Preventing Osteoporosis

About 60 percent of women and 40 percent of men over 50 have low bone mass, and those numbers increase with age. The National Osteoporosis Foundation estimates that 50% of women and 25% of men over  50 will have an osteoporosis-related fracture during their lifetime.1,2

Bone is constantly being broken down (by cells called osteoclasts) and rebuilt (by cells called osteoblasts). In osteoporosis, there is an imbalance between bone formation and bone resorption, leading to a decrease in bone mass and consequently an increase in fracture risk. The best protection against osteoporosis is a combination of exercise and excellent nutrition. These factors tip the balance toward bone building.

Weight-bearing Exercise and Strength Training

When we increase muscle strength, we increase bone strength. The most effective way to strengthen bone and protect against osteoporosis-related fractures is with strength training.3 The mechanical forces produced by exercise stimulate activity in the bone-building osteoblasts, leading to denser, stronger bones – not just stronger muscles.

Weight-bearing exercises are ideal for improving balance and building bone strength, and  non-weight bearing strength training of the lower body also helps to increase bone density.4,5 While swimming and biking are good for cardiovascular conditioning, they will not help protect against osteoporosis like running or lifting weights.6 In women who are at a risk for osteoporosis, back strengthening exercises are especially beneficial and can provide lasting protection against spinal fractures.7

For women, in addition to doing weight-bearing exercises, I also recommend wearing a weighted vest for a few hours each day for stronger bones. A weighted vest can be worn, not only during exercise, but also while you work or shop and bend, stand, and move throughout the day. Wearing a weighted vest has other benefits as well, such as burning more calories, increasing core strength and stabilizing muscles, thus improving balance and decreasing the risk of falls.8-11

For a guide to bone-building exercise, in my DVD Osteoporosis Protection for Life, I have put together a comprehensive approach that combines dietary and supplement advice with special bone-strengthening exercises, providing the information needed to put an effective osteoporosis prevention plan into action.

Bone-building nutrients

The best foods for bone health are whole plant foods. Studies show that individuals with the highest consumption of fruit and vegetables have the strongest bones.12-14

  • Calcium: Greens, seeds, and beans

Bone tissue is composed mostly of calcium phosphate and collagen, and ninety-nine percent of the body’s calcium is stored in bone.  The intermingling of bone mineral with collagen fibers provides bone with strength and flexibility.

A diet full of natural plant foods provides the calcium required to build strong bones. Green vegetables in particular are rich calcium sources. For example, one four-ounce serving of steamed kale has just as much calcium as one cup of cow’s milk. Broccoli, bok choy, sesame seeds, and garbanzo beans are also excellent calcium sources. Furthermore, the body absorbs about 50% of the calcium in many green vegetables, compared to only 32% of the calcium in milk.15 High-dose (1000 mg/day) calcium supplementation is not recommended, because several studies have linked high-dose calcium supplementation with an increased risk of cardiovascular disease.16-20  Plus, high dose calcium supplements have not been superior to lower doses in studies on preventing bone fractures.21

  • Magnesium: Nuts and seeds  

Calcium is important, but it’s not the only bone-building mineral. Sixty percent of the body’s magnesium is found in bone. Magnesium is an essential mineral crucial for all cells, plays a structural role in bone tissue, and is essential for bone formation.22,23  Magnesium deficiency diminishes osteoblast (bone-building cell) activity and promotes osteoporosis. Notably, almost half of Americans do not meet the recommended intake for  magnesium.24 Nuts and seeds are especially rich in magnesium.

  • Vitamin K1: Green vegetables

Vitamin K is a crucial component for maintaining healthy bones. A vitamin K dependent protein called osteocalcin is the most abundant protein in bone tissue after collagen; this protein binds to calcium and is crucial for bone mineralization.25 Higher intake of vitamin K1 is associated with lower rates of bone loss and fractures.26,27 Vitamin K exists as K1 and K2; the richest source of K1 is green vegetables, and K2 is produced by microorganisms. It is important to get both K1 from green vegetables and K2 from a supplement.

  • Plant protein: Beans, seeds, and nuts

Starting in mid-life and especially after the age of 70, it becomes more important to ensure adequate protein intake for healthy bones.28 For most people following a Nutritarian diet, adequate protein for maintenance of bone mass, muscle mass and muscle strength with age can be achieved easily with seeds, nuts and beans. Animal products may be added if muscle mass starts to fall too low on a completely vegan diet, in spite of appropriate exercise.

  • Phytate: Beans, whole grains, nuts and seeds

Phytate was once known as an “anti-nutrient,” a substance that prevents us from absorbing certain minerals, however the phytate in plant foods might actually benefit bone health. Studies have found that women who consume more phytate had either greater bone mineral density or less bone mass loss over time.29-31 Phytate appears to help to prevent osteoporosis by preventing bone breakdown by osteoclasts (bone-resorbing cells).32

  • Antioxidant-rich fruits  and vegetables

A three-month trial in postmenopausal women eating  dried plums (compared to dried apples) daily found an increase in bone formation markers, and a one-year trial found an increase in bone mineral density and decreased levels of bone resorption markers.33,34 Plum polyphenols have been shown to suppress the activity of osteoclasts.35 Also, higher markers of oxidative stress are linked to lower bone mineral density, suggesting that the antioxidant content of fruits and vegetables may be partially responsible for their bone health benefits.36,37 It is not that plums have special powers, however their polyphenol content is certainly higher than apples; berries are also particularly high in polyphenols.

  • Bone-healthy supplements: Vitamin D and Vitamin K2

The major source of vitamin D for most people is sun exposure, and vitamin K2 is not easily obtained from plant foods. It is important to get adequate amounts of these bone-supporting vitamins, and supplements are useful.  Vitamin D regulates calcium and phosphorus absorption, and Vitamin D deficiency is known to increase the risk of fractures.38,39 Supplementation trials using vitamin K2 (which is low in plant foods) in postmenopausal women have shown substantial reductions in the fracture risk: vertebral fracture by 60%, hip fracture by 77% and all non-vertebral fractures by 81%.26,27

Avoid foods that cause calcium loss

The worst foods for bone health are those that cause calcium to be removed from bone and lost in the urine.

  • Excess sodium promotes the excretion of calcium.40,41
  • Caffeine also contributes to urinary calcium loss. High caffeine intake is associated with increased bone loss and osteoporotic fractures.42,43

The Nutritarian diet, combined with the conservative use of supplements (see Vitamin Advisor) assures individuals they are achieving maximum protection against later life disease.  Achieving adequate muscle mass and bone mass with aging is one of the important benefits of a Nutritarian lifestyle.   


  1. Looker AC, Borrud LG, Dawson-Hughes B, et al: Osteoporosis or low bone mass at the femur neck or lumbar spine in older adults: United States, 2005-2008. NCHS Data Brief 2012:1-8.
  2. National Osteoporosis Foundation: What is Osteoporosis? []
  3. Rubin C, Turner AS, Muller R, et al: Quantity and quality of trabecular bone in the femur are enhanced by a strongly anabolic, noninvasive mechanical intervention. J Bone Miner Res 2002;17:349-357.
  4. Marques EA, Mota J, Machado L, et al: Multicomponent training program with weight-bearing exercises elicits favorable bone density, muscle strength, and balance adaptations in older women. Calcif Tissue Int 2011;88:117-129.
  5. Howe TE, Shea B, Dawson LJ, et al: Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2011:CD000333.
  6. Running not swimming or biking is best kind of loading exercise for childrens bone growth. 2004. EurekAlert! . Accessed February 2011.
  7. Sinaki M, Itoi E, Wahner HW, et al: Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women. Bone 2002;30:836-841.
  8. Greendale GA, Salem GJ, Young JT, et al: A randomized trial of weighted vest use in ambulatory older adults: strength, performance, and quality of life outcomes. J Am Geriatr Soc 2000;48:305-311.
  9. Greendale GA, Hirsch SH, Hahn TJ: The effect of a weighted vest on perceived health status and bone density in older persons. Qual Life Res 1993;2:141-152.
  10. Shaw JM, Snow CM: Weighted vest exercise improves indices of fall risk in older women. J Gerontol A Biol Sci Med Sci 1998;53:M53-58.
  11. Snow CM, Shaw JM, Winters KM, et al: Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci 2000;55:M489-491.
  12. Tucker KL, Hannan MT, Chen H, et al: Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 1999;69:727-736.
  13. New SA, Robins SP, Campbell MK, et al: Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr 2000;71:142-151.
  14. Sacco SM, Horcajada MN, Offord E: Phytonutrients for bone health during ageing. Br J Clin Pharmacol 2013;75:697-707.
  15. Weaver CM, Plawecki KL: Dietary calcium: adequacy of a vegetarian diet. Am J Clin Nutr 1994;59:1238S-1241S.
  16. Bolland MJ, Avenell A, Baron JA, et al: Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691.
  17. Michaelsson K, Melhus H, Warensjo Lemming E, et al: Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ 2013;346:f228.
  18. Bauer DC: The calcium supplement controversy: now what? J Bone Miner Res 2014;29:531-533.
  19. Wang L, Manson JE, Song Y, et al: Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 2010;152:315-323.
  20. Lewis JD, Rejnmark L, Ivey K, et al: The Cardiovascular Safety of Calcium Supplementation With or Without Vitamin D in Elderly Women: A Collaborative Meta-analysis of Published and Unpublished Trial Level Evidence from Randomised Controlled Trials. Presentation #1002. In The American Society for Bone and Mineral Research Annual Meeting; 2013.
  21. Bischoff-Ferrari HA, Willett WC, Orav EJ, et al: A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 2012;367:40-49.
  22. Castiglioni S, Cazzaniga A, Albisetti W, et al: Magnesium and osteoporosis: current state of knowledge and future research directions. Nutrients 2013;5:3022-3033.
  23. Rude RK, Singer FR, Gruber HE: Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr 2009;28:131-141.
  24. Fulgoni VL, 3rd, Keast DR, Bailey RL, et al: Foods, fortificants, and supplements: Where do Americans get their nutrients? J Nutr 2011;141:1847-1854.
  25. Kidd PM: Vitamins D and K as pleiotropic nutrients: clinical importance to the skeletal and cardiovascular systems and preliminary evidence for synergy. Altern Med Rev 2010;15:199-222.
  26. Feskanich D, Weber P, Willett WC, et al: Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr 1999;69:74-79.
  27. Cockayne S, Adamson J, Lanham-New S, et al: Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med 2006;166:1256-1261.
  28. Devine A, Dick IM, Islam AF, et al: Protein consumption is an important predictor of lower limb bone mass in elderly women. Am J Clin Nutr 2005;81:1423-1428.
  29. Lopez-Gonzalez AA, Grases F, Roca P, et al: Phytate (myo-inositol hexaphosphate) and risk factors for osteoporosis. J Med Food 2008;11:747-752.
  30. Lopez-Gonzalez AA, Grases F, Perello J, et al: Phytate levels and bone parameters: a retrospective pilot clinical trial. Front Biosci (Elite Ed) 2010;2:1093-1098.
  31. Lopez-Gonzalez AA, Grases F, Monroy N, et al: Protective effect of myo-inositol hexaphosphate (phytate) on bone mass loss in postmenopausal women. Eur J Nutr 2013;52:717-726.
  32. Arriero Mdel M, Ramis JM, Perello J, et al: Inositol hexakisphosphate inhibits osteoclastogenesis on RAW 264.7 cells and human primary osteoclasts. PLoS One 2012;7:e43187.
  33. Arjmandi BH, Khalil DA, Lucas EA, et al: Dried plums improve indices of bone formation in postmenopausal women. J Womens Health Gend Based Med 2002;11:61-68.
  34. Hooshmand S, Chai SC, Saadat RL, et al: Comparative effects of dried plum and dried apple on bone in postmenopausal women. Br J Nutr 2011;106:923-930.
  35. Bu SY, Lerner M, Stoecker BJ, et al: Dried plum polyphenols inhibit osteoclastogenesis by downregulating NFATc1 and inflammatory mediators. Calcif Tissue Int 2008;82:475-488.
  36. Sharma T, Islam N, Ahmad J, et al: Correlation between bone mineral density and oxidative stress in postmenopausal women. Indian J Endocrinol Metab 2015;19:491-497.
  37. Cervellati C, Bonaccorsi G, Cremonini E, et al: Oxidative stress and bone resorption interplay as a possible trigger for postmenopausal osteoporosis. Biomed Res Int 2014;2014:569563.
  38. Brincat M, Gambin J, Brincat M, et al: The role of vitamin D in osteoporosis. Maturitas 2015;80:329-332.
  39. Holick MF: Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004;80:1678S-1688S.
  40. Teucher B, Dainty JR, Spinks CA, et al: Sodium and bone health: impact of moderately high and low salt intakes on calcium metabolism in postmenopausal women. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 2008;23:1477-1485.
  41. Teucher B, Fairweather-Tait S: Dietary sodium as a risk factor for osteoporosis: where is the evidence? The Proceedings of the Nutrition Society 2003;62:859-866.
  42. Rapuri PB, Gallagher JC, Kinyamu HK, et al: Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr 2001;74:694-700.
  43. Hallstrom H, Wolk A, Glynn A, et al: Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women. Osteoporos Int 2006;17:1055-1064.
  45. Mahmood M, Saleh A, Al-Alawi F, et al: Health effects of soda drinking in adolescent girls in the United Arab Emirates. J Crit Care 2008;23:434-440.
  46. Larson NS, Amin R, Olsen C, et al: Effect of Diet Cola on urine calcium excretion. Abstract P2-198. In ENDO; 2010.