Osteoporosis has been a hot topic in our office since I posted my first article, Osteoporosis - How Strong Are Your Bones? Patients (mostly women in their 50s) have reached out to share their stories and concerns. I walked to my yoga class in a weighted vest (good for your bones!) and a few curious practitioners shared that they also had an osteoporosis diagnosis. Recently, a friend in his 40s broke two bones and found out that he has osteoporosis. Once the topic was out there, I was surprised by how many people were affected and wanted to talk about bone health and find ways to address it and hopefully start to slow and possibly reverse bone loss through targeted lifestyle choices.

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While conventional medicine approaches osteoporosis primarily through medication, Functional Medicine, as always, is looking for the root cause. What has led to this moment and how can we address osteoporosis at its core? Is it nutritional deficiencies, hormonal imbalances, inflammation, or chronic stress? By identifying and addressing these underlying factors, functional medicine aims to improve bone density and reduce the risk of fractures. Osteoporosis, as with most diseases, is likely caused by a multitude of factors, which gives us a variety of ways to address and support bone loss. Many of these factors are DIY - improve your diet, manage stress, and add exercise. But it is also important to work closely with a doctor and while these diet and lifestyle interventions are always helpful, sometimes medication is necessary.  

What general diet and lifestyle choices support healthy bones?

If you have been following Dr. Lipman, then you are already on a great path to support your bone health. The healthy habits he touts here on this blog and in books like How To Be Well (eat, sleep, move, protect, unwind, connect) help to create an environment for your bones to thrive. Whether you are a young or older person with healthy bones or someone dealing with bone loss - start with the basics:

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• Mediterranean Style Diet - A whole foods based diet focusing a variety of proteins, vegetables/fruit, and healthy fats. Avoid ultra processed foods, added sugar, and seed oils. Moderate intake of alcohol and caffeine.
• Consistent Exercise - Functional movement is key to bone health - daily movements like sitting/standing, tying shoes, cleaning, walking, and stairs. Finding exercise that you enjoy, like strength training, HIIT, yoga/pilates, dance, jump rope, biking, etc. and sticking to a consistent routine is also important.
• Regular Sleep - Focusing on a solid 7-9 hours per night, going to bed and waking up at a similar time.
• Stress management - Finding what helps you manage stress is important. That can be meditation, breathing, exercise, dance, listening to music, journaling - find what feels right for you.

Actions to Further Target Bone Health:

Healthy Diet for Bone Health -

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Focus on the above mentioned Mediterranean style diet and think about getting bone supportive nutrients, ideally through food, but add supplementation if needed:

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• Calcium: on everyone’s mind when it comes to bone health. Calcium provides strength and structure to the bone. Calcium from food is the most absorbable and best option. We need about 1000-1200 mg/day.

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Food High in Calcium:

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• Tofu 400 mg per ½ cup serving
• Collard greens 210 mg per ½ cup serving
• Kale 205 mg per ½ cup serving
• Bok Choy 190 mg per ½ cup serving
• Chia seeds 180 mg per 2 tablespoon  serving
• Whole Almonds 175 mg per ½ cup serving
• Spinach 120 mg per ½ cup serving
• Chickpeas 105 mg per ½ cup serving
• Turnip Greens 104 mg per ½ cup serving
• Edamame 100 mg per 1 cup serving
• Sesame Seeds 88 mg per 1 tablespoon serving

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Calcium Supplementation: Look for a more absorbable form like dicalcium malate or an algae based supplement (like Algae Cal).

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• Vitamin D3: increases calcium absorption. It is derived from the sun and some foods. Many people are deficient, so make sure to test your levels

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Foods: Salmon, sardines, egg yolks, beef liver.

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Supplementation: Look for Vitamin D3 and take it with fat for absorption.

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• Vitamin K2: activates proteins important for building and maintaining bones

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Foods: Pork, hard cheese, natto, eggs

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Supplementation: Look for a Vitamin D and K2 combo - take care of both at once!

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• Magnesium: influences osteoblasts and osteoclasts, which the body needs for bone growth and repair and indirectly influences parathyroid hormone and Vitamin D which can affect bone health

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Foods: Avocado, nuts, seeds, leafy greens, tofu, fatty fish and more

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Supplementation: There are different types of magnesium which provide different benefits, but all support levels of magnesium in the body. Find the one most appropriate for you.

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• Protein: Protein is essential for optimal bone mass gain during growth and also to preserve bone and muscle mass as we age. People are often confused by the amount of protein one should consume. This protein calculator is helpful for a general idea - see their optimal intake and other suggestions - it might be more than you think. I’m 54, a healthy weight, and would like to increase muscle - they are suggesting 83 - 124 grams/day for me.

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Foods: Animal proteins, seafood, or plant based proteins like beans, nuts, and seeds, etc

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Supplementation: A low protein diet can be supplemented with plant proteins like pea or animal/marine proteins like whey or collagen. This is especially important in a vegan or vegetarian diet!

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• There are so many more nutrients that are important for bone health - B Vitamins, Silica, Vitamin C, Boron, Zinc, Iron, Potassium, Omega 3, Phosphorus, and more!

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Foods: These come from a variety of whole foods - plant, seafood, animal. Eating a varied diet with many different colors will help to meet these needs.

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Supplements: a bone support supplement with a blend of vitamins and minerals is a great way to ensure that you are getting the variety of nutrients that you need.

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And remember more is not always better when it comes to supplementation! Calcium is the perfect example. People believe that calcium is important for bone health, so they take MORE. It’s best to meet your calcium needs through food, but supplementation can be important. Be cautious with supplements and work with a functional medicine practitioner to tailor your program. Have your doctor test your nutrient levels so that you can supplement smartly.

Exercise for Bone Health:

Bones are not the only thing to think about when it comes to the health of your bones! Keeping your muscles strong and flexible has great benefits. Balance is important too. You want to find weight bearing and muscle strengthening exercises that work for you at your level. Safety is important - so, please work with someone who understands osteoporosis to create a plan specific to your needs.

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• Strength Training - free weights, resistance bands, or body weight training are all great ways to to build strength. You can do these in a gym with equipment, with a trainer, or at home using nothing but your body doing exercises like push ups, plank, squats and lunges.  
• Weight Bearing - walking, hiking, dancing, tai chi, elliptical or treadmill, gardening, taking the stairs - all provide weight bearing movement. They are also great for cardiovascular benefits, boosting heart and circulatory health.
• Yoga - has been shown to improve flexibility, strength and balance. There are studies showing statistically significant improvement in the spine and femur. Yoga is also great to help you manage your stress and anxiety.
• OsteoStrong - is a “gym” that focuses on musculoskeletal strengthening. OsteoStrong utilizes a series of robotic musculoskeletal devices, so that people can get the benefit of impact without the associated risks. OsteoStrong increases bone density, improves balance and posture, and can make you stronger. There are wellness centers all over the country and the process takes about 15 minutes, 1 time a week.

Additional Interventions for Bone Health:

• Stop smoking - if you are a smoker, stop now. Smoking reduces the capacity of the body to absorb calcium from the diet. Nicotine also slows osteoblasts, the bone forming cells.  
• Additional supplements might be helpful. Some that have been studied - Isoflavones, Bone morphogenetic proteins (BMPs), Creatine, Hydrolyzed Collagen Powder (in combination with Vitamin D and calcium), Melatonin.
• Hormone Replacement Therapy (HRT) - menopausal and postmenopausal women are at greater risk for osteopenia and osteoporosis. HRT can increase hormones to preserve bone mineral density and reduce the risk of fractures.
• Address gut health issues - if your gut is not functioning well, it can affect bone health in a variety of ways - poor nutrient absorption, inflammation, and hindering many gut derived nutrients like SCFA and vitamins like B and K.
• Address underlying chronic inflammation - inflammation is damaging to bones, turning on osteoclasts that break down bone. Inflammation can come from a variety of places - stress, infection, toxins, a poor diet - take a look for the root cause of your inflammation.
• Treat an under or overactive parathyroid gland - Parathyroid is the master gland for regulating calcium, if this gland is not working properly it can affect bone health.
• Sauna - Dr. Rhonda Patrick talks about increasing growth hormone through sauna use. Growth hormone improves bone remodeling by stimulating osteoblasts.

Testing and Monitoring for Bone Health:

• Get a DEXA scan if you have any concerns - don’t wait until your doctor suggests it, ask for one if you think you have reason to suspect bone health concerns

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• Get blood work - ask for:

1) Nutrient deficiencies - Vitamin D, Magnesium, Zn, Iron, Omegas, Calcium, Protein

2) Inflammatory markers  

3) N-Telopeptide serum testing

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With all of this, there are still many nuances to bone health. Please take into consideration your age, current bone health, lifestyle choices, dietary choices, exercise, sleep, stress management and come up with a plan that feels realistic for you. Continue to research and adjust your plan as needed. If you can, work with a doctor who you trust, include a nutritionist to get your diet right, and find a health coach to help you create sustainable bone supportive changes in your life. At the very least, these changes will make us healthier and stronger. And if we have some success, our bones will continue to be strong and healthy into the future. As a 54 year old woman, I need this body to last for many more years of travel and exercise and good times with family and friends - luckily close monitoring and lifestyle tools give me the confidence to know I’m working hard to make that happen!