Nutrition

Nutrition for Bone Health

Last updated: May 01, 2014

Nutrition, physical activity, genetics, and overall health contribute to the density and strength of your bones. Throughout life, existing bone matter is continuously replaced with new bone matter. Between infancy and age 25 years, bone grows rapidly, making it dense and strong. But physiologic changes associated with aging, including absorbing less calcium, having lower levels of certain hormones such as testosterone and estrogen, and being less active can contribute to bone loss. In many people, bone loss eventually exceeds the amount of new bone the body produces, making bones more porous, weak, and prone to fractures and breaks — a condition known as osteoporosis (or porous bones).1

Bone Loss Facts

Approximately 10 million Americans have osteoporosis, and more than 40 million Americans have  low bone density (osteopenia) that can lead to osteoporosis if it's left untreated. Research shows that 1 in 2 white women and 1 in 5 white men will eventually have an osteoporosis-related fracture. Osteoporosis is less common in African Americans; but African Americans with osteoporosis have the same risk for fracture as white men and women.

Learn about a test 
that can assess the health of your bones
.

Why Healthy Bones Matter

When you consume too little calcium, your body begins using calcium stores in your bones to support many body functions such as nerve tranmissions, muscle function, hormone secretion, and the expansion and contraction of blood vessels. As a result, your bones can become more porous, brittle, and prone to fractures and breaks. 1

To prevent serious health problems as you age, it's important to prevent bone loss, fractures, and breaks that limit mobility and potentially cause other serious health problems and sometimes death. For example, hip and spine fractures can necessiate prolonged bedrest and lead to potentially fatal diseases of the lungs such as pneumonia. Being bed ridden also can reduce appetite, which increases overall weakness. Fractures of the spine often cause severe, long-lasting back pain and disability that can cause poor posture and make it difficult to balance properly. Poor balance and poor posture can contribute to falls, fractures, and breaks.

In addition to physiologic problems from bone loss, some people with osteoporosis suggest that their inability to participate in normal activities isolates them and makes them feel depressed.

Factors that contribute to osteoporosis include:1,2

  • Getting too little calcium
  • Getting too little vitamin D
  • Drinking too much alcohol
    • Alcohol inhibits calcium absorption
    • Alcohol prevents enzymes from converting vitamin D to its active form, which promotes calcium absorption
      and enables the growth of new bone
  • Being inactive
  • Being underweight
    • ​Many people who are underweight have lower bone density compared with people of average or above average weight
  • Certain diseases such as irritable bowel syndrome and Crohn's disease
    • ​Some gastrointestinal diseases limit the asporption of important nutrients such as calcium and vitamin D
  • Consuming too much vitamin A
    • Having too much vitamin A interferes with the aborption of vitamin D, which is necessary for calcium aborption
  • ​Eating too much salt
    • Salt increases the amount of calcium excreted in urine
  • Low hormone levels
    • Low estrogen in women, which is typical during and after menopause
    • Low testosterone in men, which often occurs with aging
  • Smoking, including regular exposure to second-hand smoke
  • Prolonged use of certain medications, including:
    • Glucocorticoids that treat asthma and rheumatoid arthritis
    • Anticoagulants such as heparin
    • Anticonvulsants such as phenytoin and carbamazepine
    • Antacids such as Maalox and Mylanta that contain aluminum, which reduces calcium absorption
    • Certain chemotherapies

Tips to Prevent Osteoporosis1,3

Because osteoporosis is difficult to reverse, prevention is key to helping protect your bone and overall health. In addition to eating foods that are rich in calcium, it is important to get plenty of vitamin D so that you absorb the calcium you eat. 

To help keep your bones strong:1,3

  • Get 1000 milligrams of calcium per day if you are a man age 50 to 70 years
  • Get 1200 mgs per day if you are a woman age 51 years older or man age 71 years and older
    • Certain foods contain supplemented calcium*
    • Diary products account for up to 80 percent of calcium
    • Calcium is available in tablet supplements 
  • Get plenty of vitamin D4
    • Choose foods that are naturally rich in or fortified with vitamin D
    • Get 20 minutes of sunlight each day 
  • Engage in weight-bearing exercises at least 6 days per week, including:1,5

The Food and Drug Administration has approved medications to prevent and treat postmenopausal osteoporosis, including the bisphosphonates Actonel®, Boniva®, and Fosamax® and hormone replacement therapies. If you are a woman who is navigating or has gone through menopause, talk with your doctor about whether you need medication to help prevent bone loss.

Good sources of dietary calcium include:3

        Food = Percent Daily Value of Calcium
       
 The daily value (DV) for calcium is 1000 mg for adults.

  • Plain, low-fat yogurt, 8 ounces = 42 
  • Part-skim mozzarella, 1.5 ounces  = 33                                                      
  • Sardines canned in oil with bones, 3 ounces = 33
  • Nonfat milk, 8 ounces = 30
  • Reduced-fat (2 %) milk, 8 ounces = 30
  • Whole milk, 8 ounces = 28
  • Calcium-fortified soy milk, 8 ounces = 30
  • Low-fat buttermilk, 8 ounces = 28
  • Reduced-fat (1%) cottage cheese, 1 cup = 14
  • Calcium-fortified orange juice, 6 ounces = 26
  • Firm tofu processed with calcium sulfate, 1/2 cup = 25
  • Canned pink salmon with bones, 3 ounces = 18
  • Ready-to-eat calcium-fortified cereal, 1 cup = 10 to 100
  • Vanilla soft frozen yogurt, 1/2 cup = 10
  • Fresh boiled turnip greens, 1/2 cup = 10
  • Raw broccoli, 1/2 cup = 2
  • Raw, chopped kale, 1 cup = 10
  • Fresh cooked kale, 1 cup = 9
  • Vanilla ice cream, 1/2 cup = 8
  • Raw, shredded Chinese cabbage (bok choi), 1 cup = 7
  • 1 slice of white bread = 7 
  • 1 slice of whole-wheat bread = 3
  • Ready-to-eat chocolate pudding, 4 ounces = 6
  • Corn tortilla, 6-inch = 5
  • Flour tortilla, 6-inch = 3
  • Reduced-fat, cultured sour cream, 2 tablespoons = 3
  • Cream cheese, 1 tablespoon = 1

Good sources of dietary vitamin D include:4

       Food = Percent Daily Value of Vitamin D
       The daily value (DV) of vitamin for adults is 400 international units (IU)*.

  • Cooked swordfish, 3 ounces = 142
  • Cooked sockeye salmon, 3 ounces = 112
  • Canned tuna packed in water and drained, 3 ounces = 39
  • Orange juice fortified with vitamin D, 1 cup = 34
  • Nonfat, reduced-fat, and whole milk fortified with vitamin D, 1 cup =29 to 31
  • Yogurt fortified with vitamin D, 6 ounces = 20
  • Margarine fortified with vitamin D, 1 tablespoon = 15
  • Sardines canned in oil and drained, 2 sardines = 12
  • Cooked liver, 3 ounces = 11
  • Cooked beef, 3 ounces = 11
  • 1 large egg = 10
  • Read-to-eat cereal fortified with vitamin D, 1 cup = 10
  • Swiss cheese, 1 ounce = 2

Things to Know About Calcium and Vitamin D3,4

  • Calcium content in milk varies by fat content, with more fat equaling less calcium
    • Check food facts labels for calcium amounts in foods and supplements
  • Calcium is best absorbed in 500-mg or smaller amounts at a time
    • Instead of taking 1000 mgs of calcium with breakfast, take smaller amounts 2 to 3 times per day
  • Caffeine reduces calcium absorption and increases calcium excretion
    • Avoid taking calcium supplements with caffeinated beverages and foods
  • Calcium supplements can interfere with absorption for certain medications
    • If you are taking medication, ask your doctor if you should take calcium supplements3
  • Vitamin D promotes calcium absorption and helps maintain healthy calcium levels in the blood

*Vitamin D content on food labels is listed as a percentage of 400 International units (IUs). For example, if a food label lists 20% vitamin D, 1 serving of the food contains 80 IUs of vitamin D.4

*Calcium content on food labels is listed as a percentage of 1000 mg. For example, if the label lists 50% calcium, 1 serving of the food contains 500 mg of calcium.3
 

References

1. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. http://nof.org/hcp/clinicians-guide. Accessed May 1, 2014.
2. Kondo K. Osteoporotic vertebral compression fractures and vertebral augmentation. Semin Intervent Radiol. 2008; 25(4):413-424.
3. National Institutes of Health. Office of Dietary Supplements. Calcium Dietary Supplement Fact Sheet. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Accessed May 1, 2014.
4. National Institutes of Health. Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed May 1, 2014.
5. International Osteoporosis Foundation. Exercise Recommendation. http://www.iofvonehealth.org/exercise-recommendations. Accessed May 1, 2014.

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