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VA Ann Arbor Healthcare System


The Importance of Diet, Nutrition and Bone Health

Couple Eating Healthy Foods

A growing field of science has shown that a well-rounded, healthy diet can be an important tool in helping prevent and manage osteoporosis and related musculoskeletal disorders.

By Bethany Grzesiak, MS, RD, TeleMOVE! Dietitian at VA Ann Arbor Healthcare System
Monday, October 3, 2016

It is easy to understand how bones can be overlooked. They are masked by multiple layers of skin, muscle and fat tissue that capture attention. Photographs of fit individuals putting their muscles on display are speckled over the internet, but not often, if ever, does a photo surface of their bone density scan results.

However, without bones we would all be a little less stable and a little wobblier. Bones accomplish the obvious by giving a body structure, but they also protect organs, support the muscles we work so hard to tone, and store important vitamins and minerals.

The human body is made of more than 200 bones in various shapes and sizes. Their makeup includes a combination of collagen and minerals, such as phosphate and calcium. The elastic quality of the collagen paired with the toughness from the minerals creates a strong yet flexible framework. As firm as bones are, that little bit of elastic-give is appreciated when a body takes a spill.

The medical diagnosis for dangerously weakened bones is known as osteoporosis, and the risk for developing the condition is derived from factors both in and out of one’s control. Unchangeable factors include the gender, age, race, family history, and body frame size of an individual. Being female, elderly, of primarily Caucasian or Asian decent, having a parent or sibling with the condition, and/or having a small body frame increases a person’s risk. Additionally, hormone imbalances can be of concern, particularly when involving sex and thyroid hormones, as well as parathyroid and adrenal glands.

A serious consequence of osteoporosis, especially among the elderly, is a hip fracture. The Center for Disease Control estimates that annually there are over 250,000 hospital admissions for hip fractures among people aged 65 and older. Locally, at the VHA Ann Arbor Medical Center the Orthopedic Care Manager, Jill Garner, recalls that from January 1, 2015 through January 1, 2016, there were 12 cases of Veterans with hip fractures requiring operations.

Thankfully, there are preventative measures that can be taken. When it comes to developing and maintaining healthy bones every stage of life is significant, but emphasis is placed on adolescent growth periods. Parents around the world urge their children to eat right so they can grow up strong. The mineral calcium is especially encouraged, with daily recommendations being up to 1300 milligrams during adolescence, the high end throughout one’s lifetime. Calcium’s prominence in this area became its claim to fame, and turned low fat dairy products and leafy green vegetables into nutrition superstars. However, it does not and cannot act alone.

If calcium is the superhero of protecting bone health, Vitamin D is surely the essential sidekick. This vital vitamin shines like the sun that generates it, working to help the calcium be absorbed from the food eaten, therefore assisting in the renewal and mineralization of bone tissue. Its importance should not be downplayed. Individuals living higher than the latitude of 37 degrees are at greater risk of deficiency, since it is difficult to receive enough sun exposure during the dreary winter months. To put that into perspective, this would include Americans living above an imaginary line drawn from Richmond, Virginia to San Francisco, California.

Adding to this issue, food sources naturally high in vitamin D are limited, with the most common being oily fish, like salmon, tuna or mackerel, as well as eggs and liver. However, for those allergic to these items or those avoiding meat, this poses a problem. Thankfully, many foods are now being fortified and the general public can get more of this nutrient by consuming dairy products, breakfast cereals, or supplements.

In 2010, the nutrition scene was rocked when enough evidence was provided to increase the daily recommendation for vitamin D. Individuals between the ages of one to seventy now require 600 international units daily, and those older than seventy require 800. To put this into perspective, 4 ounces canned tuna will provide 350 international units, whereas one hen egg will have approximate 35. Although calcium and vitamin D reign supreme, there are supporting players equally imperative to creating and maintaining bone integrity. Notable nutrients include:

  • Vitamin K: Required for the correct mineralization of bone, actually working harmoniously with vitamin D to improve bone density and reduce risk of fracture. You will find it in abundance in dark leafy green vegetables, like spinach, cabbage, and kale, as well as in liver and some fermented cheeses and soybean products.
  • Zinc: Important for the “bone remodeling cycle,” meaning bone tissue renewal. Zinc helps reduce the risk of osteoporosis by assisting cells that build bones up, and slowing down how much bone is inappropriately broken down. Foods known for having zinc include lean red meats, poultry, whole grains and legumes.
  • Magnesium: Although deficiency is rare in well-nourished people, magnesium plays an important role in the formation of bone and should not be neglected. Since we now know minerals are responsible for bones’ strength, considering 50-60% of the body’s magnesium supply is stored in bones is proof of their merit. Green leafy vegetables, legumes, nuts, unrefined grains, and fish are all good sources.

It can be observed that various foods are mentioned in this article. A well-rounded diet is crucial for maintaining good health, no matter what the focus. Highlighting the importance of these nutrients does not infer that one should overload, but merely aim for the recommended daily amount. However, if your bones are at risk of being brittle, ensuring that you are receiving enough of these nutrients in particular is advised. In severe cases, laboratory values may need to be taken to see if a vitamin or mineral supplement is necessary.

To do this through nutrition, prepare your meals and snacks to contain maximum bone-enhancing nutrition. Registered dietitian, Laura Irvin , provides ideas for her favorite ways to make a meal bone friendly, "Try sautéed spinach with your eggs in the morning, a leafy green salad with tuna or salmon added, or yogurt, fruit and nuts as an afternoon snack. It’s important to have a balanced meal every time you eat to not only maintain good bone health but to maintain overall health, weight, and well-being.”

Beyond nutrition, one should stay active. In addition to improving bone density, weight bearing exercise also increases muscle strength, balance and coordination, all of which help reduce the risk of a fall. VHA Ann Arbor Physical therapist, Andrew Grzesiak, helps Veterans create a safe activity plan that tailors to their abilities. He states, “We work to restore functional movement when possible, but also teach adaptive skills when necessary. Talking to a physical therapist will provide you with knowledge about what may contribute to falls, strategies to improve upon bone health, and tips for your general well.” He goes on to say,  "The way in which you live or your household set up is also important for identifying potential risk factors for a fall."

The human body is a powerful vessel, and thanks to its bones, can stand a little taller. The United States Department of agriculture provides information about how much of the aforementioned nutrients to consume each day to keep these bones in tip top condition. Follow the link below and select the vitamin or mineral of your choice:

USDA Vitamin and Mineral Fact Sheets

For additional questions or personalized information it is recommended that you seek the advice of your trained VA medical team.


Works Cited

PDF on Bone Health:

Vitamin D deficiency and altitudes at risk:

American Journal of Clinical Nutrition:

Vitamin K study:

Zinc and Osteoporosis Treatment:

Magnesium Fact Sheet:

Risk for Osteoporosis

Weight bearing activities and bone health:

CDC Hip Fracture Info:


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