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Nutrition For The Prevention Of Osteoporosis - Part Two

by Penny Crowther(more info)

listed in nutrition, originally published in issue 162 - September 2009

In the first part of this article (PH April 2009 Issue 157 -, I discussed the importance of minerals together with vitamins K2 and D, in maintaining healthy bones. In Part Two, I will cover diet and prevention testing.

Alkalize Your Diet

A vital part of any bone-building programme is a diet which favours alkaline foods. Increasingly, research is showing that over-acidity from excessive animal protein intake, is a major factor affecting bone strength.[1] Whilst the stomach does need to be acid for minerals such as calcium to be broken down properly, general over-acidity of the body tissues will cause calcium to be taken from the reservoir in the bones in order to buffer the excess acidity.

The Palaeolithic or Stone Age diet had a much more balanced acid to alkaline ratio than the modern diet. It was rich in seeds, nuts, fruits and plants, free of dairy and grains and meat consumption was moderate. The skeletons of stone age hunters have been found to have a 17 percent greater bone density than modern humans.[2]

Vegetarians often have a higher bone density than carnivores. Research involving 1600 women, roughly half vegetarian and half meat-eaters, found that the by the age of 80, the average meat-eater was set to lose 35 per cent of her bone density by the time she reached age 80. In comparison, a woman who had been vegetarian for at least 20 years, would have lost, on average, only 18 per cent of her bone density.

Consumption of acid producing protein has increased drastically over the past 40 or so years. The average Western diet probably contains a ratio of around 80 percent acid forming foods and only 20 percent alkaline forming foods. For people with osteoporosis, the ratio should ideally be the other way around, and for prevention a ratio of 60 or 70 percent acid versus 40 or 30 percent alkaline is recommended.

The acid or alkaline forming potential of a food can be calculated in different ways, and the results vary accordingly. The PRAL[3] method reveals cheese to be the most strongly acid forming food of all, closely followed by meat. So the much offered advice to obtain your calcium from dairy foods is highly questionable. The acid-producing factor aside, there is evidence to suggest that the calcium in dairy foods may not be well absorbed. Some studies show that calcium from green leafy vegetables is nearly twice as well absorbed as calcium from cow's milk.

Fruits and vegetables are supremely alkaline forming, and they are the bone superfoods. Aim high; 5 daily portions is a good start but make 8 your goal! A common misconception is to think that fruits are acid forming; this arises from confusing the pH of the food with the end effect it has on the body. Fruit is acid, but once digested and broken down it becomes alkaline (unless the digestive process is not efficient).

Improve your Digestion

Efficient digestion is key to healthy bones, as poor absorption will lead to deficiency of bone building vitamins and minerals despite adequate dietary intake. Crohn's disease, colitis and coeliac disease are amongst the more serious conditions involving the digestive tract. However, more subtle digestive problems are encountered frequently in practice. For example low stomach acid is increasingly common (especially as we age); this will affect absorption of minerals and lead to gas and bloating. A simple home test or a live blood microscopy are good means of checking stomach acid levels, and this can be supplemented with HCl. Following a low allergenic diet, correcting dysbiosis (gut bacteria imbalance) and treating yeast or parasitic growth are also factors to consider.

Consider Strontium

If you have already been diagnosed with osteoporosis, the medication you are most likely to be prescribed is a bisphosphonate. These drugs  work by inhibiting the breakdown of old bone. However they do not build new bone and can actively stop new bone formation. The principal side effects of bisphosphonates are digestive disturbance which is severe in some cases.

Strontium ranelate is a relatively new drug treatment which slows down bone loss, but builds new bone as well.[4]  It does not cause digestive side effects like the bisphosphonates.  In  rare cases it may cause blood clots so it is best prescribed by a GP rather than taken as a supplement.  It is not yet very common to prescribe strontium in the UK and you may need to ask your GP for it. Strontium will affect x-ray results, so if you take it you must inform the technician who does your scan, as the machine has to be recalibrated.

A practical clinical trial that used two supplements, strontium citrate and a mineral and vitamin formula containing calcium and magnesium from algae sources along with vitamins K2 and D, resulted in increased bone density measurements.[5] The change in T-score was measured using a DEXA scan before supplementation started, and 6 months after supplementation. 

Use The Bone Turnover Test

This is a very useful test. It is a newer, but scientifically validated test which can be performed at home, and measures rate of bone turnover by screening for a substance in the urine called deoxypyridinoline.  This substance is the result of the breakdown of the collagen (protein) in bone. The rate of bone turnover has been found to be an equally, if not more effective predictor of bone strength and fracture risk than bone density.[6]The great benefit of this test is that it monitors the success of a treatment programme, natural and/or medication-based. Results will show up quickly so the test can be performed before and after 2-3 months on a programme. There also no risk from low dose radiation as with the DEXA scan.


1. Sellmeyer DE et al. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women, Study of osteoporotic Fractures Research Group. AM J Clin Nutr 73 (1): 118-22. 2001.
2. Eaton SB, Nelson DA. Calcium in Evolutionary Perspective. Am J Clin Nutr 54: 2815-2875. 1991.
3. Remer T, Manz F. Potential Renal Acid Load of Foods and its Influence on Urine pH. J Am Diet Assoc 95: 791-7. 1995.
4. Meunier PJ, Roux C, Seeman E, et al. The Effects of Strontium Ranelate on the Risk of Vertebral Fracture in Women with Postmenopausal Osteoporosis. N Engl J Med.350: 459-468. 2004.
Reginster JY, et al. Strontium ranelate reduces fractures in osteoporotic women. J Clin Endocrinol Metab. 2005; 90: issue 5: Pages 2816-2822.
5.  Michalek JE, Preuss HA. Effects of the AlgaeCal(r) Bone-Health Program on Bone Mineral Density.
6. TJ Wilkin. Changing Perceptions in Osteoporosis. BMJ 27: 318 (7187): 862-4. 1999.

Further Information

For information on the bone turnover test (osteoporosis risk assessment test) see


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About Penny Crowther

Penny Crowther BANT CNHC qualified as a nutritional therapist in 1997 and has been in clinical practice ever since. She has seen several thousand clients over the years, at her practice in London and online. Penny now specializes in nutrition for women in their 40s and beyond, particularly around peri and post menopause. Mid Life for women can be a time when fluctuating hormones play havoc with your wellbeing. In the midst of all the publicity around HRT, it's easy to forget just how powerful diet and lifestyle changes can be when it comes to navigating the menopausal years.

Penny will guide and support you through specific changes to your diet, targeted to you specifically, in midlife. She provides practical, easy to follow menu plans with easy and delicious recipes. The food you eat affects every cell and system in your body. It optimizes how you look and feel, both mentally and physically.

To book an appointment view consultation options here >>

As well as being a regular columnist for Positive Health, Penny has written for Holland and Barrett, and contributed to articles for the Daily TelegraphThe Times Literary supplement, Pregnancy & Birth and Marie Claire. She has been featured in the Daily Express, Daily Mirror and on local radio.

Penny is a registered nutritional therapist with standards of training endorsed by BANT (British Association for Applied Nutrition and Nutritional Therapy) and CNHC. This includes completing 30 hours of continuing professional development, annually.

Penny’s approach to health is holistic, and takes into account emotional, mental and environmental factors as well as nutrition. She has trained in coaching and studied many complementary therapies before qualifying as a nutritionist, which provides a broad foundation of knowledge in her nutrition practice. Penny may be contacted on Tel: 07761 768 754;

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