthandosteoporosis.org/patients/³
• National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases Nation Resource Center. Osteoporosis Overview: https://www.niams.nih.gov/health-topics/bone-health-and-osteoporosis⁴

Bone-Appetit!

References:

1. Kerr C, Bottomley C, Shingler S, Giangregorio L, de Freitas HM, Patel C, Randall S, Gold DT. The importance of physical function to people with osteoporosis. Osteoporos Int 2017;28(5):1597-1607. doi: 10.1007/s00198-017-3911-9. Epub 2017 Mar 6. PMID: 28265717; PMCID: PMC5391375.
2. Muñoz-Garach A, García-Fontana B, Muñoz-Torres M. Nutrients and dietary patterns related to osteoporosis. Nutrients 2020;12(7):1986. doi: 10.3390/nu12071986. PMID: 32635394; PMCID: PMC7400143.
3. Bone Health and Osteoporosis Foundation:  https://www.bonehealthandosteoporosis.org/patients/. Accessed February 7, 2025

NIH Osteoporosis and Related Bone Diseases Nation Resource Center. Osteoporosis Overview. https://www.niams.nih.gov/health-topics/bone-health-and-osteoporosis Accessed February 7, 2025