Protein sources include lean red meat, poultry, eggs,
fish and diary as well as legumes (lentils, kidney beans),
tofu, soymilk, vegetables, nuts, seeds and grains. There
has been some conflict regarding the effect of animal
versus vegetable protein on bone health. This will be
discussed in the researchand acceptance section.
FRUIT AND VEGETABLES.The Framington Heart
Study (1948–1992) showed thatlifelong dietary intakes
of fruit and vegetables havebeneficial effects on bone
mineral density in elderly men and women. A 2006 Brit-
ish study also suggests that fruit and vegetable intakes
may have positive effects on bone mineral in adolescents
as well as older women. As of 2007, the nutrients, which
are thought to improve bone mineral density, are still to
be determined. It may be due to their alkaline nature,
which neutralizes acids of digestion without using the
buffering effects of calcium, or to theirvitamin C,beta-
carotene,vitamin K, magnesium or potassium content.
As such the recommendations are to aim for at least five
portions of fruit and vegetable a day.
VITAMIN K.Vitamin K is required for the produc-
tion of osteocalcin, which is important for bone min-
eralisation. It seems Vitamin K may not only increase
bone mineral density in osteoporotic people, but also
reduce fracture rates. However, the mechanism is not
well understood and in 2007, there is still inadequate
evidence to show adding vitamin K would be effective
in preventing or treating osteoporosis. Good dietary
sources of Vitamin K are green leafy vegetables such
as spinach, lettuce, cabbage, kale, liver and fermented
cheeses and soybeans. Keeping to the recommenda-
tion of 5 portions of fruit and vegetables a day can help
optimise Vitamin K intakes.
MAGNESIUM.Magnesium is a mineral that helps
keep blood calcium levels constant. The elderly are at
most risk of low magnesium levels, as magnesium absorp-
tion rates decrease and excretion rates increase with age.
However, as of 2007, no studies recommend magnesium
supplementation for preventing or treating osteoporosis.
Good food sources of magnesium are green leafy vegeta-
bles, legumes, nuts, seeds and whole grains.
ZINC.Zinc is a constituent of hydroxylapatite, the
main mineral component of bone. Dietary sources
include whole grain products, brewer’s yeast, wheat
bran and germ, seafood and meats and poultry. Zinc
from animal sources are more easily absorbed than
vegetable sources, so vegetarians may be at risk for
low levels of zinc.
Nutrients that hinder bone health
ALCOHOL.Moderate alcohol intake of 2 units of
alcohol /day is not thought to be harmful to bone
health. However, studies show that more than 2
units/day are associated with a decrease in bone
formation.
CAFFEINE.Caffeinehas been implicated as a factor
for osteoporosis, but without any convincing evidence
up to 2007. Moderate consumption of caffeine,
400mg/d, the equivalent of 3 to 5 cups of coffee,
depending on the size and strength, can be taken as
part of a healthy diet.
SOFT DRINKS.In 2007 there were suggestions that
the high phosphate content of carbonated cola drinks
can result in low peak bone mass. However, there is no
conclusive evidence that supports the claim. The prob-
lem tends to be the soft drinks displace milk in the diets
of children and teenagers. The advice is to consume
these drinks in moderation.
SALT.A high salt (sodium) intake increases excre-
tion of calcium in the urine, so is considered a risk
factor for bone loss and osteoporosis.
VITAMIN A.Vitamin Aplays an important part in
bone growth, but too much in the form of retinol,
found in foods of animal origin such as liver, fish
liver oils and dairy products, may promote fractures.
Vitamin A as carotene, in green leafy vegetables and
red and yellow fruits and vegetables, does not appear
to cause problems. As of 2007, more studies are
recommended.
BOTANICAL MEDICINES OR HERBAL SUPPLEMENTS.
Herbalists and Chinese medicine practitioners believe
that certain herbs can slow the rate of bone loss. Some
commonly recommended products are ones contain-
ing calcium carbonate or silica such as horsetail, oat
straw, alfalfa, licorice, marsh mallow, yellow dock,
and Asianginseng. Natural hormone therapy, using
plant estrogens (from soybeans) or progesterone (from
wild yams), may be recommended for women who
cannot or choose not to take synthetic hormones.
However, because the FDA does not regulate the
manufacture and distribution of herbal substances in
the United States, no quality standards currently exist.
Individuals need to discuss use of these substances
with their doctor or pharmacist or dietitian.Function
Bone density at any time depends on the amount
of bone formed by the early 1920s. Fracture risk is
highest in those who do not achieve peak bone mass
(the highest level of bone strength) in early life and or
lose bone rapidly with age and menopause. Increased
calcium intakes during the growth phase of childhood
and adolescence maximizes peak bone mass. An
increase of 10% in peak bone mass in adolescenceOsteoporosis diet