Nutrition and bone, muscle and joint health are closely related. A healthy diet can help you prevent and manage osteoporosis and related musculoskeletal disorders by assisting in the production and maintenance of bone. Conversely, if you're not getting the right nutrients you're putting yourself at greater risk for bone, muscle and joint disease.

So which nutrients should you be getting, and what’s the best way to get them?

Two of the most important nutrients are calcium and vitamin D. Calcium is a major building-block of bone tissue (the skeleton houses 99% of the body’s calcium stores). Vitamin D is key at it assists your body to absorb calcium – the two go hand in hand.

There are a number of foods, nutrients and vitamins, besides calcium and vitamin D, that help to prevent osteoporosis and contribute to bone, muscle and joint health, including protein, fruits and vegetables, and other vitamins and minerals.

Protein

Adequate dietary protein is essential for optimal bone mass gain during childhood and adolescence. It’s also responsible for preserving bone mass with ageing. Lack of protein robs the muscles of strength, which heightens the risk of falls, and contributes to poor recovery in patients who have had a fracture1.

Lean red meat, poultry and fish, as well as eggs and dairy foods, are excellent sources of animal protein. Vegetable sources of protein include legumes (e.g. lentils, kidney beans), soya products (e.g. tofu), grains, nuts and seeds.

Fruits and Vegetables

Fruits and vegetables contain an array of vitamins, minerals, antioxidants and alkaline salts - some or all of which can have a beneficial effect on bone. Studies have shown higher fruit and vegetable consumption is associated with beneficial effects on bone density in elderly men and women2,3.

Other vitamins and minerals

B Vitamins and Homocysteine

Some studies suggest high blood levels of the amino acid homocysteine may be linked to lower bone density and higher risk of hip fracture in the eldery. Vitamins B6 and B12, as well as folic acid, play a role in changing homocysteine into other amino acids for use by the body, so it is possible that they might play a protective role in osteoporosis. Research is ongoing as to whether supplementation with these B vitamins might reduce fracture risk4,5.

Magnesium

Magnesium plays an important role in forming bone mineral. Magnesium deficiency is rare in well-nourished populations. The elderly are sometimes risk of mild magnesium deficiency, as magnesium absorption decreases with age. Particularly good sources of magnesium include green vegetables, legumes, nuts, seeds, unrefined grains and fish6.

Vitamin A

The role of vitamin A in osteoporosis is controversial. Vitamin A is present as a compound called retinol in foods of animal origin, such as liver and other offal, fish liver oils, dairy foods and egg yolk. Some plant foods contain a precursor of vitamin A, for example in green leafy vegetables, and red and yellow coloured fruits and vegetables. Consumption of vitamin A in amounts well above the recommended daily intake may have adverse effects on bone7-9.

Such high levels of vitamin A intake are probably only achieved through over-use of supplements, and intakes from food sources are not likely to pose a problem. Further research is needed into the role of vitamin A in bone health, although many countries at present caution against taking a fish liver oil supplement and a multivitamin supplement concurrently.

Vitamin K

Vitamin K is required for the correct mineralization of bone. Some evidence suggests low vitamin K levels lead to low bone density and increased risk of fracture in the elderly. Vitamin K sources include leafy green vegetables such as lettuce, spinach and cabbage, liver and some fermented cheeses and soya bean products10,11.

Zinc

This mineral is required for bone tissue renewal and mineralization. Severe deficiency is usually associated with calorie and protein malnutrition, and contributes to impaired bone growth in children. Milder degrees of zinc deficiency have been reported in the elderly and could potentially contribute to poor bone status. Sources of zinc include lean red meat, poultry, whole grain cereals, pulses and legumes12,13.

References

1. Rizzoli R and Bonjour J-P (2004) Dietary protein and bone health. J Bone Miner Res 19:527-31
2. Tucker KL, Hannan MT, Chen H, et al. (1999) Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 69:727-736
3. Lin PH, Ginty F, Appel LJ, et al. (2003) The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr 133:3130-66
4. McLean RR, Jacques PF, Selhub J, et al. (2004) Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med 350:2042-49
5. Morris MS, Jacques PF, Selhub J (2005) Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans. Bone 37:234-42
6. Schwarz R (1990). Magnesium metabolism. In: Nutrition and Bone Development, ed. DJ Simmons, Oxford University Press, New York, pp. 148-63
7. Feskanich D, Singh V, Willett WC, et al. (2002). Vitamin A intake and hip fractures among postmenopausal women. JAMA 287:47-54
8. Michaelsson K, Lithell H, Vessby B, et al. (2003) Serum retinol levels and the risk of fracture. N Engl J Med 348:287-94
9. Barker ME, McClosky E, Saha S, et al. (2005) Serum retinoids and beta-carotene as predictors of hip and other fractures in elderly women. J Bone Miner Res 20:913-20
10. Booth SL, Tucker KL, Chen H, et al. (2000) Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women. Am J Clin Nutr 71:1201-08
11. Iwamoto J, Takeda T, Sato Y (2004) Effects of vitamin K2 on osteoporosis. Curr Pharm Des 10:2557-76
12. Hyun TH, Barrett-Connor E and Milne DB (2004) Zinc intakes and plasma concentrations in men with osteoporosis: the Rancho Bernardo Study. Am J Clin Nutr 80:715-21
13. Devine A, Rosen C, Mohan S, et al. (1998) Effects of zinc and other nutritional factors on insulin-like growth factor I and insulin-like growth factor binding proteins in postmenopausal women. Am J Clin Nutr 68:200-6