Preventing Osteoporosis

January 02, 2017 by Joel Fuhrman, MD

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 

My line of multivitamins includes vegan vitamin D3 and vitamin K2 to complement a healthful diet. In addition, some women benefit from a small daily dose of supplemental calcium, especially after menopause or if they have a low intake of calcium-rich plant foods. For women who require extra calcium, Osteo Biotect contains whole food calcium, plus a bit more vitamin D3, vitamin K2, and magnesium for bone  health.  As mentioned earlier, we also recommend exercise techniques targeted to build bone mass at critical areas.  

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
  • Soda, including diet and decaffeinated soda, is associated with bone loss. Soda consumption increases parathyroid hormone (PTH) in the blood, which increases blood calcium concentrations by stimulating bone breakdown. This increased blood calcium is then excreted in the urine.44-46

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.   


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Joel Fuhrman, M.D. is a board-certified family physician, seven-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient dense, plant-rich eating style.
For over 30 years, Dr. Fuhrman has shown that it is possible to achieve sustainable weight loss and reverse heart disease, diabetes and many other illnesses using smart nutrition. In his medical practice, and through his books and PBS television specials, he continues to bring this life-saving message to hundreds of thousands of people around the world.