In my first article on osteoporosis, I talked about what osteoporosis is, how it’s diagnosed, and also went over screening guidelines for osteoporosis. In this article, I will discuss the connection between diet and lifestyle and osteoporosis.
As a brief review, osteoporosis is a condition in which bones become ‘weak’ or ‘brittle’ from an imbalance in bone turnover taking place. There are two types of cells that are responsible for growth, repair, and regeneration of our bone tissue.1 In osteoporosis, these two cells (osteoclasts and osteoblasts) do not balance each other out. As a result, more old bone is removed while less new bone is laid down to replace this old bone leading to osteoporosis.
The Connection Between Diet and Bone Mineral Density (BMD)
Many of us have grown up in a Western culture being sold the idea we need to drink a lot of milk and consume as much dairy as possible to produce strong, healthy bones. Is this true?
Beyond calcium and possibly vitamin D, most people may not think of diet as having anything to do with our bone health, but it does. **On a side note, if you want to learn more about the calcium topic please read my article—The Calcium Myth–More Is Not Better.**
Despite being told we should drink large amounts of milk and consume dairy to make strong, healthy bones we do not have to do this. Doing so does not give us any advantage over consuming no animal products at all, not even dairy. Let’s take a look at this.
In 2015, researchers looked at three different dietary groups—meat-based, lacto-ovo vegetarian (no meat but includes eggs and dairy), and vegan (no meat, dairy, or eggs).2 Researchers concluded, “BMD did not differ between lacto-ovo vegetarians, vegans, and omnivores in the present study supporting the contention that plant-based diets are not detrimental to bone in young adults … In young adults, a well-balanced vegetarian diet may provide adequate bone-enhancing properties that negate the diet properties that adversely impact bone mineralization.”
BMD is simply a measure of how “strong” one’s bones are. This was a short study and only concluded that no harm was done in young people in regards to their bone health. It provided no conclusions about older patients more at risk for osteoporosis. But what about older individuals, especially post-menopausal females who are most at risk for developing osteoporosis?
The answer to this question came from a fascinating study done on Buddhist nuns.3 Researchers compared 105 lifelong, vegan Buddhist nuns against 105 meat-eating women in Saigon, Vietnam. They measured their BMD scores and found that “although vegans have much lower intakes of dietary calcium and protein than omnivores, veganism does not have adverse effect on bone mineral density and does not alter body composition.”
This is truly a remarkable finding given all the advertising done in America insisting that we humans consume meat and dairy at nearly every single meal to build strong healthy bones and bodies. Obviously, this is not necessarily true as seen in the Buddhist nun study.
Even increasing your fruit and vegetable intake can improve your bone health. A study published in 2006 found a positive effect on bone mineral density and fruit and vegetable intake.4 This held true for adolescent boys and girls, as well as older, post-menopausal women. The more fruits and vegetables consumed the better the bone mineral status of the individuals in these groups.
Eating more fruits and vegetables has always been the sensible thing to do for many different disease states from heart disease to diabetes, and now we know based on science it helps our bones too.5 Even if you aren’t vegan or vegetarian, including more fruits and vegetables in your diet only serves to improve your bone health and does nothing to harm it.
The Connection Between Diet and Fracture Incidence
What about different diets and fracture risk? After all, people care much more about actually breaking their bone(s) than they do about their BMD values. BMD values are just an assessment tool used in calculating fracture risk, much like getting your cholesterol level checked is an assessment tool to gauge your risk of having a heart attack. People ultimately don’t care about their cholesterol levels or BMD values. They care about breaking their bones and having heart attacks.
When it comes to dietary patterns and actual fracture occurrences, a trend has developed. It has been shown that Asian women, even with lower BMD values compared to their Western counterparts, have lower hip fracture rates.6 This is partly due to their higher consumption of plant foods, including fruits, vegetables, and soy isoflavones, and a lower intake of animal foods.
In 2014, the Journal of Nutrition looked at hip fracture risk and dietary patterns in the Singapore Chinese Health Study.7 There were over 63,257 adult men and women studied over an average of 9.9 years. Two primary dietary groups were analyzed, a meat-based group and a vegetable-fruit-soy group. These two groups were further divided into subgroups based on the amount of respective foods they ate. For example, the more fruits and vegetables a person ate the higher they categorized them within the vegetable-fruit-soy group. Investigators found that the meat-based group provided no protection against hip fracture risk regardless of what subgroup people were put in within the meat-based group. The vegetable-fruit-soy group, on the other hand, did result in less hip fractures occurring. The more fruits, veggies, and soy eaten the greater the protection seen. Individuals in the highest quintile subgroup of the vegetable-fruit-soy group had anywhere from a 21-34% smaller risk of hip fracture compared to the those in the lower quintile of the vegetable-fruit-soy subgroups. What we gain from this study is that consuming more naturally occurring, plant-based foods provides more of a benefit in reducing hip fracture risk.
Hip fracture rates are predicted to increase throughout the world in the coming years. This is likely to happen more so in non-Western countries rather than the United States and Europe due to the Westernization of the modern Asian diet. This statement comes directly from the American Journal of Clinical Nutrition – “Hip fracture incidence rates are predicted to increase the most in non-Western countries. Some experts have projected that 50% of all hip fractures in the world will occur in Asia and in other less-developed regions of the world during the 21st century. These increases will likely occur in nations undergoing changes in dietary patterns, including decreased intakes of plant food and increased intakes of animal meats.”6
The Connection Between Physical Activity and Osteoporosis
Staying physically fit and active is important for good overall health. It’s also important for bone health. Regular exercise is actually used not only in the prevention of osteoporosis, but also in the treatment of osteoporosis. It’s always a good idea to check with your physician first though before starting any exercise program.
Impact exercises or resistance training have been shown to both preserve and improve BMD in women from young to old.8 These types of exercises do this by stimulating new bone formation. Examples of these types of exercises include everything from lifting weights to doing pushups to playing tennis. Some individuals will even use a weighted vest during their exercise routine to help further improve BMD scores.9
If you are unable to do the more rigorous impact exercises just mentioned then do something simpler, like going for a brisk walk each day for thirty minutes. Even walking has been shown to positively impact BMD scores of the hip area.10 Walking will also do wonders for improving your mental health too. Being outside and physically active is a natural stress reliever so take advantage of this free form of exercise.
Another low impact exercise is yoga. Yoga has been shown to strengthen and preserve the spine improving vertebral bone health.11 Yoga challenges you both physically and mentally leading to health benefits beyond your bones. You can start this simple exercise by finding a class for beginners at your local gym or yoga studio. Yoga instructors love teaching newbies so don’t be afraid to join a class. There’s bound to be other newbies too.
While improving BMD is a nice benefit of various types of exercise programs, this does speak to the most important factor in preventing fractures. This factor is preventing falls. That’s because most osteoporotic fractures occur in connection with a fall.12 Preventing falls is crucial to improving fracture incidence in those with osteoporosis. In fact, hospitals have specific fall risk reduction programs for any patient deemed to be at risk for falls. But you don’t have to be in the hospital to take the steps needed to prevent falls. You can use some of the same exercise routines used to improve BMD scores to do this. These same exercises help to improve muscle strength, balance, and coordination. Yoga is particularly good at this. Tai chi and Qigong are two more exercise programs that improve these factors.13
Regardless of what kind of exercise you choose the most important thing is to just start. Exercising is vital to maintaining a healthy body and mind. Getting started is the hardest part. It gets easier and easier as you make it part of your daily routine.
Our diet and lifestyle choices have a big impact on bone health as you can see. Moving away from an animal-based diet and towards a plant-based diet has a positive impact on improving BMD scores and reducing fracture rates. This should be the goal of anyone with osteoporosis or anyone wanting to avoid osteoporosis. I believe these positive changes are greatly underestimated and underappreciated in the United States and other Western cultures.
Exercise is also at the backbone of a strong game plan to prevent and reverse osteoporosis in individuals. We should all strive to include some form of resistance training or type of impact exercise in our regular workout routine. Find something you enjoy and make it work for you. Your bones will thank you for many years to come. If you’d like to learn more about the diagnosis process of osteoporosis check out the articles below.
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1 Florencio-Silva R, Sasso GR da S, Sasso-Cerri E, Simões MJ, Cerri PS. Biology of Bone Tissue: Structure, Function, and Factors That Influence Bone Cells. BioMed Research International. 2015;2015:421746.
2 Knurick JR, Johnston CS, Wherry SJ, Aguayo I. Comparison of Correlates of Bone Mineral Density in Individuals Adhering to Lacto-Ovo, Vegan, or Omnivore Diets: A Cross-Sectional Investigation. Nutrients. 2015;7(5):3416-3426.
3 Ho-Pham LT, Nguyen PL, Le TT, et al. Veganism, bone mineral density, and body composition: a study in Buddhist nuns. Osteoporos Int. 2009 Dec;20(12):2087-93.
4 Prynne CJ, Mishra GD, O’Connell MA, et al. Fruit and vegetable intakes and bone mineral status: a cross sectional study in 5 age and sex cohorts. Am J Clin Nutr. 2006 Jun;83(6):1420-8.
5 Lanham-New SA. Fruit and vegetables: the unexpected natural answer to the question of osteoporosis prevention? Am J Clin Nutr. 2006 Jun;83(6):1254-5.
6 Anderson JJ. Plant-based diets and bone health: nutritional implications. Am J Clin Nutr. 1999 Sep;70(3 Suppl):539S-542S. Review.
7 Dai Z, Butler LM, van Dam RM, et al. Adherence to a vegetable-fruit-soy dietary pattern or the Alternative Healthy Eating Index is associated with lower hip fracture risk among Singapore Chinese. J Nutr. 2014 Apr;144(4):511-8.
8 Xu J, Lombardi G, Jiao W, Banfi G. Effects of Exercise on Bone Status in Female Subjects, from Young Girls to Postmenopausal Women: An Overview of Systematic Reviews and Meta-Analyses. Sports Med. 2016 Aug;46(8):1165-82.
9 Snow CM, Shaw JM, Winters KM, Witzke KA. Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci. 2000 Sep;55(9):M489-91.
10 Martyn-St James M, Carroll S. Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone. 2008 Sep;43(3):521-31.
11 Smith EN, Boser A. Yoga, vertebral fractures, and osteoporosis: research and recommendations. Int J Yoga Therap. 2013;23(1):17-23.
12 Russo CR. The effects of exercise on bone. Basic concepts and implications for the prevention of fractures. Clinical Cases in Mineral and Bone Metabolism. 2009;6(3):223-228.
13 Rogers C, Larkey LK, Keller C. A Review of Clinical Trials of Tai Chi and Qigong in Older Adults. Western journal of nursing research. 2009;31(2):245-279. doi:10.1177/0193945908327529.