Diet is an incredibly important aspect of our health and what we consume will directly impact our physical health. Bones are no different, and need to be fuelled to maintain their integrity.

When talking about our bone health in relation to our diet, there is little difference between prevention and management in the sense that both diets aim to ensure you are consuming an adequate amount of calcium to maintain bone mineral density and that the foods and drinks you consume are assisting your absorption of calcium, not hindering it.

Calcium, why is it so important?

Calcium is a mineral that helps keep our bones and teeth strong, and plays a very important role in keeping our heart pumping with the correct strength.

Our body stores its Calcium primarily in our bones, they act as a bank for calcium. If we do not consume enough calcium in our diet, then our body will make a withdrawal of calcium from our bones to keep an adequate level in our blood, this can then leave our bones weak and brittle.

As we age, our bones are not able to replace bone as quickly as when we were younger, and we also are not able to absorb calcium as well as we use to, which means our body may still take the calcium from our bones and our bones cannot repair quickly, which continues our progression from healthy bone to osteoporotic bones.

It is therefore important to consume enough calcium in our diet to keep our bones as strong as we can for as long as we can.

Dietary tips for calcium absorption

For our bones to absorb calcium we need to make sure we are consuming enough of it.

Best sources of calcium include;
Milk and milk alternatives with added calcium (we check this on the nutritional label - organic milk alternatives often do not have calcium added. We want ~ 100mg calcium per 100ml)
Cheese
Yoghurt
Kefir
Nuts such as almonds
Tofu
Fish with bones or John west have a calcium tuna (where they grind the bones into a powder and mix it in) that meets almost all of your daily needs.

Vitamin D is another important nutrient for our bones. It assists us in absorbing calcium. Vitamin D is mostly made from us being exposed to the sun, with recommendations being at least 10 minutes a day of direct sunlight on your face, arms, hands or legs to obtain a sufficient amount. Otherwise, we can gain Vitamin D through our diet.

Vitamin D foods include;
Fish
Milk
Egg yolk
Fortified beverages such as soy
Fortified margarine
Mushrooms -> if you leave mushrooms in the sun their vitamin D content increases.

Magnesium helps regulate the activity of bone-forming cells and is involved with the metabolism (breakdown and usage) or calcium. Magnesium can be found in nuts, seeds and leafy greens.

What hinders calcium absorption?

Some things to be mindful of;
Limit intake caffeine rich drinks - if you are taking a calcium supplement or eating a calcium rich food, try not to have a caffeine containing beverage such as tea, coffee, cola, energy drinks near this as it will reduce calcium absorption.
We also need to understand that there is a chemicals in certain foods called oxalates that may inhibit the absorption of calcium. Sometimes this chemical is present in high calcium foods such as spinach.

Calcium and Vitamin D intake recommendations

This is a table of the recommended amounts of calcium to consume per day based on your age and sex.
This is the minimum amount required per day to assist in the prevention of osteoporosis or the maintenance of healthy bone mineral density (strong bones!)

You will notice that Women will need a higher intake around the time that menopause usually occurs due to the loss of oestrogen.

This also outlines a misconception about calcium intake and pregnancy, as most people assume you need to consume more calcium to build the bones of the baby. But since pregnant women have higher levels of oestrogen in their systems, they can absorb calcium more easily.

You can use the calcium calculator to know if you are getting enough calcium https://osteoporosis.ca/calcium-calculator/

It is recommended that adults diagnosed with Osteoporosis consume;

>1200mg of calcium daily
>20μg of vitamin D daily

This is the same amount as what is recommended for women 51yrs+, but you will notice they expect greater than this amount, not a minimum of this amount as in the above table.

How do I know how much calcium something has in it?

This table helps to put in perspective how many milligrams of calcium is in each calcium source, so you can better map out your needs as per the recommendations for your age and sex.

So, for example if you are a female aged 51-70 you might want to consume a tub of yoghurt for breakfast, two slices of cheese and a can of tuna for lunch, and one glass of milk for dessert, and a small handful of almonds as a snack throughout the day to meet your minimum calcium requirements for the day. This is not quite enough to achieve what is recommended for the management of osteoporosis, which may sound like a large amount to look to include in your diet.

This may be due to a loss of appetite that is often experienced as we age, so if you are struggling to understand or maintain an appropriate amount of calcium, it may be of benefit to seek help from a Dietitian to assist you with getting enough calcium in your diet without having to worry so much about how full you will feel.

The calcium calculator can also assist you with picking higher calcium food products to include in your diet.

Are there any times when I should not increase my calcium intake?

There is one instance where we would need to be cautious about increasing calcium intake and would only do so under supervision of a Dietitian and/or Medical professionals. This is in the case that you have a heart condition such as hypertension, angina or arrhythmias.

As said in the beginning, calcium is important in keeping our heart pumping, specifically it is in charge of how hard the heart pumps.

Too much calcium, in the presence of these cardiac conditions may exacerbate your blood pressure issues and progress your cardiac condition

This may also lead to the need for having a calcium channel blocker as part of your medication resume, if you aren’t already on one.

So, if you have both Osteoporosis and one of these cardiac conditions, it is advised you consult your Doctor and Dietitian to ensure you are protecting your heart as well as helping your bones.

Who can help me?

A qualified Dietitian can assist you with managing your diet to ensure you are receiving enough calcium to help keep your bones strong, as well as manage the other vitamins and minerals responsible for maintaining bone mineral density. Alongside your GP, they can also account for medications and age related changes to provide optimal care for your individual situation.

See "Osteoporosis & Osteopenia" to learn more about this condition, and stay tuned for "Osteoporosis & Exercise"

Written by Shara Foster

Diet and Osteoporosis/Osteopenia