Beyond Calcium: Nutrition and Supplements for Osteoporosis

What questions do you have about nutrition and supplements for osteoporosis?

In recent Flipping 50 content I’ve been visiting the importance of muscle and bone health for women over 50. Especially as we’re at home altering schedules – some for the better (88% more exercise) and some for worse (a shortage of dumbbells for home use and gym closures and only 30% returning to gyms currently) how we exercise matters.

During menopause your loss of bone accelerates at an alarming 3-5% from a steady 1-3% unless there has been adequate weight training stimulus occurring since age 30. Women in menopause and beyond can’t wait to lift weight.

If you need a program that takes care of your at home strength build for women in menopause : STRONGER (https://www.flippingfifty.com/getstronger) is open until October 1.

What I’ve lightly touched on is nutrition. This post in in response to many consequent questions from blog readers, podcast listeners, and YouTube channel viewers (links in the show notes) who’s number one question is, does calcium help?

Disclaimer

First, I am not a RD nor a nutritionist. I am a Medical Exercise Specialist, and a Certified Strength & Conditioning Coach and Health Coach and prior University instructor. Teaching the basics of nutrition (to students, clients, and trainers) has been a paramount part of my job for 34 years. I have a scope of practice and within this post I observe it. I’m presenting facts for you to make educated decisions.

I will from time to time share what I do. As a woman in midlife using research for my own dual goals of health now and longevity. This post visits recent studies on the topic of bone health, nutrition, and exercise. When combined nutrition, exercise, and supporting lifestyle habits are your best strong bone plan.

Nutrition and Supplements for Osteoporosis

Studies showed that higher protein intakes result in a significant decrease in hip fractures. One systematic review supports that a protein intake above the current RDA may reduce hip fracture risk and may play a beneficial role in BMD maintenance and loss in older adults.

In an expert consensus paper from 2018, assessing the risks and benefits of dietary protein for bone health, concluded that a protein intake above the RDA is beneficial for older adults. A long-term protein intake of 2 g/kg body weight/day is reported safe for healthy adults.

e.g. 130

59 kg

118 grams of protein per day

There is an association between a dietary protein intake above the current RDA of 0.8 g/kg body weight/day and a reduced hip fracture risk in older adults.(1)

How to Consume Protein

What’s important here is how to consume that protein. This is not an end-of-the-day total as many apps would suggest. Spreading that protein evenly distributed over the day is best for protein synthesis, or absorption. About 30 grams of protein, slightly more even at breakfast, at each meal is best.

In an unintuitive move if you’re sitting at dinner with your children and grandchildren, you would have the larger portion of salmon or chicken off the grill. Your muscle protein synthesis is reduced due to age so to achieve comparable muscle benefit, you’ll require more protein.

Old Nutrition and Supplements for Osteoporosis Ways

While once thought higher protein ingestion caused calcium leaching, that thinking is no longer present in research. Much more severe problems are found with diets lacking in protein than those with high levels of protein.

That said, activity level and appropriate strength training, and weight bearing exercise as well as overall health of the diet and regular checks for overall adequate micronutrient sufficiency are important. Protein intake, and resistance training are more beneficial when combined than either are in isolation.

Calcium and Vitamin D

Recent studies have questioned the usefulness of calcium and vitamin D supplements in decreasing the risk of fractures. The adequate intake of protein, vegetables and other nutrients is also of interest, and recommendations have been established by expert consensus and clinical practice guidelines. 

European guidance for the diagnosis and management of osteoporosis in postmenopausal women recommends a daily intake of at least 1000 mg/day of calcium, 800 IU/day of vitamin D to maintain serum 25-hydroxyvitamin D levels >50 nmol/L and 1 g/kg body weight of protein for all women aged over 50 years for the prevention of the age-related deterioration of musculoskeletal health.

Know Your Micronutrient Levels

I’ll link to my lab testing where it’s wise to test rather than follow daily recommendations. If you’re deficient, the daily recommendation won’t be enough to bring you to a sufficient state. I prefer to test rather than guess. If you struggle with compliance, especially if you’re not at ideal weight, energy, as well as concerned about bone density or currently your immune system, find out your numbers, go over them to discuss optimal levels and it is much easier to be compliant.

In the US, data from the NHANES III population-based survey, including a cohort of nearly 10,000 women and men, showed no correlation between calcium intake and BMD at the hip site, and the correlation was more applicable for subjects with higher levels of 25(OH)D.

Calcium 

Only women with higher 25(OH)D levels seemed to benefit from a higher calcium intake. Other studies were not able to associate a higher milk intake or total dairy product consumption with the risk of hip fracture in women or men. The Study of Women’s Health Across the Nation (SWAN) recently tried to demonstrate the benefits of dairy intake for bones, but its results were not positive for long-term bone health.

Specific Supplements

Dietary potassium may reduce the acid load and, thus, calcium depletion from bones. Apart from its role in the maintenance of an alkaline state in the body, potassium can also increase the accumulation of calcium in the kidneys. 

Magnesium

  • 50-60% of it is in bone
  • Improves solubility of calcium
  • Improves osteoblast (bone reformation)
  • Activates vitamin D

Protein Overall fewer fractures

higher bone mass

Vitamin C Positive associations with BMD at hip and lumbar spine

Folate and vitamin B-12 might also influence bone by reducing homocysteine concentrations; homocysteine is linked to lower BMD and a higher risk of fracture.

Vitamin K showed no conclusive evidence of support for bone density.

Various Diets and Osteoporosis

Meditarranean diet – has a positive effect on bone density

SAD or Western (processed meats, grains, and sugar)– has a negative effect on bone density

Asian, Korean, and Japanese varied-

  • if high in meat, alcohol and sugar there is low BMD,
  • higher kimchee and seaweed was associated with low bone density,
  • if high in vegetables and soy or fermented soy, reduced risk of fracture (3)

Vegetarians and Vegans – limited available evidence suggests that, on balance, vegetarians—especially vegans—may be at higher risk of low BMD and fractures with 4% and 6% lower BMD at the femur neck, respectively

In more studies on vegans, incidence of low bone mineral density compared to fish eaters and meat eaters was high only if calcium intake was low. (2) What does appear to be true is that vegans and vegetarians’ high alkaline diet is an advantage for optimal bone while low protein is a disadvantage. For carnivores, a higher alkaline diet will improve pH to benefit bone density.

Full Circle: Nutrition and Supplements for Osteoporosis

“The countries with the highest milk and dairy consumption are also those with the highest osteoporosis rates. The connection between calcium consumption and bone health is actually very weak. The connection between bone health and dairy consumption is almost non-existent.” -Amy Lanou, Ph.D, nutrition director for the Physicians Committee for Responsible Medicine in Washington, D.C.

Not only that but increased milk consumption is linked to increased mortality rate. Strong words, right? Many of these studies were longitudinal, conducted over long periods of time, 12 years for instance. It’s those I pay attention to.

Dairy at Fault?

Is it responsible for osteoporosis? The very thing we’ve been brought up to believe is the thing to prevent it? The acidic effects of milk (or dairy) may cause a biological correction for your kidneys. Calcium from bones is excreted when your natural blood pH level becomes acidic in effort to neutralize the rise in acidity. (5)

Do you have questions on nutrition and supplements for osteoporosis?

  • Alternative milks – 420 mg of calcium
  • Coconut yogurt – 320 mg of calcium
  • Low oxalate greens – kale and collards

Coming up soon: Supplements for Fat Metabolism in Menopause

Alterations in lipid metabolism and excessive adipose tissue play a key role in the synthesis of excess fatty acids, adipocytokines, proinflammatory cytokines, and reactive oxygen species, which result in the development of insulin resistance, abdominal adiposity, and dyslipidemia. (4)

I’ll review both dietary and exercise recommendations and beneficial combinations. I’ll discuss findings on vitamin D, omega-3 fatty acids, antioxidants, phytochemicals—and their food sources—to aid the management of abnormal lipid metabolism in postmenopausal women.

I’ll share the research much of which has been used in development of Fit – U my program for women with 20 or more pounds to lose.  

References:

Resources mentioned in this episode:

STRONGER – 12 week strength program

Fit U – for women with 20 or more pounds to lose

Yourlabwork.com/flipping-50 for self-directed testing your micronutrients

Show notes:

Flippingfifty dot com/supplements-for-osteoporosis

2 thoughts on “Beyond Calcium: Nutrition and Supplements for Osteoporosis”

  1. Nicely done Deborah – a very concise yet comprehensive overview. One comment/observation: when you addressed protein and how requirements increase with age, you didn’t really differentiate types and explain benefits or downsides of them. Just some “food for thought” for your next commentary : )

    I hope that you are doing well during these crazy times!

    1. Hi Kevin! What a pleasant surprise! You’re right. I was on the long side as it was. I had just covered that component in a well-attended master class for September with our tribe so this piece of content was complimentary to it. A bit of where I left off. In case anyone else is feeling that left something out it’s here: https://www.flippingfifty.com/ultimateguide Grab a chair, or go for a hike, it’s long with lots of Q and A! Hope you’re well too! It’s certainly been a ride! Love to hear how PTonthenet is doing this year.

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