Whenever we discuss osteoporosis and diet, it is important to remember that between 60-70% of your risk in getting osteoporosis is genetic. But, beyond wishing your parents had really big bones, this information is only helpful because it puts into context the fact that no single lifestyle or dietary change will prevent osteoporosis. Instead, multiple changes benefit bones and reduce risk.

Studies of young men and bone density show that weight bearing exercise significantly increases bone density. Young women show less benefit. Other studies on young women athletes show that estrogen levels significantly affect bone density. Women experiencing osteoporosis should have hormonal levels checked as part of their care. Multiple studies on post-menopausal women show that increasing estrogen levels increase bone density.

Calcium supplementation alone has a small positive effect on bone density. The European recommendation is between 700-800mg a day of supplemental calcium.

Women who drank an extra gallon and a half of calcium fortified milk every week for a year decreased their bone loss by 2% over their regular diets. While every bit helps, this study was not controlled for vitamin D intake, which is also added to milk. Calcium levels need to be matched with phosphate levels, because too much of one will drain the other. Soft drinks are often high in phosphates, which leads to calcium leeching.

Studies have found that, during the winter months in the higher latitudes, most women are not receiving sufficient vitamin D. Sunlight exposure during the summer may be sufficient, but during the winter dietary sources became significant. Most women reported (5-10micrograms) some supplementation were not getting enough to make any difference in their blood levels. The European recommendation is between 400-800IU (10 to 20 micrograms) a day. Vitamin D activates the gut to absorb calcium.

In contrast with vitamin D, high vitamin A interferes with bone formation. Women taking too high a level of vitamin A (more than 3000 micrograms a day) had a significantly higher risk of bone fracture. Beta carotene intake did not influence fracture risk.

Soy isoflavones interact within the body like very weak estrogen. Studies in Japan suggest that high soy protein intake is associated with a higher bone density and a lower level of bone breakdown.

Rats with removed ovaries (no estrogen) did not experience bone loss when supplied with high levels of copper. Multiple vitamin supplements should provide sufficient copper, zinc, and boron.

While caffeine intake did not cause bone loss in rats, high intakes of caffeine (18 ounces of coffee a day) caused significant bone loss in women.

The Framingham Osteoporosis Study found that fruit and vegetable intake had a beneficial effect on bone density. They also found protein intake had a beneficial effect. A diet high in omega-3 fatty acids (fish, flaxseeds, nuts) may have a protective effect on bone. High candy consumption was associated with low bone density in both men and women.

Initial treatment of compression fractures includes bed rest, pain management with local and systemic analgesia, bracing to improve comfort, and patient reassurance. The bracing should not increase patient discomfort.

Exercise has definite benefits for osteoporotic women with compression fractures. Extension exercises (bending backwards) were quite helpful. In contrast, flexion exercises (bending forward) actually increased fracture risk beyond doing nothing. Over a long period, women with regularly exercised, strong back muscles had almost three times less risk of compression fracture.

Xylitol fed rats had increased bone density, but this has not had human trials yet.

Dried plums, a rich source of phenolic and flavonoid compounds, significantly increased bone density markers in a short term trial.

Simvastatin increased bone healing in the femurs of mice.

DHEA provided better bone formation than estrogen replacement therapy in young women.

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