Category Archives: osteoporosis


Osteoporosis – Love Your Bones; Protect Your Future

Osteoporosis: Protect Your Bones – Three Key Nutrients You May Be Missing

October 20th is World Osteoporosis Day. This year, the theme of the campaign is Love Your Bones; Protect Your Future, encouraging all of us to take early action to protect bone health.

From the age of 50, one in every three women and one in five men will suffer a bone fracture as a result of poor bone health. “The progressive bone loss that occurs with osteoporosis may be invisible and painless, but this ‘silent’ disease results in fractures which cause pain, disability, and ultimately loss of independence or premature death,” states Prof. John Kanis, President of the International Osteoporosis Foundation.

Fortunately, taking care to adopt a healthy diet and undertake regular exercise is well-known to help protect bone health in later years. Vitamin and mineral supplements containing key nutrients for bone health – such as calcium, magnesium, vitamins D and K, and boron – can also be a sensible way of providing additional protection.

While many of us are aware of the role of nutrients such as calcium and vitamin D in bone health, it is important to note that healthy bones are dependent on a whole host of nutritional factors. Below are the top three commonly overlooked bone-boosters.

1. Protein

In the past, there has been concern over the link between protein intake and bone loss. It was believed that high protein intake might result in loss of bone mass by causing calcium to be leeched from bones.

However, more recent research has found that, provided calcium intake is sufficient, adults with the highest protein intakes have the lowest rates of bone loss (1). Protein makes up about 50% of bone, and so bone requires a constant intake of protein to maintain its mass.

Ensuring a good intake of foods high in both calcium and protein is essential, especially for older people whose protein intake tends to be lower. For those who drink protein shakes, try adding in some calcium-rich kale, Greek yoghurt or a spoon of tahini or almond butter. Aside from dairy, good sources of both calcium and protein are canned salmon (with bones), tofu, almonds, white beans and sesame seeds. The top choice however, is tinned sardines which are cheap, easily available and also provide another little-known bone builder, omega-3.

2. Omega-3

Osteoporosis has strong links with inflammation, because inflammatory compounds have a direct effect on the cells that form and break down bone.

It is widely understood that omega-3 fats have an anti-inflammatory effect. While larger studies are needed to confirm this benefit, research to date is promising. For example, combining exercise with omega-3 supplements has been shown to improve bone density better than exercise alone (2). In a second study, a test diet with a higher amount of omega-3 fats was found to reduce bone breakdown, when compared with a typical Western diet (3).

Taking care to include sources of omega-3 in the diet is recommended to fight chronic inflammation. Omega-3 fats are abundant in oily fish, and are also present in leafy greens, chia and flaxseed.

3. Antioxidants

Oxidative stress is damage that occurs when free radicals attack our body. This can include damage to bone, by reducing bone formation and increasing bone resorption.

Women with osteoporosis have been found to have lower levels of antioxidant nutrients in their blood than women with healthy bones (4). Fortunately, antioxidants in both whole foods and supplements have been found to protect bone health (5,6).

Including antioxidant-rich foods would therefore appear to be a sensible way to help keep bones healthy. While some might choose an antioxidant supplement, key antioxidants are also easy to include in our daily diet. For example, blueberries and green tea supply flavonoids, tomatoes are a rich source of lycopene and red grapes provide resveratrol.

1. Thorpe et al (2008) Effects of meat consumption and vegetarian diet on risk of wrist fracture over 25 years in cohort of peri- and postmenopausal women. Public Health Nutr. 11(6):564-572
2. Tartibian et al (2011) Long-term aerobic exercise and omega-3 supplementation modulate osteoporosis through inflammatory mechanisms in post-menopausal women: a randomized, repeated measures study.” Nutr & Met 8:71
3. Griel et al (2007) An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J.16;6:2.
4. Maggio et al. (2003). Marked decrease in plasma antioxidants in aged osteoporotic women: Results of a cross-sectional study. J Clin Endocrinol Metab, 88(4), 1523-1527.
5. Peters, B. S., & Martini, L. A. (2010). Nutritional aspects of the prevention and treatment of osteoporosis. Arq Bras Endocrinol Metab, 54(2), 179-185.
6. Rao et al (2007). Lycopene consumption decreases oxidative stress and bone resorption markers in postmenopausal women. Osteoporos Int, 18(1), 109-115.

Beating Osteoporosis

Osteoporosis: Is Calcium the Key?

Is Calcium the Key to Preventing Osteoporosis?

World Osteoporosis Day takes place every year on October 20. The campaign, organised by the International Osteoporosis Foundation (IOF), aims to raise global awareness of the prevention, diagnosis and treatment of osteoporosis and metabolic bone disease.

Our bones are constantly being broken down and rebuilt in a process known as ‘bone turnover’. In our early years, bone is built faster than it is broken down, and we reach our ‘peak bone mass’ at some point during our 20s. After this time, preserving healthy bones becomes a vital health concern. If bone is broken down more quickly than it is remade, then osteoporosis may occur.

This condition is of particular concern to postmenopausal women who produce less of the bone-protecting hormone oestrogen. Women lose more bone during their menopausal years than at any other time in their life [1]. However, men are under-diagnosed when it comes to osteoporosis and are more likely to go untreated.

The Key Three: Calcium, Magnesium and Vitamin D

Calcium is widely understood to play a key role in bone health and in preventing osteoporosis. After all, 99% of the body’s calcium is stored in bone. However, a calcium-rich diet in the absence of other bone-building nutrients is not effective in building healthy bones. Good quality studies have even linked high calcium intake with increased risk of bone fracture. This is most likely because calcium must work alongside other nutrients to build and maintain healthy bones.

Calcium must be absorbed and retained effectively to benefit bones. This requires two more nutritional helpers: magnesium and vitamin D. These three nutrients work synergistically – none is effective without the others.

60% of the magnesium in our body is stored in our bones. Magnesium works hand in hand with calcium by stimulating the hormone calcitonin which helps to draw calcium into bone and keep it there. Magnesium is also required in order to convert vitamin D to its active form.

Unfortunately many of us fail to meet the recommended daily intake of magnesium. Deficiency in this mineral is a particular concern for girls. In a recent national survey, more than 50% of girls between the ages of 11 and 18 had inadequate magnesium intake, putting them at risk of osteoporosis in later years.

Vitamin D is also essential for calcium absorption, helping to transport calcium out of the intestine and into the bloodstream. An estimated 60-70% of the UK population are low in Vitamin D. Elderly people and darker skinned populations are at particular risk of osteoporosis due to this. It is difficult to obtain sufficient Vitamin D from diet alone. Supplements or sun exposure (around 15 minutes each day) are the best ways to obtain the daily requirement of this vitamin to support healthy bones and prevent osteoporosis from occurring.

Nutrients for Bone Retention

Building healthy bone is only one part of the picture. Once healthy bone has been built, it is important to ensure that it is retained. Preventing bone from being broken down is essential in warding off osteoporosis. Special compounds in plant foods play a key role in preventing bone from being broken down. These compounds have ‘bone resorption inhibiting properties’. They support bone health by ‘turning off’ osteoclasts, the cells that break down bone tissue.

Dried plums, a source of phenols, have been shown in human studies to improve bone density by preventing bone breakdown. Other phytonutrients such as quercetin and hesperidin, present in fruits and vegetables such as onions, broccoli and citrus fruits, show similar benefits. Including these fruits and vegetables regularly alongside sources of calcium, magnesium and Vitamin D is the key to nourishing strong and healthy bones, therefore preventing osteoporosis in later life [2].

Bone Boosting Recipes

Dried Plum ‘Bone Booster’ Snack Bars

Prep Time: 10 minutes Cook Time: 30 minutes Serves: 8

Special phenolic compounds in dried plums increase levels of a hormone linked to bone formation. These compounds also help to prevent bone from being broken down. Dried plums, or prunes, are also high in antioxidants and provide an excellent source of potassium, boron and copper – essential nutrients for bone health. Soy flour provides a source of ‘bone boosting’ phytoestrogens, while almonds, pumpkin seeds and sunflower seeds are useful sources of calcium and magnesium. [3]


  • Olive oil cooking spray
  • ¼ cup Dried Plum (Prune) purée
  • ¼ cup honey
  • ¼ cup orange juice
  • 1 egg white
  • 2 tsp grated orange zest
  • ¼ cup soy flour
  • ½ tsp cinnamon
  • ½ teaspoon baking powder
  • ½ cup rolled oats
  • ½ cup whole almonds
  • ½ cup unsweetened shredded coconut
  • ¼ cup raw pumpkin seeds
  • ¼ cup raw sunflower seeds


Heat oven to 160°C. Spray an 8×8” baking pan with cooking spray and line with parchment paper, leaving the paper overhanging on 2 sides. In a large mixing bowl, whisk together dried plum purée, honey, orange juice, egg white and orange zest. In small bowl, whisk together flour, cinnamon and baking powder. Fold flour mixture, oats, almonds, coconut, pumpkin seeds and sunflower seeds into dried plum mixture.

Press mixture evenly into prepared pan. Bake about 30 minutes or until firm to the touch. Cool on rack; remove from pan, using paper to lift it out. Cut in four, then cut across in half to make 8 bars.

Nutrition Facts

Calories: 212
Cholesterol: 0mg
Total Fat: 12g
Saturated Fat: 4g
Sodium: 41mg
Carbohydrate: 22g
Protein: 6g
Fibre: 3g
Potassium: 159mg

‘Better Bones’ Banana Oat Bars

Makes one 9×9-inch pan. 6 Servings.

Oats and flaxseed provide lignans which support bone and hormonal health after menopause. Bananas provide potassium which helps to prevent loss of calcium from the body. Anti-inflammatory omega 3, in the ground flaxseed and walnuts, is linked with improved bone density. Special phenolic compounds in dried plums increase levels of a hormone linked to bone formation. These compounds also help to prevent bone from being broken down. Dried plums, or prunes, are also high in antioxidants and provide essential nutrients for bone health such as potassium, boron and copper.


  • 2 large, very ripe bananas
  • 1 teaspoon vanilla (optional)
  • 2 cups rolled oats
  • 1/4 cup pitted, chopped prunes
  • 1/4 cup chopped walnuts
  • 2 tbsp ground flaxseed
  • Grated nutmeg or cinnamon (optional)


Heat the oven to 180°C and lightly grease a 9×9-inch square baking dish with olive oil.

Peel the bananas and mash their flesh in a medium mixing bowl until no large chunks remain. Stir in the vanilla, if using. Add the oats and stir them in. Stir in the prunes and nuts.

Pat the thick mixture evenly into the baking pan. Sprinkle the top lightly with cinnamon. Bake for 30 minutes or until the edges just begin to crisp up.

Per serving:

Calories: 200
Fat: 4.9g
Fibre: 5.6g
Sugar: 10.7g
Protein: 5.5g

Written by Nadia Mason

1. Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr. 2003;77:504-511.
2. Hooshmand et al (2011) Comparative effects of dried plum and dried apple on bone in postmenopausal women. Brr J Nutr 106(6):923-30.
3. Gunn et al (2015) Nutrients Increased Intake of Selected Vegetables, Herbs and Fruit may Reduce Bone Turnover in Post-Menopausal Women 7(4): 2499–2517.


The importance of bone health

Bone health is an issue which is becoming increasingly more prominent in today’s society. According to the National Osteoporosis Society (1), one in two women and one in five men over the age of 50 in the UK will suffer with a bone fracture. This is mainly due to poor bone health which means that we all need to know how important it is to build and maintain strong bones.

In addition to weight baring exercise, nutrition is absolutely vital for establishing strong bones in childhood and adolescence as this is when the body passes through the bone growth stages to create individual peak bone mass. Within the 4 years surrounding an adolescent’s peak height, around 39% of their total body bone mineral is gained. This highlights how crucial this time is for building strong bones for the future as we go in to adulthood, as low bone mineral growth during youth is linked to the risk of developing brittle bones and osteoporosis in older age.

Fresh Orange Juice
Many Fresh Orange Juice's can be bought fortified with Calcium, Magnesium or Vitamin D.

Nutrients such as calcium, vitamins D and K and magnesium have all been specifically identified for bone health and having an influence on bone mineral density. A recent review (2) published in the journal Clinical Biochemistry focuses in particular on calcium’s effect on bone health. They reviewed numerous research papers looking into the effects of certain calcium rich foods on bone density.

For example, one study reported that women who had a lower intake of milk in childhood and adolescence had low bone density in adulthood and as a result they had a much greater risk of fractures later in life. Additionally, the authors reported on findings that with low intake of cow’s milk, even pre-pubertal children can have a higher risk of fractures which shows how important calcium intake is in early life.

As well as dietary calcium intake, calcium supplementation has also been found to be a fantastic contributor to bone mineral accretion. So be sure you add calcium to your family’s supplement regime to ensure all your bones are as strong as they can be to help prevent breakages.

Once peak bone mass is achieved around the age of 20 it needs to be maintained in the bone maintenance stage which lasts around 10-20 years. Then as we reach middle age our bone density starts to reduce by approximately 0.5–1.0% per year. However, it is important to note that female bone losses can be considerably more around the time of the menopause, at around 2–3% per year due to decreases in oestrogen levels. This represents a crucial time for maintaining bone density through our food and nutrition choices. Not surprisingly, calcium intake has been linked to the prevention of bone loss around this time.

Within the review paper, the research indicates that baseline calcium intakes of 500–1000 mg/day (meeting the recommended intake of 700mg a day) which were increased by 500–1200 mg/day prevented bone loss.

In order to be within this calcium intake, try to include the following foods into your typical day’s food intake, which combined equates to around 1578mg of calcium:

Typical servings: plain low fat yoghurt, 225g (415 mg of calcium), cheddar cheese, 40g (307mg), milk (around 300mg), pink salmon, 85g (181mg), Orange juice, calcium-fortified, 170ml (375mg). Dietary calcium is also available from sources such as other dairy products, bony fish, legumes, certain nuts (such as almonds and Brazil nuts), fortified soya milk and some fortified breakfast cereals also contain smaller amounts of calcium.

However, the report noted that most people’s calcium intake from dietary sources is often not sufficient especially for those that do not drink milk e.g. Chinese cultures. They therefore recommended calcium supplementation to meet the requirement. Vitamin D is also a great contributor to healthy bones on its own however when combined with calcium it has a much greater effect and the review noted that supplemental vitamin D combined with supplemental calcium can help to slow bone loss. This study included 1200 mg/day calcium and 1000 IU/day vitamin D supplementation and found that the two nutrients used together had a greater effect on maintaining bone density than when used individually.

It was also noted that calcium and vitamin D supplementation, at an intake of around 1000–1200mg calcium (depending on dietary calcium intake) and 800 IU vitamin D daily, is particularly important for those with osteoporosis or those at risk of its development. However, make sure that you are not exceeding the recommended upper limit of calcium which is 3,000 mg/day for children and adolescents aged 9–18 years, 2,500 mg/day for 19–50 year olds and 2,000mg/day for those aged> 50 years.

What all of this means it that it is really important to get enough calcium and vitamin D in both food and supplement forms to help keep bones healthy and strong, and also that your kids are getting enough to help build their bones for the future.

Written by Lauren Foster

(1) National Osteoporosis Society

(2) Zhu, K. & Prince, R.L. (2012) Calcium and bone. Clinical Biochemistry, p7.


Dried plums can help prevent osteoporosis

As a nutritional therapist, I am always interested in new dietary approaches to protect our health as we age.  I was particularly interested to read about a recent study which found dried plums to be of significant benefit in supporting bone health.

The study, published in the British Journal of Nutrition, found that eating dried plums increased bone formation in postmenopausal women.

Although bone is often thought of as inert, it is in fact a ‘living structure’, constantly being broken down and rebuilt.  This is a process known as ‘bone turnover’.  If bone is broken down more quickly than it is remade, then osteoporosis can result.  This condition is of particular concern to postmenopausal women who produce less of the bone-protecting hormone oestrogen.

Dried plums can help prevent osteoporosis
A recent study has found dried plums to be of significant benefit in supporting bone health (2)

The bone-thinning disease, osteoporosis, is in fact a major health concern in the UK.  In the over-50s, 1 in 3 women and 1 in 12 men are affected.

The study, conducted by Professor Bahram H. Arjmandi, tested the effects of daily consumption of 100g dried plums on the bone density of 55 postmenopausal women over a 12 month period.  A control group were given 100g dried apples.

Bone health in the women was measured at 3, 6, 9 and 12 months, by measuring markers of bone turnover in the blood.  X-rays were also used at these intervals to assess bone mineral density.

Over the 12-month period, dried plums resulted in increased bone density of both the ulna (a bone in the forearm) and the spine.  No such effect was seen in the group taking the dried apple.

Professor Arjamandi reasons that the special phenolic compounds in dried plums increase levels of a hormone linked to bone formation.  These compounds also help to prevent bone from being broken down. Dried plums, or prunes, are also high in antioxidants and provide essential nutrients for bone health such as potassium, boron and copper.

Introducing dried plums into the daily diet may therefore be a positive step in the prevention of osteoporosis.  “Don’t wait until you get a fracture or you are diagnosed with osteoporosis and have to have prescribed medicine,” Arjmandi suggests, “People could start eating two to three dried plums per day and increase gradually to perhaps six to ten per day.  Prunes can be eaten in all forms and can be included in a variety of recipes.”

Dried fruits certainly offer a variety of health benefits, as they are higher in fibre and phenols, and are more nutrient-dense, than fresh fruit.  For those interested in maintaining or improving their bone health, this initial research suggests that introducing prunes in particular to the diet could be a positive step.

Written by Nadia Mason


1.  Shirin Hooshmand, Sheau C. Chai, Raz L. Saadat, Mark E. Payton, Kenneth Brummel-Smith, Bahram H. Arjmandi.Comparative effects of dried plum and dried apple on bone in postmenopausal women. British Journal of Nutrition, 2011; 1 DOI: 10.1017/S000711451100119X

2.  Image courtesy of Just4you.


Fish and fish oils may be important for bone health

The long chain omega 3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in oily fish such as salmon, mackerel, trout and sardines, play an important role in optimal health.  As previously mentioned in my blog posts they are important for our hearts, brain, eyes and may protect against various conditions.  There is also some evidence to suggest that these fatty acids are important for bone health and perhaps prevent against osteoporosis and osteoarthritis.

Pharma Nord Bio Fish Oil
A new study has found that fish consumption may protect against bone loss.

A new study published in the American Journal of Clinical Nutrition (1) has found that fish consumption may protect against bone loss.  The study aimed to look at the association between dietary intake of fatty acids and fish and bone mineral density in older adults (average age of 75 years).  The study tracked changes in bone mineral density over a four year period.

The results of the study showed that high intakes of fish, 3 or more servings of fish a week, were associated with maintenance (ie no changes) in bone mineral density in men and women.  The study was only an association study so it does not prove that eating fish can prevent bone loss in old age however, previous studies  have also found that eating a diet rich in fish or having good intakes of the fish oils EPA and DHA, may contribute to a reduced risk of osteoporosis.  It is thought that the fish oils may be working to protect bone through their anti-inflammatory actions.  Inflammation in the body is known to be involved in the process of bone loss.

More evidence and further research is needed before firm conclusions can be drawn, however, oily fish has been shown in numerous studies to benefit health so including at least 2 servings a week in the diet is a good idea.   For individuals who don’t regularly eat fish a fish oil supplement rich in DHA and EPA may be worth considering but it is always best to check with a medical doctor prior to starting any new supplement regimen.

A healthy diet is important for strong, healthy bones.  Calcium, vitamin D are well known to be important for healthy bones but there are many other nutrients that are involved in bone strength such as magnesium, zinc, copper, potassium, silicon, manganese, vitamin K, vitamin C, vitamin B and phytonutrients – biochemical plant compounds found in fruits and vegetables.  A varied, healthy diet, especially on rich in fruits and vegetables and unprocessed unrefined pulses, beans, nuts/seeds and wholegrains, will provide a huge array of nutrients that may positively impact bone health.  Please read my other posts relating to bone health for more information on how good nutrition may be helpful to keep bones strong.

(1)  Emily K Farina EK et al.  2011.  Protective effects of fish intake and interactive effects of long-chain polyunsaturated fatty acid intakes on hip bone mineral density in older adults: the Framingham Osteoporosis Study.  Am J Clin Nutr.  93:1142-1151.

Written by Ani Richardson


The importance of vitamin D for calcium utilisation in the body

 In January  I wrote about the benefits of combined calcium and vitamin D supplements for fracture prevention.  Many adults, particularly women, are interested in eating for bone strength and prevention of osteoporosis (or brittle bones).

Many people still assume that a higher calcium intake is key for osteoporosis prevention.  As you can see from the posts linked above there are many nutrients that interact to protect our bones.  Calcium is, indeed, very important for bones however, recent evidence (1) seems to suggest that increasing calcium intakes may not help bone strength if the body is deficient in vitamin D, or body levels are insufficient.  This is a worrying concern since, as you will know from my past posts on vitamin D, most people in the UK have insufficient levels of this crucial vitamin.

This recent study (1) explored the importance of dietary calcium intake and blood serum vitamin D status with regards to bone mineral density in about 5000 women and men.  The researchers found that among men and women vitamin D status seemed to be the dominant predictor of bone mineral density relative to calcium intake.  The study highlights the importance of vitamin D and its ability to help the body utilise calcium efficiently, thus helping to explain why increasing calcium intakes alone is not always a successful way of dealing with osteoporosis prevention. 

Calcium is vital for bone mass, but nutrient interactions do need to be taken into account.  “The study supports the idea that correcting inadequate blood levels of vitamin D is more important than increasing dietary calcium intake beyond 566 mg a day among women and 626 mg a day among men for better bone mineral density” (2).  It seems that only women with the very lowest vitamin D levels seemed to benefit from higher calcium intakes.

Again, this adds to the evidence for the importance of vitamin D, to recap: most people in the UK do not get enough vitamin D and have insufficient/deficient levels in their blood.  There is no current consensus about the amount of daily vitamin D intake necessary to maintain blood levels at around 40-50 nmol/l (which is currently seen as optimal by many medical practitioners).  Most adult (age 18 and over) individuals in the UK would probably require a supplement of around 2000iu vitamin D daily.  It is always a good idea to check with a medical doctor prior to starting any supplement regimen.  Higher doses, up to 5000iu daily, may well be useful but I would not recommend such a regimen unless under the supervision of a medical doctor who can monitor blood levels regularly.  When looking for vitamin D supplements two forms are generally available.   Cholecalciferol, known as vitamin D3, and ergocalciferol or vitamin D2. Cholecalciferol is generally taken to be the more potent, easily absorbed and preferred form of vitamin D.

 (1)Bischoff-Ferrari HA et al.  2009.  Dietary Calcium and Serum 25-Hydroxyvitamin D Status in Relation to BMD Among U.S. Adults. Journal of Bone and Mineral Research.  24 (5): 935- 942

(2)Press release.   USDA/Agricultural Research Service (2010, March 15). Vitamin D and calcium interplay explored. ScienceDaily. Retrieved March 15, 2010, from­ /releases/2010/03/100312133716.htm

Written by Ani Kowal


Onions and bone density, an unlikely connection?

Recently I attended a seminar which concentrated on bone health in women going through the menopause.  The decrease in blood serum oestrogen after menopause is associated with bone loss and subsequent brittle bones and osteoporosis.

A study(1) was briefly mentioned at the seminar which seemed to suggest that onion consumption was linked to bone health in peri- and post-menopausal women.  I was intrigued!  The study found that individuals who consumed onions once a day or more had an overall bone density that was significantly greater than individuals who consumed onions once per month or less.  This association was apparent even after the authors took various other factors (that can affect bone health) into account such as age, body mass index (BMI), daily calcium intake, serum vitamin D, serum parathyroid hormone, oestrogen use, smoking status, and exercise status.  This suggests that onion consumption may be an independent factor in bone health. The study also found that older women who consume onions most frequently may decrease their risk of hip fracture by more than 20% versus those who never consume onions.

Why would onions be having this kind of effect? A possible explanation could be that onions contain a flavonoid (bioactive plant compound) called quercetin which has antioxidant and anti-inflammatory actions in the body and has been linked with protecting against heart disease, cancer and asthma.  Quercetin is also found in apples and grapes.  Two laboratory studies (2,3) last year found that quercetin could increase new bone formation.

Quercetin is also classes as a phytoestrogen.  Phytoestrogens are natural plant-derived compounds that bind to oestrogen receptors and have oestrogen-like activity in the body.  Recently phytoestrogens have attracted much attention among public and medical communities because of their potential beneficial role in prevention and treatment of cardiovascular diseases, osteoporosis, diabetes and obesity, menopausal symptoms, renal diseases and various cancers.

Our bone cells (osteoblasts) have two oestrogen receptors on their surface and certain phytoestrogens, including quercetin, can interact with these oestrogen receptors in bone.  It is possible that quercetin binds to the bone oestrogen receptors and stimulates and increases bone formation and bone mineralisation.  Further studies are needed to investigate these ideas. The authors of one of the studies say (3)If quercetin, this common constituent in fruits and vegetables, can be shown to increase bone forming activities in bone cells and improve healing in bone defects, it may be the long-sought-after safe and ideal agent for stimulation of bone formation and bone defect repair

Onions are one of my favourite vegetables and easy to integrate into meals and salads.  Apples and grapes are also easily incorporated into the daily diet.  Last year I wrote about the importance of fruit and vegetables for bone health.  A number of studies over the last decade have suggested a clear, positive link between fruit and vegetable consumption and bone health.  These foods provide a huge range of nutrients that are important for bone health.  In addition to the nutrients, fruit and vegetables positively effect the pH balance (a measure of acid-alkali balance) in the body, by increasing the alkalinity in the body (making the body less acidic), which plays a major role in the prevention of calcium loss from bones.  Foods which are acid forming in the body include foods such as most meat and animal protein, cheddar cheese and many grain products e.g. white bread, pasta, cornflakes.  If the body is too acidic, and not in pH balance, then bones can release their calcium (which increases alkalinity) into the blood to try and maintain the balance.  Obviously calcium loss is not what we want!! 

Providing the body with abundant supplies of vegetables and fruits, especially those high in quercetin, may help to keep our bones strong as well as protecting us from many other diseases.  Quercetin supplements are also readily available to buy, usually as an antioxidant boost for the body and for allergy prevention and treatment, although their impact on bone health have not yet been tested. 

Please also read my other various posts on osteoporosis for more information on how to keep bones healthy

(1) Matheson EM et al.  2009.  The association between onion consumption and bone density in perimenopausal and postmenopausal non-Hispanic white women 50 years and older. Menopause.  16(4):756-9.
(2) Wong RW & Rabie AB.  2008.  Effect of quercetin on bone formation. J Orthop Res.26(8):1061-6.
(3)Wong RW &  Rabie AB.  2008.  Effect of quercetin on preosteoblasts and bone defects. Open Orthop J. 10;2:27-32.

Written by Ani Kowal


Can carotenoids create stronger bones?

In October of last year I wrote about eating for bone health and mentioned the clear and positive associations between fruit and vegetable consumption and strong bones (1).  The post concentrated mainly on the way these foods act to effect the pH balance within the body.  Fruits and vegetables contain a huge array of vitamins, minerals and phytonutrients/flavonoids (chemically active plant compounds) that may also act to strengthen bone.

Last month a paper was published in the American Journal of Clinical Nutrition (2) which points toward the bone protective effects of carotenoids.  Previous evidence suggests that carotenoids may be acting to prevent bone loss and also to stimulate bone cell growth. Carotenoids, found abundantly in fruit and vegetables, act as antioxidants in the body and it is this mechanism that may be protecting the bones from damage by naturally occurring unstable oxygen molecules in the body, known as free radicals.  Antioxidants may help to ‘quench’ the destructive free radical molecules and therefore protect against damage.  As nutrients, antioxidants are ingested in the diet and are then distributed via the blood into various parts of the body tissues, including the bones.  

The researchers involved in this latest study (2) looked at the potential effects on bone mineral density of overall and individual intake of several carotenoid compounds, including alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein and zeaxanthin.  The study scientists tracked the bone mineral density in the hip and spine of 213 men and 390 women over the course of four years.  They found that carotenoid intake was associated with some levels of protection against bone mineral density losses at the hip in men and at the spine in women.  The results suggest that carotenoids, especially lycopene, may be protective against bone loss in older adults.  Further studies are certainly needed but the evidence adds further weight to the mounting data which shows just how important fruits and vegetables are to the whole body, including our bones.

A diet rich in colourful fruits, vegetables will provide plentiful amounts of antioxidants.  Carotenoids are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.

Absorption of carotenoids from foods into the body is greatly affected by fat.  Without a fat source carotenoids are not easily absorbed.  Fat acts as a carrier for these nutrients to allow them passage from the gut into our blood and bodily cells.  I am certainly not suggesting that you drown your vegetables or salads in gallons of oil, however, I am a firm believer in using small amounts of olive oil in dressings and cooking.  Including some nuts, seeds or olives in salads may also be helpful in order to gain maximum absorption of these important nutrients. 

If you are looking at carotenoid supplements, especially lycopene, look for those that contain an oil carrier, these will aid maximum absorption.  Of course fruits and vegetables contain far more than just carotenoids and a supplement cannot be seen as a substitute for good dietary habits, but if you feel that you do not get a good variety of vegetables and fruits in your daily diet you may wish to consider a supplement to help make up for any short-fall.

It is particularly important that young people look after their bone health, a balanced diet as well as exercise is vital in this respect.  Recently the National Osteoporosis Society (NOS) produced a press release and report regarding their findings that young people in the UK are endangering their health by not looking after their bones.  Prevention is the key to osteoporosis which affects up to three million people in the UK.

The NOS found that (3) that less than a quarter of people knew they should start looking after their bones before the age of 30, despite the fact that bone strength actually peaks during our 20s. Younger people need to ‘bank’ plenty of bone by the age of 30 as bones tend not to regenerate as quickly after that.  
• Almost half (49%) of young people (18-24 yrs) did not know there were any steps they could take to keep their bones healthy;
• More than half were unaware that exercise can help reduce the risk of osteoporosis;
• One in three did not know about the positive role diet can play.

Professor Roger Francis, Chair of the charity’s Medical Board, states(3):
Our bones are living tissue, much like our skin. New bone replaces old throughout our lives. But the most crucial years are when we’re young as this is when the cells building new bone are most active. Until our mid 20s our bones are gaining density and strength. From our 30s onwards our bones gradually lose their density. The more we can build up our bones when we are young the better we can help to protect ourselves against osteoporosis and fragility fractures in later life.” (3)

Women are more at risk of developing osteoporosis since their bones are smaller and also more vulnerable to hormonal changes.  Being underweight, and having a low BMI (body mass index) is also a big risk factor.  Currently many girls and women are striving to reach a low bodyweight and achieve the size zero that is touted by so many celebrities.  The report found that only 21% of people knew that being underweight was a significant risk factor for osteoporosis development (3).

Encouraging young people to eat fruit and vegetables, as well as foods rich in calcium, magnesium and other minerals is very important for bone strength and development.  Please visit the National Osteoporosis Society website for more information about bone health. A very informative document about osteoporosis can be downloaded from the site and my post about eating for strong bones may also be of interest.


(1) New SA.  2003.  Intake of fruit and vegetables:implications for bone health.  Proc Nutr Soc.  62:889-899
(2) Sahni S et al.  2009.  Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham Osteoporosis Study. Am J Clin Nutr 89: 416-424
NOS press release

Written by Ani Kowal


New evidence points toward the importance of B vitamins for bone health

On Monday I wrote generally about bone health.  Today I wanted to highlight the relatively recent research linking various B vitamins to bone health and strength. 

Scientists have been interested in preventing heart disease with the use of B vitamins for a while now.  This stems from the mounting research which suggests that elevated homocysteine levels are a risk factor for heart disease.

Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of heart disease and other disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels

Just recently research has been published (2,3) which suggests that B vitamins may also be important for the health of our bones and that elevated homocysteine levels may be implicated in bone deterioration.

In one study (2) the researchers wanted to examine the associations of blood plasma concentrations of folate, vitamin B12, vitamin B6, and homocysteine with bone loss and hip fracture risk in elderly men and women.  The study included a total of 1002 men and women with the average age of 75, their blood levels of B vitamins were measured at the start of the study and they were followed for 4 years.  Bone loss was associated with low vitamin B6 levels and low levels of vitamins B12 and B6 were associated with hip fracture risk.  The participants with high homocysteine levels also had a higher risk for hip fracture.

The study suggests that both low vitamin B status and high homocysteine levels may be a risk factor for hip fracture.  The authors of the study conclude that it is not entirely clear why or how B vitamins or homocysteine are related to bone health or fracture risk and that clinical trials with B vitamin supplements may help to provide more information. 

I find the results of the study very interesting as they highlight another area where nutrition is linked to health.  An overall healthy diet rich in a variety of unprocessed foods really does provide nutrients to all cells in the body.  Bones rely on essential nutrients as much as any other part of us!  All the cells in our body require regular, good supplies of the whole spectrum of nutrients.  A healthy diet really is important for so many reasons!

Vitamin B6 is found in foods like potatoes, bananas, beans and chickpeas, avocados, fish and poultry.  Vitamin B12 is found mainly in meat, fish and poultry.  Eggs and cheese also contain B12 as does brewer’s yeast.  Many vegetarians and vegans have very low intakes of this vital nutrient and may wish to consider a multi-B vitamin supplement.  Folic acid is found in beans, green vegetables and wholegrains.  If you decide you would like to take a vitamin B supplement I would always suggest a broad spectrum supplement that supplies adequate, but not megadose, levels of all of the B vitamins (not single nutrient supplements), these vitamins work best together as a team!


(1)The National Osteoporosis Society
(2)McLean R et al.  2008.  Plasma B Vitamins, Homocysteine, and Their Relation with Bone Loss and Hip Fracture in Elderly Men and Women.  J Clin Endocrinol Metab.  93: 2206-2212
(3)Cagnacci A et al.  2008.  Relation of folates, vitamin B12 and homocysteine to vertebral bone mineral density change in postmenopausal women. A five-year longitudinal evaluation. Bone.  42(2):314-20.

Written by Ani Kowal


Eating for bone strength

World Osteoporosis Day occurs on Monday October 20th and the National Osteoporosis Society (NOS) is running a UK-wide campaign ‘Love Your Bones’ which is intended to raise awareness about the importance of healthy bones.  The goal of the National Osteoporosis Society is to improve understanding of osteoporosis, what causes it and to promote the steps people can take to keep their bones healthy and reduce their risk.

“Osteoporosis literally means ‘porous bones’. Our bones are made up of a thick outer shell and a strong inner mesh which looks like a honeycomb made up of tiny struts of bone. Osteoporosis means some of these struts become thin or break, making bones more fragile and prone to fracture. It often remains undetected until a bone is first broken, which commonly occurs in the wrists, hips and spinal bones. It is these broken bones or fractures which can lead to the pain associated with osteoporosis. Spinal fractures can also cause loss of height and curvature of the spine.”(1)

Please visit the NOS for loads more information on bone health.  They have many online and downloadable resources, including a booklet ‘Healthy Eating For Strong Bones’ and a page dedicated to the ‘Sunlight Campaign’ which highlights the fact that sunlight is one of the very best natural sources of vitamin D, a vitamin that is essential for the building of healthy bones and the prevention of osteoporosis.  The NOS point out that up to 15 % of people in the UK are estimated to have low levels of vitamin D, while 80% have levels which are considered unhealthy.  There have now been many calls for a revised vitamin D intake recommendation in the UK(2) due to extensive evidence of low levels. The NOS website provides simple tips for boosting your vitamin D levels.

Calcium and Vitamin D
A recent review paper(2) looked at the evidence surrounding the importance of calcium and vitamin D for bone health and the prevention and treatment of osteoporosis.  The paper points out that an estimated one in three women and one in twelve men aged over 55 years will suffer from osteoporosis in their lifetime.  This represents a huge cost in the UK (many millions of pounds per year).  Calcium supplements appear to be effective in reducing bone loss in women in late post menopause (after five years), particularly in those with a low daily calcium intake (less than 400 mg/d).  Supplementation with vitamin D and calcium has also been shown to reduce fracture rates in some elderly populations. Low vitamin D status is associated with an increased risk of falling and a variety of other health outcomes and is an area that requires urgent attention.

It is very important to consider bone health at an early age, this is because peak bone mass (peak bone strength) is reached before the age of 30, after this age bone gradually grows weaker.  Building up great bone strength early on in life will help reduce the risk of osteoporosis later in life.  Most studies show that calcium, supplemental or high dietary intake, is important in at a young age in order to reach a good peak bone mass (3), 600mg-1,000mg calcium daily before the age of 25 may be beneficial to reaching a good bone mass.  As mentioned above evidence regarding supplementation later in life is mixed.  However, a supplement containing vitamin D and calcium could be useful in maintaining bone mass (providing around 800mg calcium daily and 20mcg/800IU vitamin D).

Other nutrients
The role of other nutrients on bone remains to be fully defined(2), although there are promising data in the literature for links between various nutrients including: magnesium, zinc, copper, potassium, silicon, manganese, vitamin K, vitamin C, vitamin B and phytonutrients (biochemical plant compounds).  A varied, healthy diet, especially on rich in fruits and vegetables, will provide a huge array of nutrients that may positively impact bone health.  If you feel your diet is lacking you may wish to consider a high quality food-state multi-vitamin and mineral supplement.  This is NOT a substitute for good dietary habits!! 

Omega 3 fatty acids
Yes, it is the fish oils making an appearance again!  Eating a diet rich in the omega 3 fatty acids EPA and DHA, found in oily fish such as mackerel, salmon and sardines, may contribute to a reduced risk of osteoporosis by inhibiting the production of pro-inflammatory chemicals (eicosanoids) that are known to be involved in the process of bone loss.  This is a relatively new field of interest in osteoporosis.  Two recent reviews (4,5) looked at the evidence so far which does indicate a benefit, though the authors point out that further evidence is needed before firm conclusions can be drawn.  However, due to the numerous health benefits of omega 3 fatty acids (see previous blog posts) I would suggest the regular inclusion of oily fish in the diet (at least twice weekly), or taking a supplement providing around 250mg EPA and 250mg DHA a day.  For vegetarians I would suggest a daily flaxseed oil supplement to provide around 500mg alpha-linolenic acid (a shorter chain omega 3 fatty acid).


Fruits and Vegetables
A number of studies over the last decade have suggested a clear, positive link between fruit and vegetable consumption and bone health(6).  These foods provide a huge range of nutrients that are important for bone health.  In addition to the nutrients fruit and vegetables positively affect the pH balance (a measure of acid-alkali balance) in the body, by increasing the alkalinity in the body (making the body less acidic), which plays a major role in the prevention of calcium loss from bones.  Foods which are acid forming in the body include foods such as most meat and animal protein, cheddar cheese and many grain products e.g. white bread, pasta, cornflakes.  If the body is too acidic, not in pH balance, then bones can release their calcium (which increases alkalinity) into the blood to try and maintain the balance.  Obviously calcium loss is not what we want!!  Providing the body with abundant supplies of vegetables and fruits may well help to keep our bones strong as well as protecting us from many other diseases.

If you drink a lot of caffeinated tea, coffee or regularly consume fizzy drinks you may wish to reduce the amount you consume in order to protect your bones.  High intakes of these drinks can have a negative effect on bones.  The phosphoric acid they contain may cause calcium loss from bones.

Visit the National Osteoporosis Society website for more information

(1)The National Osteoporosis Society
(2) New-Lanham SA.  2008.  Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment.  Proc Nutr Soc.  67(2):163-76.
(3) Eastell R & Lambert H.  2002.  Strategies for skeletal health in the elderly.  Proc Nutr Soc.  61:173-180
(4)Salari P et al.  2008.  A systematic review of the impact of the impact of n-3 fatty acids in bone health and osteoporosis.  Med Sci Monit.  14:RA37-44
(5)Fernandes G et al.  2008.  Effects of n-3 fatty acids on autoimmunity and osteoporosis.  Front Biosci.  13:4015-4020
(6) New SA.  2003.  Intake of fruit and vegetables:implications for bone health.  Proc Nutr Soc.  62:889-899

Written by Ani Kowal