[4 min read] Medical nutrition therapy for bone health

Did you know that more than 4.5 million Australians over 50 years of age have osteoporosis, a metabolic disease characterised by decreased bone mass? Poor bone health can have a devastating impact on individuals, causing significant reduction in mobility, function, and quality of life, such as the inability to dress oneself or walk; poor self-esteem, body image, and mood; and a feeling of isolation and helplessness [1].

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Medical Nutrition Management.

Osteoporosis also represents a large and growing health burden – in 2017, the total direct cost of osteoporosis in Australia was estimated to be $3.44 billion, with fractures accounting for 68% of this total cost [2].

Primary care physicians have an important role in prevention, identification, and treatment of poor bone health in patients. Efforts should be focused on offering treatment to those groups with the highest risk of fracture, particularly those that have had a fragility fracture [3, 4].

Nutritional considerations

Nutrition plays a critical role in the prevention of low bone mineral density and falls, as well as in maintaining optimal skeletal health across the lifespan [5]. Dietary recommendations include:

Protein

High-protein diets were once thought to leach calcium from bones but now are thought to play an important role in building bone. Epidemiologic studies show greater protein intake to be beneficial to bone health in adults, especially older adults. Moreover, randomised controlled trials show that protein’s positive effect on bone health is the result of its ability to increase intestinal calcium intake [6].

Calcium and vitamin D

Low calcium and vitamin D intakes are associated with increased risk of poor bone health [7]. For patients who struggle to get enough of either nutrient through diet, taking a supplement may be a pragmatic option. Dairy foods are the richest sources of calcium and vitamin D (in the case of fortified milk), but there are non-dairy milk products fortified with both nutrients, which is important for vegans and some vegetarians. Still, there exists some controversy over how effective calcium and vitamin D are in preventing bone loss.

Alcohol

Long-term alcohol consumption can interfere with bone growth and replacement of bone tissue (i.e., remodelling), resulting in decreased bone density and increased risk of fracture [8]. However, the precise amount of alcohol required to affect calcium status and whether moderate alcohol consumption is harmful to bone is unknown [9].

There is synergy in the lifestyle recommendations for bone health with other aspects of health, so these should be addressed as thoroughly as possible in medical nutrition therapy to best protect, support and build better bone health for all patients.

Learn more about nutrition for bone health with the online HealthCert Professional Diploma program in Medical Nutrition Management.

– Lynette Law, Accredited Practising Dietitian

Read another article like this one: Nutrition therapy for metabolic syndrome


References

  1. Banefelt, J., et al., Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int, 2019. 30(3): p. 601-609.
  2. Tatangelo, G., et al., The Cost of Osteoporosis, Osteopenia, and Associated Fractures in Australia in 2017. Journal of Bone and Mineral Research, 2019. 34(4): p. 616-625.
  3. Bliuc, D., et al., Risk of subsequent fractures and mortality in elderly women and men with fragility fractures with and without osteoporotic bone density: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res, 2015. 30(4): p. 637-46.
  4. von Friesendorff, M., et al., Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int, 2016. 27(10): p. 2945-53.
  5. Lewis, J.R., T. Voortman, and J.P. Ioannidis, Evaluating and Strengthening the Evidence for Nutritional Bone Research: Ready to Break New Ground? J Bone Miner Res, 2021. 36(2): p. 219-226.
  6. Mangano, K.M., S. Sahni, and J.E. Kerstetter, Dietary protein is beneficial to bone health under conditions of adequate calcium intake: an update on clinical research. Curr Opin Clin Nutr Metab Care, 2014. 17(1): p. 69-74.
  7. Balk, E.M., et al., Global dietary calcium intake among adults: a systematic review. Osteoporos Int, 2017. 28(12): p. 3315-3324.
  8. Sampson, H.W., Alcohol’s harmful effects on bone. Alcohol Health Res World, 1998. 22(3): p. 190-4.
  9. Keiver, K. and J. Weinberg, Effect of duration of alcohol consumption on calcium and bone metabolism during pregnancy in the rat. Alcohol Clin Exp Res, 2003. 27(9): p. 1507-19.

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