Calcium-containing foods and vitamin D: How to eat healthily for osteoporosis
Diet significant influences our bone stability. A wholesome, balanced, calcium-rich diet with fruit and vegetables forms the basis for a stable skeleton. Fruit and vegetables contain many nutrients, including vitamin K, C and B, potassium and magnesium, which are also involved in bone metabolism.
What can I eat? The dietary plan and table provide guidance
Calcium is a mineral. It is stored in the bones and released again when too little is taken in through the diet. This can weaken the bones on a long-term basis. In case of calcium deficiency, the body gets the necessary mineral from the bones. This can lead to increased bone loss. This can lead to osteopenia (reduction in bone density, often a precursor to osteoporosis) or osteoporosis itself. Calcium-rich products allow the health-conscious to do all they can to avoid the condition and those who are already ill to improve their therapy.
Develop a nutritional plan with a specialist to meet your individual nutritional needs. This should be agreed with your doctor or a nutritionist. For guidance, a table of foods suitable for osteoporosis patients is provided.
The German Society for Nutrition (DGE) recommends adults consume 1,000 milligrams of calcium per day.1 This is also the value recommended by the Osteology Umbrella Organisation (DVO). Overall, 46 percent of men and 55 percent of women consume less than the recommended amount of calcium.2
Which foods contain high levels of calcium?
Without calcium, bone formation cannot take place. In addition to calcium-rich mineral water (with at least 150 mg calcium per litre), the following foods are high in calcium:
- Vegetables: Broccoli, green cabbage, rocket, lamb’s lettuce
- Dairy products: Hard cheese, yoghurt, milk, buttermilk
- Nuts/seeds: Sesame, almonds, hazelnuts, sunflower seeds and pumpkin seeds
- Plant-based protein: Pulses, tofu, lupin beans
- Fish: Coldwater fish such as herring, mackerel, salmon provide vitamin D
Vitamin D and bone formation: Key role in the absorption of calcium
Vitamin D ensures optimum calcium absorption in the bones. It enables calcium to be absorbed from the bowels and for the mineral to be stored in the bones.
The patient’s vitamin D level should be checked by a doctor regularly to ensure that calcium absorption is as good as it can be. Where necessary, vitamin D supplements can be taken. The dosage should always be agreed with the doctor. If you spend a lot of time in the fresh air, your bones will be even stronger because the body produces vitamin D itself thanks to sunlight exposure. In contrast, we consume very little Vitamin D in food. Examples of foods that contain the "sun vitamin" are fish and seafood (e.g. herring, salmon, tuna, eel or oysters), cheese, egg yolk and avocado.
Tasty recipes for an osteoporosis diet
Get some inspiration for a varied diet. We have put together a few recipes in our osteoporosis guide:
- Bircher muesli for 2 people (p. 15)
- Fruity broccoli salad for 2 people (p. 16)
- Cream of broccoli soup (p. 16)
- Courgette carpaccio for 2 people (p. 17)
- Courgette spaghetti (p. 17)
Calcium-robbers: These foods should be avoided if you have osteoporosis
Some ingredients deprive the body of the calcium. You should avoid eating these calcium-robbers to ensure your diet is balanced:
Phosphate: Excessive intake of phosphate can lead to increased degradation of calcium from the bones and obstruct the uptake of the mineral through the intestine. Phosphate is found in many foods, such as ready meals, fast foods, chips, cola, fizzy drinks, processed cheese, meat extracts and yeast. Meat generally contains a lot of phosphate, especially pork and sausages.
Oxalic acid: It can combine with calcium in the intestine and reduce its absorption during metabolism. For example, beetroot, spinach, chard and rhubarb or chocolate contain a lot of oxalic acid.
Phytic acid: Acts like oxalic acid. It can combine with calcium, trace elements or minerals in the intestine and make absorption during metabolism more difficult. Phytate occurs among other things in wheat, barley and rye bran. Bread made from bran-free cereals is particularly good for osteoporosis patients.
Sodium chloride: Promotes calcium excretion in urine. You should therefore refrain from high-salt foods and add only a moderate amount of salt during cooking.
Osteoporosis and lactose intolerance – what can you do about it?
A calcium-rich diet is good for the bones. Some people, however, do not tolerate lactose, which is the sugar found in milk. Lactose intolerance leads to digestive problems, abdominal pain and diarrhoea, for example, if products containing lactose are consumed. Dairy products should therefore be avoided. To continue to get enough calcium, osteoporosis patients must get the mineral from other food sources.
Tip: Lactose-free milk and dairy products are a good alternative. They do not contain the milk sugar. Lactose-free dairy products still contain all the other nutrients, including the essential calcium.
Coffee and osteoporosis: Three to four cups a day doesn’t weaken the bones
For a long time, coffee was considered to be a risk factor for osteoporotic bone fractures because caffeine causes increased calcium excretion. Swedish researchers investigated these relationships in a large study involving 61,433 women born from 1914 to 1948.3
Moderate coffee consumption of three to four cups a day is harmless according to this study. Many people drink their coffee with plenty of milk, which benefits their calcium intake.
Smoking worsens osteoporosis
Another reason to stop smoking: The probability of suffering an osteoporotic bone fracture is significantly higher for smokers than non-smokers. According to one study, among smokers men are even more affected than women. Of the smokers studied, 58 percent had lower bone density than a healthy average adult.4
Diagnosis & treatment
Symptoms, prevention and treatment of osteoporosis
Back brace for the treatment of osteoporosis
Tips and tricks for a healthy way of life
1 Deutsche Gesellschaft für Ernährung; Empfohlene Zufuhr Calcium. Online published on: www.dge.de/wissenschaft/referenzwerte/calcium/ (Last accessed 05.07.2018)
2 MRI – Max Ruber Institut, Bundesforschungsinstitut für Ernährung und Lebensmittel: Ergebnisbericht Teil 2; Nationale Verzehrsstudie II, Karlsruhe 2008: Die bundesweite Befragung zur Ernährung von Jugendlichen und Erwachsenen
3 Hallström H et al. Am J Epidemiol 2013;178(6):898-909
4 Jaramillo JD et al. Ann Am Thorac Soc 2015;12(5):648-656.