Bone health tends to become more top of mind as we get older, especially because we’re more likely to develop osteoporosis with age. But in truth, osteoporosis prevention should be something prioritized from childhood. It’s estimated that 10 million Americans have osteoporosis, and 44 million others have low bone density, according to the Bone Health & Osteoporosis Foundation. While 1 in 2 women and up to 1 in 4 men will break a bone due to osteoporosis after age 50, the stage is set long before that.
I’ve heard osteoporosis called a “pediatric silent disease,” because of how important it is to develop habits that support building peak bone mass in childhood and adolescence, since our best bone-building years end in our mid-20s. While having a family history of osteoporosis greatly increases the odds that you and your children will eventually develop it — thanks, genetics — diet and physical activity are two factors we can modify to support healthy bones at any age. These are my top three tips for a bone-friendly diet.
Tip No. 1: Eat enough
While there are specific nutrients that are key for bone health, simply eating enough matters, too. When calorie intake is too low, this can directly contribute to bone loss, in part because intake of key nutrients drops, too. It can also cause bone loss indirectly via loss of estrogen (in females) or testosterone (in males). The greater the calorie deficit, the greater the risk, which is why the risk of bone loss in people with anorexia as well as in athletes who aren’t eating enough to fuel their activity is well established. But behaviors like chronic dieting, skipping meals and overexercising also pose a risk.
Once you’re eating enough food, the focus shifts to protein, which provides important building blocks for bone. The recommended daily allowance of 0.36 grams of protein per pound of body weight per day is not enough, as that’s the amount needed to avoid a protein deficiency. Aiming for 0.55 to 0.68 grams of protein per pound of body weight — or even a bit higher — each day is more optimal (if you never weigh yourself, use your best estimate). That would look like 83 to 102 grams per day for someone who weighs 150 pounds, or 110-136 grams for someone who weighs 200 pounds. To put that in perspective, the 1 ounce equivalent (7 grams) of protein equals about 1 ounce by weight of meat, poultry or fish. It also equals one egg, 1 cup of milk, 1 cup of cooked pasta, ½ cup of cooked beans, 2 tablespoons of peanut butter or 1 ounce by weight (about ¼ cup) of nuts or seeds.
Tip No. 2: Eat plants
While protein is important, our overall eating pattern matters, too. There are many reasons why it’s a good idea to eat enough fruits and vegetables, and bone health is one of them. A diet rich in fruits and vegetables provides antioxidants, potassium, magnesium, vitamin K and vitamin C, each of which plays a role in bone health.
Another benefit of plant-forward diets is that they are anti-inflammatory, and that benefit extends to bones. Osteoclasts — cells that degrade bone — are turned on by inflammation. That’s likely why some evidence suggests that the Mediterranean diet may help protect bone and delay osteoporosis. On that note, keep in mind that drinking more than two servings of alcohol per day, even red wine, is probably not good for bones, as excessive alcohol consumption can be inflammatory.
Tip No. 3: Include bone-building nutrients
No bone-friendly diet would be complete without a few more specific nutrients that are key for bone health. Calcium is one of them, of course, and it’s recommended that women get 1,000 milligrams of calcium per day up to age 50 and 1,200 mg per day after that. (Men need the same amounts, but their transition age is 70.) Calcium has an upper daily limit — 2,000 mg for adults ages 51 and older, 2,500 mg for younger adults — so more isn’t better, and we can’t really absorb more than 500 to 600 mg per meal.
Dairy milk, yogurt, kefir and cheese — except cottage cheese, which is low in calcium — are obvious sources of calcium. Nondairy sources of calcium include canned sardines and salmon that still have their bones (the canning process makes the bones soft enough to eat), although those are getting harder to find. Plant-based sources of calcium include tofu made with calcium, tempeh, calcium-fortified plant milks and other foods, and some dark leafy vegetables — collard greens, broccoli raab, turnip greens and kale are the best of the bunch. It’s ideal to get your calcium from food, and getting calcium from dairy products or fortified plant milks can make it easy to spread your intake throughout the day for maximum absorption and minimum reliance on calcium supplements to bridge the gap.
Keep in mind that dairy foods are rich in bone-building nutrients other than calcium, such as protein, potassium and vitamin D, which is essential for absorbing calcium. Because our vitamin D levels can change throughout the year, especially in northern states like Washington, many people may need to add supplements during the winter months. After age 50, the Bone Health & Osteoporosis Foundation recommends 800-1,000 IU of supplemental vitamin D taken with food for osteoporosis prevention. Fatty fish such as salmon and sardines contain vitamin D as well as omega-3 fatty acids, which have anti-inflammatory benefits.
Don’t forget physical activity
Super briefly, when exercising for bone health, incorporate activities that build strength and balance. Weight-bearing activities such as walking, running and resistance/strength training stimulate bones and help you maintain muscle, which makes it more likely that you can stop a fall and prevent a fracture if you lose your balance.