Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It often affects older adults, especially women, due to hormonal changes that can impact bone density (more to come - I’m putting together something exciting about this!). Interestingly, although we may not develop osteoporosis until later in life, the process of our bones losing density starts happening much earlier in life. In fact, we hit peak bone mass around age 30 and from there our lifestyle and habits determine how quickly we start to develop bone weakness, eventually leading to osteoporosis. So, like many things in health, what we do in our 20’s and 30’s will determine our quality of life and vitality as our level of wisdom increases!
Understanding Osteoporosis
Our bones are constantly renewing themselves through a balance of breaking down old bone tissue and building new bone. With osteoporosis, bone loss happens faster than bone formation, leading to lower bone density. Common signs include back pain, changes in posture, and a higher risk of fractures. In fact, in severe cases of osteoporosis, even simple things like coughing, sneezing or bumping into something can cause your bones to break.
When it comes to developing osteoporosis there are things that are within your control, your lifestyle; and things that are not, called non-modifiable risk factors. Also there are certain medications or medical conditions that can increase your risk of developing osteoporosis.
Non-modifiable risk factors: being older than 50 years old, being a woman, being postmenopausal, having a family history of osteoporosis and having a small frame (me raising my hand since I’m a whopping 5 feet tall :) ).
Lifestyle: how much activity you do, whether you smoke and drink alcohol, your nutrition and whether you are getting enough key vitamins/minerals (such as vitamin D, vitamin K, calcium and magnesium)
Medications: steroids, proton pump inhibitors called PPIs (which are used to treat acid reflux), some anxiety and depression medication, some medications used to treat Type 2 Diabetes, some anti-seizure medication and some cancer medications.
Medical conditions: celiac disease, inflammatory bowel disease, cancer, lupus or kidney/liver disease
Prevention Tips
Even if you fall in the category of having or living with non-modifiable risk factors, there is still a lot you can do to prevent osteoporosis. Here are the key nutrients, vitamins and lifestyle habits that will help you stack the deck in your favor!
Calcium
Like I mentioned above, our bones are constantly remodeling - breaking down and rebuilding. To accomplish this remodeling our bones need calcium. As our level of wisdom increases, our bones will tend to lose more calcium than they maintain, which will increase our chance of developing osteoporosis. One group of women that is especially high risk, are women who are postmenopausal.
Do you remember the ‘Got Milk” commercials?? In fact, there is a more recent advertisement #TeamMilk for the Every Women’s Marathon. Based on these well known commercials that are widely publicized, the public has been led to believe that drinking milk helps to build strong bones and in turn helps to prevent osteoporosis. Unfortunately the research does not support this claim. While cow’s milk will certainly provide large amounts of calcium, around 300 mg for a cup of milk, this cup of milk also contains saturated fats, sugars, animal proteins and sometimes growth hormones and contaminants. So if you’re not drinking milk to get calcium, where else can you get it and just how much do you need? Focus on plant-based sources like leafy greens (kale, bok choy, collard greens), fortified plant milks, almonds, tofu, and chia seeds. If you choose to eat animal sources then look to dairy, eggs and certain shellfish. The daily recommended calcium intake varies.
Adults: 1,000 mg/day
Women over 50 years old and men over 70 years old: 1,200 mg/day for women
Children and teens: 1,300 mg/day
Vitamin D
Vitamin D plays a huge role in bone health and is essential for preventing osteoporosis. Vitamin D helps our bodies absorb calcium, so even a calcium-rich diet can’t fully support bone health without an adequate amount of Vitamin D. Therefore, to reduce the risk of broken bones and to support long term bone strength, it is critical to maintain adequate Vitamin D levels. If you have never had your Vitamin D levels checked, it may be a good idea to discuss this with your physician. I will caution you though, in our current insurance driven healthcare system, most insurance companies will not pay for Vitamin D testing. This is one of the many reasons I opened a direct primary care (DPC) practice so that I can order this test at a very minimal cost to my patients and without interference from insurance.
While many people think of vitamin D as something we get primarily from animal sources, there are several plant-based options as well. Certain mushrooms, like shiitake can provide vitamin D. Also, fortified plant-based milks, orange juice, and cereals are also good sources of vitamin D. This means that if you choose to have a more plant-based nutritional pattern you can still get your Vitamin D without relying on animal products. One added recommendation is to get enough mid-day sun! Check out my Vitamin D video on Walk With A Doc!
Incorporating these sources into your diet, along with regular sun exposure when possible, can help make sure you support bone health naturally. For those living in colder climates, locations with limited sun exposure, or those with darker skin, more sunlight may be required. The general recommendation is to get 10-30 minutes of sun exposure a day around mid-day, over much of your body. If you are taking a Vitamin D supplementation, it is recommended that you get your blood checked to ensure you are in the desired range.
Vitamin K2
Along with vitamin D, vitamin K plays a really big role in supporting bone health. These two vitamins work together to make sure that calcium can enter your bones instead of building up in the bloodstream or other organs.
Vitamin K1 is available in many plant foods like leafy greens, broccoli, cauliflower, prunes, peas, parsley, and scallions. Our bodies can convert some Vitamin K1 into K2 in our gut, but this process can be inefficient, especially for people with poor gut health (ie leaky gut). You can find plant based dietary sources of K2 in fermented foods, tempeh, sauerkraut, and kimchi. Because K1 -> K2 conversion isn’t reliable and there isn’t an available test to measure K2 levels, some plant-based eaters may benefit from a K2 supplement. Taking vitamin D and K2 together, or in a combined supplement, is an excellent way to support bone health! Respond to this blog if you would like access to supplements at wholesale prices. I pass along 100% of my physician discount.
Vitamin B12
Vitamin B12 deficiency may also contribute to the risk of developing osteoporosis. Although more research is needed, current evidence suggests that B12 deficiency may increase the risk of bone loss and eventually osteoporosis. Since Vitamin B12 is made in the gut of animals as they digest their food; vegans and vegetarians are often at a higher risk for B12 deficiency. Fortunately, adding a B12 supplement to your routine is both simple and affordable - in fact I personally take a liquid B12 supplement. If you haven’t already I would recommend discussing the following with your physician - do you need testing for Vitamin B12 deficiency? Do you need to take a Vitamin B12 supplement? What is the right form of Vitamin B12 supplementation?
Going Beyond Your Plate
While a healthy, plant predominant nutritional pattern is a key choice in preventing osteoporosis, it’s only part of the solution. Regular physical activity is also crucial for bone health. Among the best exercises are weight-bearing activities like walking, running, weight lifting, dancing, stair climbing, tennis and pickleball. Side note - pickleball is growing like wildfire in Portland, how about in your area?
These exercises use your body weight to put stress on your bones, which helps maintain and even improve bone strength. It’s a perfect example of “strength through action,” where the stress from physical activity triggers your body to build and strengthen your bones.
So, how much exercise is ideal? Many experts suggest getting at least 30 minutes of weight-bearing exercise most days of the week to keep your bones strong and healthy. I would say this is a bare minimum and ideally you want to be perpetually in motion and active every day. In addition to being in motion, we want to engage in a variety of dedicated physical activity at least 5 days a week. For women going through the menopausal transition, we should also be doing strength training at least 2 days a week. On those days, don’t shy away from learning how to lift heavy weights! There is something magical that happens for our metabolism and hormones when we lift heavy. If you want more information about The Vitality Collective, the private social community for women going through the menopausal transition; reply to this email.
What to avoid
Now on to what you may be doing, unknowingly, that could be working against your calcium balance. Here are the foods and beverages that may actually promote calcium loss from your bones.
Sodium
Did you know that foods high in sodium, like fast food, canned soups and many packaged snacks, can actually contribute to calcium loss? While a little salt can enhance the flavor of your meals, it’s best to avoid going overboard—especially at home. Instead, try using spices and salt-free seasonings to bring out the natural flavors of your dishes. Not only will your taste buds thank you, but your bones will too.
Wheat Bran
Wheat bran is a great source of fiber, but it has a catch: it’s high in phytates. This compound can interfere with calcium absorption, much like oxalic acid in some leafy greens. On top of that, when you eat 100% wheat bran it can reduce the amount of calcium that is absorbed from calcium-rich foods that you’re eating at the same time. That bowl of 100% wheat bran cereal and milk means your body will absorb less calcium from the milk. So, if you're trying to maximize your calcium intake, be mindful of how much wheat bran you are eating and what you’re eating it with. Good news - oat bran does not have the same negative impact on calcium absorption.
Alcohol
Enjoying an occasional drink? Just remember that alcohol is not the best companion for strong bones. Alcohol disrupts the balance of bone remodeling - the breaking down and making of new bone, which leads to decreased bone density and increases your risk of fractures. Heavy alcohol consumption is also the leading risk factor for avascular necrosis, when the blood supply to a portion of bone is compromised which eventually leads to bone death. Alcohol is a risky and toxic substance, not just to your bones, but every organ in your body.
Caffeine
If you’re a coffee or tea lover, here’s something to consider: caffeine can reduce calcium absorption and may contribute to bone loss over time. This doesn’t mean you need to give up your morning cup of coffee, but moderation is key. Also, try to avoid caffeinated drinks within two hours of eating calcium-rich foods or taking calcium supplements, so you can get the most out of your calcium intake.
Soda
Soda is not a great choice because of how much sugar it contains and it turns out it is also not a good choice for your bones—especially dark colas. With the large sugar content in sodas it is the perfect breeding ground for mold. Thankfully, the growth of this mold is prevented by the high levels of phosphoric acid. Unfortunately this phosphoric acid, which is made from phosphorus, can cause your body to pull calcium from your bones in an effort to keep calcium and phosphorus balanced. Given this, it is worth swapping out soda for a calcium- -friendly alternative.
Animal Protein
If you choose to eat animal protein it may come with a hidden cost for your bones. High levels of sulfur-containing amino acids, cysteine and methionine, which is found in meat and eggs, can lead to calcium being pulled from your bones. This is done in order to neutralize the acid that cysteine and methionine produce in your blood. If you are not ready to move towards a plant based lifestyle, then I would recommend balancing your meat intake with more plant-based foods. Plant-based proteins tend to have far fewer sulfur-containing amino acids, making them a great alternative for keeping your calcium where they belong—in your bones.
Summary
Osteoporosis is a common condition, but having risk factors doesn’t mean it’s your destiny. Here is your bone protection checklist:
Focus on calcium-rich, whole plant foods
Stay perpetually in motion and engage in regular weight-bearing exercises
Do strength training and make it heavy!
Soak up healthy sunlight
Use supplements as directed by your physician
If you’re managing a medical condition, taking medications, or facing challenges that may affect your bone health, talk with your physician. Together, you can create a plan to strengthen and support your bones—because a strong skeleton means a stronger, healthier you.
As a special bonus here is a free recipe pack jammed with simple, easy plant based recipes that include the key vitamins and nutrients to help you build strong bones! Even if you choose to eat meat you can modify these recipes or use them on your meat-less days!
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