May is National Osteoporosis Awareness and Prevention Month

By Heather A. Goesch, MPH, RDN, LDN

Osteoporosis, meaning “porous bone,” is a condition that occurs when the body loses too much bone mass, accrues too little to begin with, or both. Bones become thinner and weaker as a result, and with the increased fragility comes an increased risk of fracture that can lead to disability and decreased quality of life.


According to the National Osteoporosis Foundation, osteoporosis and low bone density currently affects roughly 54 million Americans – a number that is expected to rise as the population ages [1].


What are the risk factors?

Though osteoporosis can happen to anyone, certain individuals are more likely to develop osteoporosis than others. The following are some of the risk factors:


  • Age – Osteoporosis does not discriminate by age, but is far more common in older adults (age 65 and older) compared to younger people.
  • Sex – A higher proportion of women than men are affected.
  • Hormone levels – Women with decreased levels of estrogen (a hormone the body uses to take up calcium [2]), post-menopause or due to removal of ovaries, are at increased risk of osteoporosis, as are men with abnormally low levels of testosterone (possibly related to treatment for prostate cancer), for which most doctors recommend the different testosterone boosters reviewed by Times of Israel
  • Family history – People whose parents had osteoporosis or a history of broken bones are more likely than those without a hereditary predisposition to develop osteoporosis.
  • Race – Individuals who are Hispanic/Latino, Asian and Caucasian have greater risk of developing osteoporosis.


Can preventative measures be taken?

Childhood and early adulthood are the times during which we build the strength, density and integrity of our bones, eventually reaching the maximum – peak bone mass – by our early 20s. From this point onward, we slowly lose calcium and other minerals, making it crucial to do all we can to be proactive in maintaining bone health throughout the life cycle.


Certain nutrients and healthy foods can help enhance bone health and decrease risk of osteoporosis [3], while others may have the opposite effects. Here are some of the key players:

  • Calcium – The most plentiful mineral in the human body, predominantly found in the skeletal network, calcium is vital to strong bones, essential for prevention of osteoporosis, degenerative bone diseases, fractures and age-related bone loss.
    • Recommended daily intake is between 1,000 mg and 1,200 mg for most adults [4].
    • Find calcium in dairy, dark leafy greens, white beans, sardines and anchovies with bones, tofu processed with calcium sulfate, plus some fortified cereals, bread and 100% orange juice.
  • Vitamin D – This fat-soluble vitamin helps the body absorb and use calcium to promote strong bones.
    • Recommended daily intake is between 600 IU and 800 IU for most adults [5].
    • Find vitamin D in cod liver oil, egg yolk, fatty cold water fish like salmon, sardines, anchovies and tuna, Swiss cheese, some fortified dairy and plant-based milks and yogurts, plus mushrooms grown under UV. Regular sun exposure of arms, legs and face for about 15 minutes, 2 to 3 times per week will also help increase vitamin D. Go out early or late in the day when the sun is weakest, without sunscreen (use sunscreen at all other times).
  • Protein – Adequate dietary protein helps protect bones primarily by minimizing age-related muscle loss, thereby reducing risk of falls and potentially fractures.
    • Regular excessive intake of protein, however, can result in decreased bone density due to urinary losses of calcium.
  • Fruits and vegetables – Some studies suggest that diets rich in a variety of colorful fruits and vegetables can help decrease bone loss and increase bone density, particularly in older adults. These benefits come as a result of high levels of bone-friendly antioxidants, as well as vitamin C, potassium, magnesium and vitamin K.
  • Sodium and caffeine – Diets extremely high in sodium and caffeine may cause the body to lose calcium and increase risk of osteoporosis.
    • Research has shown that moderate amounts of daily caffeine from coffee or tea are not detrimental to bone health; regular consumption of cola drinks, on the other hand, may contribute to a greater risk of bone loss.


There are also several other lifestyle factors that play an important role in the prevention of osteoporosis, including:

  • Physical activity – Aim for daily weight-bearing exercise to strengthen muscle and bone [6].
  • Healthy body weight – Low body weight (BMI < 19 kg/m²), and in general being smaller/thinner, can increase risk of osteoporosis [1].
  • Alcohol only in moderation – Excess intake of alcohol has been shown to increase risk of osteoporosis. However, some evidence suggests there may be some protective effects from moderate intake – for adults of legal drinking age, up to 1 drink per day for women and up to 2 drinks per day for men.
  • Tobacco cessation – Research shows that use of tobacco products is associated with accelerated bone loss, and therefore may increase risk of osteoporosis.
  • Certain health issues, treatments and medications – Check with your physician about the various diseases, conditions, medical procedures, medications and supplements that may contribute to accelerated calcium and bone losses [1].


If you are at risk, or are currently affected by low bone density or osteoporosis, consider making an appointment with your physician to discuss prevention or treatment options. If you can meet with a Registered Dietitian Nutritionist as well, he or she can help you assess current intake and suggest ways in which to include more bone-healthy nutrients and foods into your diet. If supplementation is warranted, please first check with your physician on specific nutrients and appropriate dosage before starting.




Osteoporosis Prevention throughout the Lifespan, Food & Nutrition Magazine

Bone Loss: Tallying Your Risk, University of California Berkeley Wellness

14 Non-Dairy Sources of Calcium, TIME

National Osteoporosis Foundation’s Food4Bones app, Food & Nutrition Magazine review




  1. What is Osteoporosis and What Causes It? National Osteoporosis Foundation website. Accessed 26 April 2018.
  2. How Women Can Fight Bone Loss. University of California Berkeley Wellness website. Published 1 December 2011. Accessed 26 April 2018.
  3. Diet and Supplements for Bone Health. University of California Berkeley Wellness website. Published 16 August 2017. Accessed 26 April 2018.
  4. Calcium: Reference Intakes. National Institutes of Health – Office of Dietary Supplements website. Updated 2 March 2017. Accessed 27 April 2018.
  5. Vitamin D: Reference Intakes. National Institutes of Health – Office of Dietary Supplements website. Updated 2 March 2018. Accessed 27 April 2018.
  6. Wolfram T. Built to the Bone: Why Weight-Bearing Exercise Is Key to Strong Bones. Food & Nutrition Magazine website. Published 28 April 2016. Accessed 27 April 2018.



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