Bone health and nutrition: meal plans for clients with osteoporosis

Nutrition is key when it comes to bone health and dealing with related diseases like osteoporosis. Here’s how you can create a meal plan that focuses on certain nutrients to help your clients eat their way to better bone density.?

If your client is suffering from osteoporosis (or has an increased risk of the disease), there are a few ways that you can nutritionally support them. But before exploring some key nutrients to focus on, let’s understand what osteoporosis is and what risk factors you should be aware of.

What is osteoporosis?

Osteoporosis is a bone disease that is marked by progressive loss of bone mineral density and compromised bone strength, which increases the risk of fractures over time [1]. This has become a chronic issue over the years, as it’s now estimated that more than 200 million people worldwide suffer from osteoporosis, with 1 in 3 women over the age of 50 years experiencing osteoporotic fractures in their lifetime [1].

Bone health can be affected by numerous things–including lifestyle choices, genetics, hormones, medical conditions, and certain nutrients–so as a nutrition professional, it’s important to evaluate your client as a whole to provide the best nutritional guidance possible.

Risk factors for osteoporosis

Unfortunately, osteoporosis does not usually present any symptoms, so your client may not realize they have the disease until a bone fracture occurs. As such, evaluating risk factors plays a large role in helping clients with osteoporosis, so here are some common ones to be aware of.?

• Race, age and gender. While osteoporosis can occur in any race, age and gender group, it is more common with Caucasians, older people, and women [2].?
• Body size. It’s been found that women and men who have more slender builds are at a greater risk for osteoporosis when compared to those of larger stature [2].?
• Family history. The risk of developing osteoporosis can increase if your client has a family history of the disease.
• Changes to hormones. Menopause is a common cause of osteoporosis due to the changes in estrogen levels [3].
• Other medical conditions. Conditions such as gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa can contribute to your client developing osteoporosis [4].
• Lifestyle. Low levels of physical activity, excess alcohol consumption, and smoking increase the risk of osteoporosis.?
• Plant-based diets. Vegetarians and vegans are at greater risk of developing osteoporosis and experiencing hip fractures when compared to their omnivore counterparts [15].

Nutrients of concern for bone health

Diet plays a major role in bone health and preventing or managing osteoporosis. If your client suffers from this disease (or is at risk), here are some nutrients of concern to focus on.?

Calcium

Calcium is the most abundant mineral in the body and plays an important role in muscle contractions, releasing hormones, and transmitting messages through the nerves. It’s also a crucial nutrient to consider when it comes to bone density, as it plays an integral part in bone structure [5].?

Since bones undergo a remodeling process, they continuously gain and lose calcium, which can either benefit bones or spell disaster depending on your client’s dietary intake. If calcium intake is adequate, the bones benefit; when intake is low, the body takes calcium from bones to compensate, which can lead to weakened bones and an increased risk of fractures.

The recommended daily amount (RDA) for calcium is 1,000 mg for most adults 19 – 70 years of age, and 1,200 mg for women over 50 and men over 70 [5]. While you can obtain calcium through dietary sources, supplementation may also be necessary to fit your client’s needs.

Tip: calcium functions best when paired with vitamin D. This vitamin helps the body process and absorb calcium, so it’s important to make sure that both of these nutrient needs are met in your client’s diet.

Vitamin D

Often referred to as the “sunshine vitamin”, vitamin D can be produced in the skin when exposed to UVB rays, and/or obtained through diet as either D2 (present in plants and yeast) or D3 (in animal sources).

Vitamin D has a plethora of benefits–like immune health, cancer prevention, and reduced risk of diabetes–and can even be used to improve athletic performance. Moreover, it’s crucial in maintaining bone health; since vitamin D increases calcium absorption in the gut and regulates calcium and phosphorus, studies have shown that low vitamin D status can contribute to osteoporosis and other bone diseases [6].

The RDA for people between the ages of 1 and 70 is 600 IU per day, and for adults over 70 the RDA is 800 IU per day [6]. However, it’s been found that deficiency is common–since many people do not get enough daylight year-round to produce adequate vitamin D and it’s only found in a few foods, supplementation may be necessary to meet vitamin D needs [6].

Protein

Protein is an essential macronutrient that is composed of 20 different amino acids, which are considered to be building blocks of the body. Nine of the amino acids need to be consumed via dietary sources because the body is unable to produce them on its own; this helps build and repair muscles, heal wounds and injuries, and synthesize hormones and enzymes. Protein has also been positively correlated with bone strength, since studies have found that adequate protein intake is associated with better bone strength, slower rate of bone loss, and reduced risk of hip fracture, especially among the elderly [7].

The Dietary Reference Intake (DRI) for protein is as follows:

• Sedentary men and women: 0.8 g protein/kg of body weight/day [8]?
• Sedentary adults over 65 years old: 1 to 1.2 g protein/kg of body weight/day [9]?
• Athletes and highly active people: 1.2-2.0 g/kg of body weight/day, depending on training needs and goals [10]

However, these numbers will vary depending on your client’s activity levels, age, lifestyle, and other needs, so take that into consideration when determining how much protein is right for them.

Vitamin B12

Vitamin B12 plays a large role in the central nervous system, formation of healthy red blood cells, and DNA synthesis [11]. It’s also crucial for rebuilding bones, as deficiency has been associated with increased fracture risks, lower bone mineral density, and reduced bone turnover, especially in those who follow a vegetarian or vegan diet [12,13,14].

The RDA for vitamin B12 is 2.4 mcg/day for both men and women over 14 years old, with this number slightly increasing to 2.6 mcg/day and 2.8 mcg/day for pregnant and lactating women, respectively [11]. While you can obtain vitamin B12 through dietary sources, supplementation may also be necessary to fit your client’s needs.

Zinc

Zinc is an essential mineral that is involved in immune function, protein synthesis, wound healing, DNA synthesis, cell division, normal skeletal growth, and bone homeostasis [16]. It’s also been shown to promote bone regeneration, as zinc can positively affect chondrocyte and osteoblast functions, while inhibiting osteoclast activity [17]. As such, studies suggest that a zinc deficiency can lead to an increased risk of bone disease and fractures.

The RDA for zinc is 11 mg/day for men over 14 years old, and 8 mg/day for women over 19; this number increases to 11 mg/day and 12 mg/day for pregnant and lactating women, respectively [16]. While you can obtain zinc through dietary sources, supplementation may also be necessary to fit your client’s needs.

How to nutritionally guide clients to better bone health

Now that we’ve covered some nutrients of concern for osteoporosis, let’s dive a bit deeper and discuss some foods you can include in your client’s meal plan to help boost bone health.?

• Calcium: milk, cheese and other dairy products, green leafy vegetables (kale, broccoli, and collard greens), fortified foods, chia seeds, lentils, and sardines.
• Vitamin D: fatty fish (such as trout, salmon, tuna, and mackerel), fish liver oils, mushrooms, and fortified foods.?
• Protein: eggs, dairy, lean meat, poultry, fish, beans, soybeans, tofu, protein powder and protein-fortified foods
• Vitamin B12: fish, meat, poultry, eggs, dairy products, and fortified foods
• Zinc: oysters, crab, lobster, red meat, poultry, beans, nuts, whole grains, fortified breakfast cereals, and dairy products

If you need some more inspiration, check out this 7-day example meal plan.

Tip: nutrients like vitamin C, magnesium, omega-3 fatty acids, phosphorus and vitamin K also play a role in skeletal health. These can be obtained through a well-balanced diet and/or with supplementation.

While nutrition is crucial for maintaining (and improving) bone health, it’s not the only factor to consider. You can help your clients continue to strengthen their bone density or manage osteoporosis through:

• Limiting high salt foods, alcohol, soft drinks, and high caffeine intake.
• Staying physically active and participating in weight-bearing exercises.
• Quitting cigarettes.

Summary

Nutrition is key when it comes to bone strength and dealing with related diseases like osteoporosis. Thanks to certain nutrients, you can help your clients achieve better bone health through targeted dietary suggestions and improved lifestyle choices.?

References

1. S?zen, T., ?z???k, L., & Ba?aran, N. ?. (2017). An overview and management of osteoporosis. European journal of rheumatology, 4(1), 46–56. https://doi.org/10.5152/eurjrheum.2016.048?
2. Alswat K. A. (2017). Gender Disparities in Osteoporosis. Journal of clinical medicine research, 9(5), 382–387. https://doi.org/10.14740/jocmr2970w?
3. Endocrine Society. (2022, January 24). Menopause and Bone Loss. Endocrine Society. Retrieved March 31, 2022, from https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-loss?
4. U.S. Department of Health and Human Services. (n.d.). Osteoporosis overview. National Institutes of Health. Retrieved March 31, 2022, from https://www.bones.nih.gov/health-info/bone/osteoporosis/overview?
5. U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements - calcium. NIH Office of Dietary Supplements. Retrieved March 31, 2022, from https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/?
6. Chang, S.-W., & Lee, H.-C. (2019). Vitamin D and health - the missing vitamin in humans. Pediatrics & Neonatology, 60(3), 237–244. https://doi.org/10.1016/j.pedneo.2019.04.007?
7. Rizzoli, R., Biver, E., Bonjour, J. P., Coxam, V., Goltzman, D., Kanis, J. A., Lappe, J., Rejnmark, L., Sahni, S., Weaver, C., Weiler, H., & Reginster, J. Y. (2018). Benefits and safety of dietary protein for bone health-an expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteopororosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 29(9), 1933–1948. https://doi.org/10.1007/s00198-018-4534-5?
8. J?ger, R., Kerksick, C. M., Campbell, B. I., Cribb, P. J., Wells, S. D., Skwiat, T. M., Purpura, M., Ziegenfuss, T. N., Ferrando, A. A., Arent, S. M., Smith-Ryan, A. E., Stout, J. R., Arciero, P. J., Ormsbee, M. J., Taylor, L. W., Wilborn, C. D., Kalman, D. S., Kreider, R. B., Willoughby, D. S., … Antonio, J. (2017). International Society of Sports Nutrition Position Stand: Protein and exercise. Journal of the International Society of Sports Nutrition, 14(1). https://doi.org/10.1186/s12970-017-0177-8?
9. Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., Phillips, S., Sieber, C., Stehle, P., Teta, D., Visvanathan, R., Volpi, E., & Boirie, Y. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the Prot-Age Study Group. Journal of the American Medical Directors Association, 14(8), 542–559. https://doi.org/10.1016/j.jamda.2013.05.021?
10. Stokes, T., Hector, A., Morton, R., McGlory, C., & Phillips, S. (2018). Recent perspectives regarding the role of dietary protein for the promotion of muscle hypertrophy with resistance exercise training. Nutrients, 10(2), 180. https://doi.org/10.3390/nu10020180?
11. U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements - vitamin B12. NIH Office of Dietary Supplements. Retrieved March 31, 2022, from https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/?
12. Rizzo, G., Laganà, A. S., Rapisarda, A. M., La Ferrera, G. M., Buscema, M., Rossetti, P., Nigro, A., Muscia, V., Valenti, G., Sapia, F., Sarpietro, G., Zigarelli, M., & Vitale, S. G. (2016). Vitamin B12 among Vegetarians: Status, Assessment and Supplementation. Nutrients, 8(12), 767. https://doi.org/10.3390/nu8120767?
13. Pawlak R. (2021). Vitamin B12 status is a risk factor for bone fractures among vegans. Medical hypotheses, 153, 110625. https://doi.org/10.1016/j.mehy.2021.110625?
14. USDA/Agricultural Research Service. (2005, April 23). Fight Osteoporosis: Bone Up On B12. ScienceDaily. Retrieved March 29, 2022 from www.sciencedaily.com/releases/2005/04/050421235233.htm?
15. Tong, T. Y. N., Appleby, P. N., Armstrong, M. E. G., Fensom, G. K., Knuppel, A., Papier, K., Perez-Cornago, A., Travis, R. C., & Key, T. J. (2020, November 23). Vegetarian and vegan diets and risks of total and site-specific fractures: Results from the prospective epic-oxford study - BMC medicine. BioMed Central. Retrieved March 31, 2022, from https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01815-3
16. U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements - zinc. NIH Office of Dietary Supplements. Retrieved March 31, 2022, from https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/?
17. O'Connor, J. P., Kanjilal, D., Teitelbaum, M., Lin, S. S., & Cottrell, J. A. (2020). Zinc as a Therapeutic Agent in Bone Regeneration. Materials (Basel, Switzerland), 13(10), 2211. https://doi.org/10.3390/ma13102211