Osteoporosis Prevention – Thinking Beyond Calcium

Featured article in the Summer 2017 Issue of Nutrition Close-Up; written by Pamela Hernandez, CPT

A 2013 report in The Journals of Gerontology, Biological Sciences and Medical Sciences stated that osteoporosis-related fractures are a substantial burden, not just on our public health but also our economy. In the United States, they estimated the cost of fractures to exceed $19 billion annually.1

For years, women have been coached to get their calcium to prevent osteoporosis. Advertising campaigns with white mustaches and creamy cups of yogurt encouraged women of all ages to get three servings of dairy products a day to prevent osteoporosis and its related health problems. Calcium supplements and bone health treatments are also highly advertised to women in the United States. Yet according to the International Osteoporosis Foundation, “osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million U.S. women and men aged 50 and older.”2

Which begs the question, are we doing enough for bone health?

Calcium intake is just one part of a three-pronged strategy for osteoporosis prevention.

In addition to getting enough calcium, women should also be counseled to get enough protein in their daily diet. A study recently published in the American Journal of Clinical Nutrition seems to indicate that protein intake is also part of the formula to prevent osteoporosis.3 The study conducted on 746 postmenopausal women found a positive relationship between protein intake, specifically dairy and animal protein, and bone strength and architecture. Meaning it is not just calcium that builds strong bones, but also protein.

The third often missing but critical element in a comprehensive osteoporosis prevention plan is exercise; specifically load bearing and strength training activities. The medical profession has long encouraged load-bearing exercise such as running or jumping activities to help strengthen bones. However, a meta-analysis published in 2016 in the journal Sports Medicine indicates that a combination of impact exercise (like running) and strength training is the best course of action to improve and maintain bone mineral density in both pre- and post-menopausal women.4

Health and fitness professionals can help their female clients create a lifestyle that supports good bone health at all stages of life with these three key steps.

Emphasize calcium from whole food sources. Calcium supplement recommendations should come from a doctor or registered dietitian. Other health and fitness professional instead can help a client get her daily intake of calcium from both dairy and non-dairy foods. Most women know that yogurt and milk are great sources of calcium however they don’t know that leafy greens like 1? c. kale and foods like tofu and fortified cereals can be good sources of calcium.5 This can be especially helpful for those who suffer from dairy intolerance or allergies.

Educate clients on how to balance the plate with quality protein sources. Women on the go tend to rely on easy to grab foods like fruit or low fat snacks like pretzels or popcorn. Educating clients on how to pair up a protein with their favorite snack, like a hard-boiled egg with pretzels or a piece of natural and nitrate-free beef jerky to go with the banana, not only helps bone health; it also helps balance blood sugar and keep hunger at bay a little longer.6

Create exercise programs that include both weight bearing and strength training exercises. For clients who can’t or don’t like to run, small bursts of plyometric exercises like jump squats, dancing or even stair climbing can prove an adequate stimulus for osteoporosis prevention. Following Physical Activity Guidelines for Americans7 by participating in weight training exercise two or more days a week will also provide the needed strength training activities to support good bone health.

These small but impactful steps along with bone density screenings make a more comprehensive plan to battling the public health crisis of osteoporosis.

For more information on dietary protein’s impact on bone health, visit ENC’s website to learn the findings of a recent meta-analysis.




  1. Cauley Jane A. Public Health Impact of Osteoporosis. J Gerontol A Biol Sci Med Sci. 2013. 68: 1243–1251.
  2. International Osteoporosis Foundation. Facts and Statistics. Version Current 13 March 2017. Internet: https://www.iofbonehealth.org/facts-statistics (accessed 13 March 2017)
  3. Durosier-Izart C, Biver C, Merminod F, et al. Peripheral skeletal bone strength is positively correlated with total and dairy protein intakes in healthy post menopausal women. Am J Clin Nutr. 2017; e-pub ahead of print.
  4. Xu J, Lombardi G, Jiao W, et al. Effects of Exercise on Bone Status in Female Subjects, Young Girls to Postmenopausal Women: An Overview of Systematic Review and Meta-Analyses. Sports Medicine. 2016. 46:1165-82.
  5. U.S. DHHS. National Institutes of Health. Calcium Fact Sheet for Health Professionals.
  6. Leidy HJ, et al. The role of protein in weight loss and maintenance. Am J Clin Nutr 2015;101:1320S-1329S.
  7. U.S. DHHS. 2008 Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008. ODPHP Publication No. U0036.
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