As with calcium, evidence from surveys show that
intake levels fall below the recommendations. In the
USA, the NHANES (1999-2000), found a prevalence
of vitamin D insufficiency in healthy adults living in
Canada and the United States despite their Vitamin D
food fortification programs. The UK NDNS (1998) of
people aged 65 years and over found that approxi-
mately 98% had vitamin D intakes below the level.
The same survey in 1990 of people aged 4 to 18 years
also found a low vitamin D state in a significant pro-
portion of those surveyed. In both sexes, this problem
increased with age and thought linked to less time
spent outside.
As of 2007, the IOF recommends the 2002 The
Food and Agriculture Organisation (FAO) and the
World Health Organisation (WHO) recommended
Vitamin D intakes, which are based on Western Euro-
pean, American and Canadian data.
In addition to calcium and Vitamin D there is some
evidence to suggest that other nutrients are beneficial to
bonehealthsuchasmagnesium,zinc,vitaminsA, B, C,
and K, however some of the evidence is weak and
controversial as discussed below.Description
The osteoporosis diet focuses on maintaining or
building strong bones throughout life. The emphasis is
on Calcium and Vitamin D, but a balanced diet, with
adequateproteinand fresh fruits and vegetables and
moderate intakes of alcohol, is also recommended.
Other nutrients, which may promote or hinder bone
health, are also included in this section.Nutrients that promote bone health
CALCIUM.There are many foods that contain cal-
cium, but not all are good sources because the calcium
may not be well absorbed. Some non-dairy sources of
calcium, such as cereals and pulses, contain compounds
that bind to the calcium reducing its ability to be
absorbed. For example, oxalates in spinach and rhubarb
and phytates in pulses such as lentil, chickpeas and
beans, and cereals and seeds. They do not however inter-
fere with the absorption of calcium from other foods.
The most readily absorbed sources of dietary cal-
cium include:
Dairy products: These are rich sources of well-
absorbed calcium and include foods such as milk,
cheese, cream, yoghurt and fromage fraise. They
are also a good source of other nutrients that that
work together to help protect bone such as protein,
Vitamin D, zinc and magnesium. Three servings of
dairy foods daily is the recommendation. One serv-ing is approximately 250ml milk, 200 g yoghurt and
40 g cheese, which provide 300mg calcium.
Green leafy vegetables: These include broccoli, col-
lard greens, mustard greens, kale and bok choy.
Broccoli (85g) provides 34mg calcium
Tinned fish: These need to fish with edible bones such
as sardine, pilchards, and salmon. Tinned sardines
(100g) provides 430mg calcium
Nuts and seeds: Especially Brazil nuts and almonds.
6 almonds provides 31mg calcium
Fruit: Especially oranges, apricots and dried figs. 1
orange provides 75mg calcium
Tofu set with calcium: If it is prepared using calcium
sulphate tofu (100g) contains 200–330mg calcium.
Some foods and drinks are fortified with calcium
such as breads, cereals, orange juice and Soya milk
(Soya milk doesn’t naturally contain calcium). These
products should be specifically labeled as such.
VITAMIN D.It is made in the body by the action of
the sun on the skin and a fifteen-minute walk each day
usually provides all the vitamin D the body needs.
Vitamin D is also fat-soluble vitamin found mainly
in foods of animal origin.
Dietary sources of Vitamin D include:
Oily fish: Salmon, tuna, mackerel, and sardines.
Tinned sardine (100g) provides 260 IU Vitamin D
Liver: Cooked liver (100g) provides 17 IU Vitamin D
Egg yolk: 1 whole egg provides 20 IU Vitamin D
Fish oil: 1 tablespoon provides 1360 IU Vitamin
In some countries vitamin D is added to breakfast
cereals, grain products and pastas, milk, milk prod-
ucts, margarine, and infant formula. In the US milk
has been fortified since the 1930’s, which almost elim-
inated rickets. In 2003 the Food and Drug Adminis-
tration (FDA) approved the fortification of calcium-
fortified juice and juice drinks. Canada has mandatory
fortification of milk and margarine. In the UK, all
margarine is fortified with vitamin D and it is added
voluntarily to other fat spreads and some breakfast
cereals. In Australia, margarine and some milk prod-
ucts are fortified. Finland introduced fortification of
milk and margarines in 2003, while other European
countries do not allow for any food fortification.
PROTEIN.During growth, low protein intakes can
impair bone development increasing the risk for osteo-
porosis later in life. Protein is also important for main-
taining muscle mass and strength. This is particularly
important for the elderly to help prevent falls and
fractures.Osteoporosis diet