Osteoporosis
Food, diet and supplements for osteoporosis
A calcium rich diet is an important component of managing osteoporosis well. Calcium is particularly good for the bones. An adequate intake of calcium in the young will help them achieve a peak of bone mass and in the elderly it helps to reduce age-related bone loss. The best sources of calcium are to be found in dairy products, such as milk and cheese. Vitamin D helps the body absorb calcium.
There are lots of calcium supplements available in the market but most of the people we talked to were prescribed calcium tablets and vitamin D by their GP or consultants, in particular Adcal D3 and Calcichew D3 Forte. Vitamin D is made by the skin when exposed to sunlight but in some groups, like the elderly, deficiency can occur due to lack of sun exposure. Most people residing in the UK is vitamin D deficient at the end of winter. Lack of vitamin D can cause bone loss, and replenishing vitamin D may also help prevent fractures from falls. Foods that are good sources of vitamin D are: liver, butter but the main source is oily fish, like sardines and mackerel. There are vitamin D supplements available over the counter in health food shops and chemists.
Most of the people we talked to said that they had a ‘good diet’ meaning that they have a balanced diet that includes food from the main four group categories' fruit and vegetables, protein (dairy products, eggs and meat), carbohydrates and pulses. Some people said that they were amazed to have been diagnosed with osteoporosis because all their lives they have had a diet rich in calcium.
Pat now eats more dairy products and grows her own vegetables.
Pat now eats more dairy products and grows her own vegetables.
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And what have you changed about your diet?
I eat more dairy products now. I’m not a lover of yogurt but I will eat them. Because I don’t like much milk in my hot drinks. I’ll drink cold milk till it comes out of my ears. But you give me a cup of tea or a cup of coffee, I only like enough milk just to cover the bottom of the cup. Don’t ask me why. It’s just a fad I’ve got. But I always have a milky drink before I go to bed, hot chocolate.
But green vegetables, I mean we’ve always eaten, so it’s nothing new to me, eating this and fruit.
Do you grow your own vegetables …?
If you saw the size of my garden. But we have got a few potatoes in and we’ve got Jack and the Beanstalk. I planted some, got some runner beans and they’re going skywards. And we’ve got a couple of pea plants in and lettuces and mint and parsley and dill and chives, bay. And I’ve got a little greenhouse, it’s only this big, and it’s got tomatoes in. And it’s only 4 foot across. You see, I can’t bend down. [husband] does, [husband] puts the pots on the table and I put the plants in. And then they go down on the floor. And that’s what we do. He’s the labourer and I’m the gardener.
Following diagnosis many of the people we talked to had made a conscious choice to increase their intake of calcium in their diets by eating more dairy products like milk and cheese. Also some people had researched the best sources of calcium, apart from dairy products, and mentioned food like broccoli, sardines, oily fish, sesame seeds, calcium fortified cereals and tofu as good additional sources of calcium.
Clare has oat-based cereal for breakfast and she now eats more green vegetables.
Clare has oat-based cereal for breakfast and she now eats more green vegetables.
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Tell me about diet, what have you modified, what are you eating more of and less of?
I am eating Ready Brek every morning because on the sheet from the [hospital] it said Ready Brek was one of the highest foods in calcium. It’s revolting. So I eat that for breakfast and then I make sure that I have more green vegetables, perhaps than I had before. But I eat an enormous amount of salad and green, greens there with spinach salad or something like that. But I do try and have broccoli at least four or five times a week, and I drink a lot of water eat more fish. And that's all really.
And what have you, have you seen the need to stop eating or limiting certain foods or not?
Well I don’t, I don't smoke and I don’t’, virtually don't drink so I thought those were the two essential things not to do. And I just eat what's put in front of me or what I put in front of myself basically. No I don't really.
What is this Ready Brek?
Right.
Would you explain to us that?
It's, I suppose it's oats or something like that but modified and calcium added, it says on the packet. And it's in an orange package and you can get it from any of the big supermarkets. And I just have thirty grams a day and add some milk and then put it in the microwave for a minute and a half, which just cooks it a bit. And I add some raisins to it because I can't bear it on its own [laughs].
It's like a porridge.
It is. It’s like …
And does it taste like a porridge?
I dislike it so intensely, I find it hard to say [laughs]. Not a very good advertisement for it, is it? It doesn't taste a great deal. I suppose porridge would be the nearest thing, a very sloppy porridge would be the nearest way to describe it. It's flaky, sort of substance before you add milk.
Chris eats more calcium-rich foods and avoids red meat.
Chris eats more calcium-rich foods and avoids red meat.
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Tell me, have you made any changes to your diet since diagnosis?
Yes, I eat a lot more calcium-rich foods. I know what foods are good for me and for my osteoporosis. I eat a lot more yogurt, sesame seeds, figs that are growing out on the trees, you know, that sort of thing. I do, I’m aware of what I eat. I have a greater awareness.
What about drinking alcohol?
I don’t drink really very much. I mean an occasional glass of wine. But not really, no.
Yes, I eat a lot more calcium-rich foods. I know what foods are good for me and for my osteoporosis. I eat a lot more yogurt, sesame seeds, figs that are growing out on the trees, you know, that sort of thing. I do, I’m aware of what I eat. I have a greater awareness.
What about drinking alcohol?
I don’t drink really very much. I mean an occasional glass of wine. But not really, no.
Are you a vegetarian?
I eat, yes, I’m more, I’m sort of semi-vegetarian. I don’t eat red meat. I’ll eat chicken and fish. Not, I really don’t eat red meat. I don’t like red meat.
And any supplements, vitamin supplements?
Occasionally I used to take vitamin supplements. But I think that I, you know, if you eat reasonably well, they’re not required.
And any supplements, vitamin supplements?
Occasionally I used to take vitamin supplements. But I think that I, you know, if you eat reasonably well, they’re not required.
Carol drinks soya milk every day and eats plenty of fruit and nuts and she takes a few supplements.
Carol drinks soya milk every day and eats plenty of fruit and nuts and she takes a few supplements.
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I mean, diet’s obviously important. And perhaps I wasn’t as careful before with what I ate and drank. And I must admit I used to hate milk, even when I was child in school. The smell of the milk in the school, it used to make me feel sick and I used to hate it. And that stayed with me right from sort of infants’ school. So I never drank milk. Now I’m drinking lots of soya milk every day and I drink skimmed milk and I have lots of fruit and vegetables and some of the things that were recommended to me were apricots, which I didn’t like, but I have them in my breakfast bowl. And brazil nuts. So I have quite a lot of fruit. I have sort of with my breakfast, I’ll have the muesli with the grapes, strawberries, apricots, dates, sultanas. That sets me up for the day really.
Yes, so I’m more aware of my diet now than I ever was. You think you can just get away with it when you’re young. What you don’t realise is that you’re going to pay for it when you’re older.
So I don’t know, yeah, I mean, to be quite honest, now I have come to terms with it, as one does, and I do forget that I have osteoporosis apart from the fact that I’ve got my medication lined up in the morning and apart from the Adcal and the ibandronic acid I also take selenium one a day and B-complex one a day. And also the high strength chondroitin and Glucosamine. And I never ever took a tablet before in my life. But these things, I think, probably are good for this condition. So I line them all up in the morning and if I forget whether I’ve taken them or not I just look at the little bowl with them in and I can see whether one’s missing or it isn’t.
Before being diagnosed with osteoporosis several people had a dairy-free diet for medical reasons or to alleviate pain caused by arthritis. Gloria’s doctor put her on a low fat diet to prevent the recurrence of kidney stones. Jenny who suffered from ME and Betty who was diagnosed with osteoarthritis avoided eating dairy products for many years. Betty said that the pain and inflammation she had from her osteoarthritis was lessened by it. But she is unsure as to whether it was the dairy free diet or other factors that eased the pain. Since being diagnosed with osteoporosis she has started to include dairy products in her diet.
Gloria stopped taking dairy products after she had surgery to removed stones from her kidneys....
Gloria stopped taking dairy products after she had surgery to removed stones from her kidneys....
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Have you made any changes to your diet since diagnosis?
Yeah. Yeah, this I thought may have been a contributing factor. Years ago I had kidney stones and I had an operation on both my kidneys with the kidney stones big operation, it was before keyhole surgery. And at that time the hospital or the consultant decided that the contributing factor to my kidney stones was dairy products like milk and cheese and. So to cut down on milk, not drink milk. Could have it in cereal, as a cereal or in a drink but not drink milk and try not to eat an awful lot of cheese and also strawberries and rhubarb. But so I hadn’t had a lot of dairy, I never drank milk and this was from I was in my early thirties and I didn’t have much cheese.
Well then when I was diagnosed with osteoporosis you need the calcium and I do remember asking the doctor, you know, I said, ‘Well for years I hadn’t had dairy products in a great quantity and now I can have, you know, I’ve I should have it because of my osteoporosis.’ And he sort of said, ‘Well kidney stones are easier to deal with.’
It’s easier to deal with a kidney stone now than it is the osteoporosis.’ So yes I still don’t drink milk because I don’t like it but I do tend to have more on my cereal and I have cheese and yoghurt, and I never liked yoghurt but I have yoghurts. I eat lots of fruit and fresh vegetables and I’m very aware of trying to have a healthy diet. Yes and I’ve got like the healthy eating booklet from the national society. The osteoporosis society. Yes. I mean there’s some things that I just don’t like but I do try to eat more healthily and if I haven’t had my fruit or, you know, sort of something that’s healthy I you know, I do think, ‘I should I should really eat more.’
Michelle, Jane and Ann were diagnosed with coeliac disease and this has added an additional aspect to the management of their osteoporosis because they had to balance a gluten free diet with a high calcium-intake diet. This can be time consuming and tricky for working people like Jane and Michelle. Jane also finds it socially limiting because she prefers not to eat out.
Jane, Sarah and Iris have had the opportunity to talk about food and nutrition with a dietician. Iris was referred by the osteoporosis specialist nurse because she had been suffering for years with irritable bowel symptoms. The specialist helped Iris to identify her triggers and by excluding oats and red wine she was able to control it. Seeing the dietician has also given Iris the confidence to make changes to her diet. Keith was asked to fill in a questionnaire about diet and lifestyle when he went to the hospital to have his DXA scan and was told it was good on calcium sources but low on vegetables.
Some of the people we talked to were unable to tolerate dairy products in their diets and relied on calcium supplements. A few also said that they drank goats or soya milk instead of cow's milk. Both Michelle and Jenny felt unsure as to whether it provided the same benefits as the calcium that is provided from food.
Jenny had ME for over twenty years and found that in the past it was very difficult to find...
Jenny had ME for over twenty years and found that in the past it was very difficult to find...
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I have got problems with diet. I knew about calcium and I did try and have pilchards, I could cope with pilchards for the last twenty years, fish with bones, bony fish but that obviously wasn’t enough. So I was aware, sort of at the back of my mind that I wasn’t really having very much calcium. I was on soya milk but in those days, twenty years ago, it wasn’t fortified with calcium. You could just have soya milk and it wasn’t fortified. These days it is and that’s a lot better. So I was really quite depleted in calcium. But I have always been aware of diet and eating as healthily as I could. I was very restricted after the ME so a lot of the foods that would have done me favours I couldn’t really eat. But fish I did try and have two or three times a week. So I thought that would be enough but obviously it wasn’t enough.
Over the last twenty years I had ME which really upset me and I’ve got a lot of allergies to different foods. And I have been juggling around making my own things for the last twenty years. So a lot of dairy, all dairy seems to be out, and wheat and a lot of other foods. So I have had to be very careful and it’s not the food that I should be eating to help the bones unfortunately. But I do the best I can and eat fish with bones three times a week. I buy my own special biscuits that are not wheat but probably not a lot of goodness in that, I don’t know. But I get by as best I can. But I always cook vegetables and we have fruit and I make my own soups. I do a lot of home cooking. I’m not into junk food at all or convenience food. Not just for me, but for my husband. When I brought my son up we didn’t have a lot of convenience foods. I’m really into diet, you know, it’s my thing. It’s become my thing - because of my restrictions.
And have you found alternative sources of calcium because you can't have the...?
Well I’ve been having tablets but I don’t think they’ve really agreed with me. The calcium supplements. It’s really difficult. I’ve tried a bit of cheese but I had terrible indigestion after that yesterday. All the time I’m trying different things which I think might help. But I have been relying on the supplements and extra tablets to give me my quota of what I should have per day.
(Text altered in accordance to Jenny's wishes.)
Many people had reduced their consumption of animal protein, such as meat and cheese. They know that eating it regularly and in large amounts encourages the body to draw calcium from the bones to aid its digestion. Some people described themselves as ‘semi-vegetarians’ and avoid eating red meat altogether. Emma is vegetarian for cultural reasons and most of her life, except for the period when she arrived in the UK, has not consumed any meat. After diagnosis she was concerned that her diet was inadequate for someone with osteoporosis but her GP has reassured her that she has a healthy and a good diet.
Emma's GP reassured her that her vegetarian diet was a healthy and good diet for her osteoporosis...
Emma's GP reassured her that her vegetarian diet was a healthy and good diet for her osteoporosis...
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Actually I was all the time born a vegetarian but when I came in this country I started eating meat for a while. And then suddenly when I lost my husband and he had a kidney problems and all those things then I realised I should not be eating too much meat and everything. Internally I didn’t like very much, because I myself is a, work I have done nutrition myself. So I stopped eating meat. So is my son, so is my daughter. And so we decided to become vegetarian. But I am very conscious what I eat so that we don’t lack any sort of vitamins.
And my first doctor was good as well because when we used to ask him what to eat and what not to, he said, “You should eat everything, balance everything so don’t worry what you are. Don’t worry that you are vegetarian that you are suffering, it’s not like that.”
So you eat pulses?
Yeah.
Like lentils and things?
But my GP, first GP was good. She used to give example of my own father-in-law because he was 97 at that time. So she said, “Look at your father-in—law, he’s 97, has he ever eaten any meat?” I said, “No.” So he said, “OK, then, just think how he is good, so you can be good as well, if you eat properly.” And that’s it. But she never used to say, “Yeah, you should eat meat.” Or anything. So I thought our food is good, so why can’t we eat a balanced diet?
But recently I have started taking omega 3. Omega 3?And cod liver oil. Because that helps my bones. To me I feel that that helps a lot. Pain is less. And I have cut down my painkillers, a lot of painkillers.
Now?
Since I’ve taken this omega 3 and cod liver oil.
Marylin admits that her diet is poor because she tends to eat lot of biscuits and cakes. This has always been the case even in the past when she was training hard to run marathons. She remembers losing a lot of weight in her teen years and thinks that maybe it is related to her developing osteoporosis.
Weight
Not becoming overweight is helpful in most conditions including osteoporosis and many people we talked to tried to control their weight though exercise and diet. Some people said that they have put on weight following a fracture and/or retirement. And the main reason for it is not overeating or eating the wrong food but lack of exercise. Robert feels unfit and gets out of breath easily and said that he is three stones heavier than his original weight.
Sarah thinks that it is her lack of exercise rather than her diet that has contributed to her...
Sarah thinks that it is her lack of exercise rather than her diet that has contributed to her...
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I’m almost vegetarian. I will eat like a tiny bit of chicken because I know that I ought to but I do not enjoy it. I eat quite a few pulses. And I, I like Mediterranean food, so I cook a lot of things like aubergine and other pulses and fish and this and that. But that’s why I can’t understand why I’m putting on weight, because I don’t eat chips, I don’t fry anything. But I do have olive oil on things. But then that’s helpful.
Healthy.
Yes, I know. So, I don’t suppose I have enough calcium apart from the tablets.
You don’t eat cheese.
I eat it a bit, but not too much because they say that’s bad for you. So what are you supposed to do?
High cholesterol.
Yes, that’s the problem, my cholesterol.
Do you eat yogurt?
Not enough. We do get a lot of plain yogurt, Greek yogurt. And I’ve started making my own yogurt. Which is quite hit or miss. But supposedly it’s, it’s a good way of doing it, cheap, economical. But mine always ends up, I think you have, to appreciate it you have to have made it yourself so you know what’s got in it because otherwise you go “Ugh, what’s that?”
Have you made any changes to your diet since you were diagnosed?
No I haven’t made any changes.
Have you talked to or has your doctor talked to you about losing weight?
Oh, I’ve been to a dietician. I’ve gone, yes.
He sent you to a dietician?
Oh, no, it wasn’t. That was my cholesterol problem. That’s why I went to the dietician, to try and cut my cholesterol down. But I don’t, you know, the cake, I’ll have a slice of cake out of a whole cake. I do enjoy that but I don’t go mad. And I have a slice of chocolate, perhaps on, maybe on the same day. After that it’s, I eat loads of vegetables. And spinach because I know it’s good for me. I like the spinach. I do Mediterranean cooking because I used to be married to a Greek man and I learnt a lot of Greek food. And I do love it still. So I’ll continue cooking like that. So at least that’s one good thing he did for me, got me into this kind of cooking. Yummy. That’s very healthy. So I will put it down to, my tummy, as lack of exercise. That’s all I can think of. I don’t think it’s my diet.
But you have put on weight now because you have had that break? That fracture two years ago and then another one?
Yes, I wasn’t able to, and I’m not working. Because when I was at work I was up and down all the time answering the phone, dashing round to get somebody, coming back. And it’s amazing what you wear off in the course of a day. And I’d walk as fast as I could to the hospital when I was working and walk as fast as I could coming back. So that was a good bit of exercise as well. I was a bit slower coming home than going to work in the mornings, I must say. Didn’t have quite the same energy. But I must be missing that a lot. But I try to do, when I’m doing the housework I’m trying to think, “Oh, that’s a, that’s a few calories off, doing this and that.” Using it as an exercise excuse.
So would you say that sort of you have put on weight within the last two years or so?
Yes, I have. Because clothes that I had two years ago I can’t wear now. I’ve gone up to size 18. Bit depressing.
No, I haven’t made any changes.
Several people decided to lose weight and said that they felt better for it.
Margery felt her weight was putting a strain on her back and knees. Her doctor advised her not to...
Margery felt her weight was putting a strain on her back and knees. Her doctor advised her not to...
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Any changes that you have made to your diet?
Yes. I have tried I did feel I was overweight, though my doctor told me I haven’t to lose too much weight because it did protect my bones, but I was and still am slightly overweight now and I did try and reduce. I have lost two stones in the past about three years because I felt that my weight was putting a strain particularly on my back and on my knees. I do try and have a high calcium diet. I eat, always have yoghurt and cheese and I try to keep a balance between too much fat not getting enough calcium.
I have always had a very high consumption of fruit and vegetables, always salad every day and a reasonable amount of protein. I am not a vegetarian, but I do try and, I’m interested in food, I’m interested in cooking and I do try and have a good health diet.
I have cut down on very fatty cheeses. I tend to eat cottage cheese and lower fat cheese now. I cut out all sweet things. I tend to get my sweet from fruit rather than from cakes and biscuits and so on. I have cut down slightly on size of portions as well. I think perhaps quantity was important as well as the quality of the food.
However, a few of the elderly people we talked to complained of lack of appetite and of losing weight as a result of stomach problems caused by their medication. Some were taking Lanzoprazole to help alleviate the pain cause by acid reflux. Beryl said that she has lost a lot of weight, around three stones.
Beryl has little appetite because of her stomach problems caused by the side effect of medication.
Beryl has little appetite because of her stomach problems caused by the side effect of medication.
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Now tell me about your diet. Do you cook regularly?
I’m cooking today because my daughter’s coming up. But I get some of those ready meals, sometimes I’ll cook. You know it all depends.
But on average would you say that you have more ready meals than?
No I think I cook more but I haven’t got no, I’ve lost my appetite. I can’t eat at the moment so I. That’s why probably I’m getting the ready meals because I make, not eating much at all.
How much energy? Well not a lot because I’m not eating. I’m not eating very well because I get a lot of problems with my stomach. You know I have sickness and that quite often. And I, I can’t eat anything.
Has the doctor given you anything for it?
I’ve got them boxes and
Lansoprazole?
Well yeah something. But they don’t. Nothing seems to taste any good, you know what I mean? Everything seems to taste horrible. And the only things I like eating is sweet stuff and I’m not supposed to eat sweet stuff [laugh].
Tell me more about your diet. Ok you have lost appetite. How long ago?
Well put it this way, about eight years ago, nine. I was eleven stone. At Christmas I went, I was six stone. I’ve gone up a little bit. I’m just under the seven now but that’s a lot of weight to lose isn’t it from not actually on a diet. But sometimes I just have one potato and then I can’t eat. But then I’d like a pudding but you see I’m not supposed to eat sweet stuff. So I’m a loser all the way round [laugh].
What about drinking milk and eating cheese and eggs?
I don’t like eggs. I don’t like cheese.
And milk?
Not very keen on milk.
Ok and meat?
I’ve got, I used to love meat but I’ve gone off that. I’m like enjoying salads the more lately.
And what about fish?
I don’t like fish. I had kipper for breakfast.
That’s good. Every day?
No, no a lot of times I don’t have breakfast. Sometimes I’ll have porridge. I will admit sometimes I have porridge. Yeah because then I make it with milk as well. But I haven’t had that for two or three weeks. I’ll have to start on that again. See if that will build me up. Because I look in the photos and that now and I think, “Oh my god”! I don’t recognise myself.
Several of the elderly people we talked to stressed that they have an adequate diet but now they can only manage smaller portions and prefer a snack in the evening.
James says that because he is not exercising a lot he now has small, simple meals.
James says that because he is not exercising a lot he now has small, simple meals.
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I think we have a pretty good diet but we keep it as simple as possible which makes sense.
What do you mean? Can you tell me more about it?
Well, we wouldn’t spend a lot of time each day preparing a big meal. We, we do have a roast joint once a week. But otherwise we buy in things like fish cakes or prepared meat pies. Things like that and the evening is, is a small meal. It still has to be prepared as, as does breakfast of course. But again, we keep that simple so that it’s either cereal or, or porridge. It seems the only sensible thing to do but after all if we’re not exercising an awful lot we don’t need heavy meals do we.
Just enough to be of adequate nutrition.
We try to keep a sensible balance of, of fish and meat, eggs, cheese that kind of thing. And, and such vegetables as we feel inclined to have or prepare and cook.
Many of the people we interviewed live on their own, and are unable to lift and carry things. This causes problems when shopping for groceries and people had to think of ways of getting around it. Some like Joan and Betty have learnt to use a computer and order the bulk of their shopping online. James and his wife do the groceries once a week in a supermarket that has delivery facilities. Sydney on the other hand, goes into the city centre twice a week to buy his groceries (see also Impact on home life).
Supplements
Many people we talked to did not take vitamins or other supplements and some said that they did not need it because they had a good, balanced diet. Those who took them on a regular basis saw supplements as part of their self-help programme. A few said that they take them to compensate for a less than adequate diet during the week, or because they are not taking any prescribed medication for osteoporosis, or because certain ones like omega3 and cod liver oil help them with their pain. But others, like Marylin have stopped taking any supplements after diagnosis because she thinks it didn’t do her any good.
Last reviewed June 2017.
Last updated June 2017.
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