Bone mineral density refers to the level of minerals in the bones, which indicates their strength and density. Bone mineral density that falls below the normal levels but is not low enough to be classified as osteoporosis is called osteopenia.
Osteopenia generally doesn’t cause pain or other symptoms. But it’s important to understand how to prevent it because it can progress to osteoporosis, in which the bones are so weak they fracture easily.
Age is one of the main causes of low bone mineral density. With age, bones start losing minerals, heaviness (mass) and structure, which makes them weaker and more prone to breaking.
Several factors may contribute to osteopenia, including eating disorders, metabolism problems, chemotherapy, exposure to radiation, family history, thin body structure, lack of adequate physical activity, smoking, regular consumption of sodas and drinking excessive amounts of alcohol.
Also, women are at a higher risk of osteopenia and osteoporosis than men.
There are no defining symptoms of osteopenia. You may experience no pain or other changes as the bones become thinner. This is why it is important to get a bone mineral density test every few years after the age of 35.
If you fall in the high risk category for osteopenia, you can make simple lifestyle and dietary changes now to prevent loss of bone mineral density and the progression to osteoporosis.
Here are the top 10 ways to prevent loss of bone mineral density (osteopenia).
1. Consume Adequate Calcium
Calcium is one of the most important nutrients for improving bone density. Bones are mainly made of calcium, so this nutrient is crucial for preventing any bone-related diseases.
In fact, a diet that is low in calcium contributes to low bone density and early bone loss. People between ages 19 and 50 should consume about 1,000 mg of calcium a day. For women, it is 1,200 mg of calcium a day.
You can get your daily calcium requirement from organic dairy products, sardines, dark green vegetables (such as collard greens, bok choy and broccoli), blackstrap molasses, fortified soy products like tofu, dried fruits (for example dried plums), and a number of other nutritional foods. If you do not consume a balanced diet, you should consult your doctor about taking a calcium supplement.
2. Boost Your Vitamin D Intake
Vitamin D is another important nutrient that supports bone health and plays a key role in reducing the risk of osteopenia. Vitamin D also helps your body better utilize calcium.
A 2014 study by Regis University reports that vitamin D deficiency is a significant factor in osteoporosis and osteopenia. Vitamin D deficiency had a higher statistical significance than exercise history, steroid use and gender.
The recommended daily supplement is 2,000 IU daily for adults.
Plus, you can get vitamin D in eggs, salmon, sardines, swordfish and fortified foods like cereal and orange juice.
The body also produces vitamin D when exposed to the sun, so enjoy 10 to 15 minutes of early morning sun exposure daily.
3. Stay Active
Regular exercise is beneficial for overall health and bone health is no exception. Bone forms and remodels in response to physical stress, hence regular physical activity is helpful for preventing loss of bone mineral density.
In fact, living a sedentary lifestyle is a risk factor for osteopenia and osteoporosis.
For bone health, aim for at least 30 minutes of light weight-bearing activities most days of the week. Activities like walking, hiking and dancing are all good choices to exercise your body and prevent osteopenia.
Exercises with elastic bands can help the bones in the upper body. It can also improve strength and balance, which helps prevent falls and the associated fractures in those who already have osteoporosis.
4. Quit Smoking
Smoking is bad for your overall health and particularly for bone health.
Smoking can prevent the body from efficiently absorbing calcium, thus decreasing bone mass. In fact, smokers are at a higher risk of fractures than non-smokers.
A 2007 study published in Clinical Science reports that smoking appears to exert a negative effect on bone mass at the major sites of osteoporotic fractures, namely the hips, lumbar spine and forearms. This influence appears independent of other risk factors for fractures, such as age, weight, gender and menopausal status.
Try to quit smoking as soon as possible by getting help from professionals as well as family members and friends.
5. Consume Less Caffeine
Coffee has some health benefits when consumed in limited amounts, but unfortunately caffeine in any form is not good for your bone health.
Excess caffeine intake can interfere with the body’s ability to absorb calcium, which is important for bone health.
A 1994 study published in the American Journal of Clinical Nutrition reports daily consumption of caffeine in amounts equal to or greater than that obtained from about two to three servings of brewed coffee may accelerate bone loss from the spine and total body in women with calcium intakes below the recommended dietary allowance of 800 mg.
Another 2001 study published in the American Journal of Clinical Nutrition reports that caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes.
6. Eat Foods Rich in Vitamin K
You can give a boost to your bone mineral density level with vitamin K. This particular vitamin also helps the body make proteins for healthy bones and reduces the amount of calcium excreted by the body.
A 2007 study published the British Journal of Nutrition reports that better vitamin K status is associated with increased bone mineral content in young girls. However, further studies are still required to examine the association between vitamin K and bone health.
To support your bone health, eat foods rich in vitamin K like kale, Brussels sprouts, turnip greens, fermented dairy products, prunes, and broccoli.
7. Pump Up Your Potassium Level
It is true that potassium is important for muscle health, but it is also beneficial for bone health.
This mineral may neutralize acids that remove calcium from the body, a nutrient that is crucial for bone health.
A 2005 study published in the American Journal of Clinical Nutrition reports that low dietary potassium intake and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women.
A later 2009 study published in Osteoporosis International found that potassium intake shows positive association with bone density in elderly women, suggesting that increasing consumption of food rich in potassium may play a role in osteoporosis prevention.
The best sources of potassium are bananas, avocados, strawberries, oranges, mangos, kiwis, apricots, dates, carrots, sweet potatoes, spinach, broccoli, Swiss chard and red peppers. The recommended daily intake of potassium for adults is 4700 mg .
8. Eat Magnesium-Rich Foods
To improve bone health and reduce the risk of osteopenia, you should eat magnesium-rich foods every day.
Magnesium is needed in over 325 enzyme systems in the body that control thousands of chemical interactions and also is important for bone health. It stimulates the hormone calcitonin, which helps preserve bone structure by drawing calcium out of the blood and soft tissues back into the bones.
A 2013 study published in Nutrients reports that magnesium is a contributing factor in bone health. Optimizing magnesium intake might represent an effective and low-cost preventive measure against osteoporosis in individuals with documented magnesium deficiency.
Good food sources of magnesium include almonds, avocados, bananas, beans, pumpkin seeds, tofu, soy milk, cashews, pecans, walnuts, potatoes with skin, yogurt, blackstrap molasses, whole grains and green leafy vegetables.
You can also take supplements, but only after consulting your doctor.
9. Reduce Your Sodium Intake
Salt is known to cause excessive calcium excretion through the kidneys. In fact, excessive sodium intake appears to be a risk factor for bone fragility.
A 2013 study by the Endocrine Society reports that a high-salt diet raises a woman’s risk of breaking a bone after menopause, no matter what her bone density is.
To improve your bone health, it is important to limit your salt intake. The American Heart Association suggests taking in less than 1,500 mg of salt daily.
10. Eat Foods Rich in Vitamin C
Vitamin C can also prevent loss of bone mineral density.
Collagen is the main protein in bones, and vitamin C plays a major role in collagen synthesis.
Consuming adequate amounts of vitamin C can help improve bone density. This can result in strong, structurally sound bones, as well as reduce the risk of fractures.
To get vitamin C, eat fruits and vegetables that are high in vitamin C like oranges, bell peppers, broccoli, strawberries, Brussels sprouts, pineapple, kiwi, cantaloupe, and cauliflower.
You can also take a vitamin C supplement, after consulting your doctor.
Expert Answers (Q&A)
Answered by Dr. Daniel Zanotti, MD (Orthopedic Surgeon)
Is it possible to reverse bone density loss?
Yes, it is possible to reverse bone density loss, although it is not easy. Humans typically build up bone mass until their 20’s or 30’s. At that point, both men and women begin to lose bone density as a normal part of aging. Weight-bearing exercise, proper calcium and vitamin D intake, and a healthy diet all help to minimize the normal bone density loss.
There are medications that can actually increase bone density, and these are used in severe cases of osteoporosis. However, these medicines can have serious side effects. Additionally, they have not been definitively proven to reduce the risk of fracture, which is the main issue with bone density loss.
Which vitamins and minerals are best for dealing with osteopenia?
As I noted above, calcium and vitamin D deficiency is the main contributor to osteopenia. Calcium is found in many food such as milk and cheese. Vitamin D is found in many foods such as fish (salmon and tuna), dairy foods, and eggs.
Vitamin D is also present in sunlight, so good exposure to the sun can aid in vitamin D intake. Vitamin D is needed to allow the human body to absorb and utilize calcium properly, so taking calcium supplements without adequate vitamin D does not help much.
Are there any particular foods that osteopenia patients should not eat?
There are some foods to avoid if you have osteopenia. Beans, salt, sodas and caffeine have been shown to inhibit bone formation. Salt competes with calcium in the bone building process, and the phosphorus in sodas can lead to calcium being expelled in the kidneys.
Which physical exercises help in fighting bone density loss?
We encourage anyone with osteopenia to begin or increase weight-bearing activities. This is important in the bone building process. High impact activities and severe twisting activities place significant stress on the bones, so these should be avoided.
Walking, elliptical biking and other weight bearing activities put just enough stress on the bones to help stimulate bone healing and minimize bone loss. When bone is not stimulated or used, the body begins to utilize calcium and other bone-building elements for other bodily functions by removing it from the bone itself.
Yoga is an excellent exercise for osteopenia as it is weight-bearing for both the upper and lower body, yet is relatively low impact. Additionally, it encourages flexibility and muscle strengthening.
Please provide some additional tips to help increase bone density for the benefit of our readers.
The main thing to realize with osteopenia is that both men and women lose bone mass at the same rate after age 30. Men happen to start with higher bone mass, so the effects of osteopenia or osteoporosis do not hit them as early as women.
Everyone over age 50 should have a bone density test (DEXA scan) to check their level of bone loss. A proper diet, weight-bearing exercise program, and proper monitoring of bone density can help people avoid the painful and life changing issues of fractures and skeletal injury.
About Dr. Daniel Zanotti, MD: is a board-certified orthopedic surgeon with a subspecialty certification in Orthopedic Sports Medicine and holds a Doctor of Medicine degree from Pennsylvania State University. He has been practicing at the Center for Orthopedics since 2003, after, completing his orthopedic residency and general surgery internship at The Milton S. Hershey Medical Center in Hershey, Pennsylvania.
During his sports medicine fellowship at the prestigious Kerlan-Jobe Orthopaedic Clinic in Los Angeles, served as a team physician for the Los Angeles Lakers, Dodgers, Sparks, Galaxy and Kings, as well as the Anaheim Angels and Mighty Ducks.