BONE HEALTH » introduction & osteoporosis


The Breakdown

There’s a fair bit of ground to cover so we’ll take it step by step. The posts on osteoporosis have been separated into several articles to to provide you with the most vital information in a way that is easy to read and navigate through:

Osteoporosis: Introduction

Having previously worked as the dietitian at the Osteoporosis Program at British Columbia’s Women’s Hospital, I've learned just how manageable it is to minimize bone loss through dietary intervention. In the next few articles I'd like to share some of my expertise in the area with you.

People following a plant-based diet are often asked where they get their calcium from. I assure you the problem is not exclusive to vegans. I see far too many people with inadequate calcium intake; not just patients that came to the Osteoporosis Clinic but also patients that came to see me in private practice, as well as family and friends. I won’t lie: before I acquired the position I was barely getting any calcium at all (and I wasn’t even plant-based then!). But as you'll come to learn, inadequate calcium intake is not the sole reason for the development of osteoporosis. We’ll explore this further in the following posts, but let’s first review some basics.

The Basics

Osteoporosis literally means ‘porous bones’; it’s a condition in which the bone strength is compromised due to reduced bone mass. This bone deterioration makes the bones more fragile and increases risk of fracture.

You can't always feel it in your bones.

I often hear people saying they have pain in their joints or back and fear this may be osteoporosis; this is likely osteoarthtritis or some other condition. Osteoporosis is known as the "silent thief" - it cannot be felt unless a fracture as already occurred.

Primary Osteoporosis: is believed to be a bone disorder of unknown origin, where genetics likely plays a role.

  • Remember genetics is like a loaded gun – environment and lifestyle choices are what pull the trigger.

  • In other words: even if you have a genetic predisposition to developing the disease, you can exert some control with diet, physical activity, smoking cessation, etc.

Secondary Osteoporosis: is as a result of other imbalances that cause reduced bone mass. This includes, but is not limited to:

  • hormone abnormalities (premature menopause; primary hyperparathyroidism),

  • decreased nutrient intake (eating disorders; poor dietary choices; excess alcohol consumption),

  • impaired nutrient absorption (Celiac disease; inflammation of the gut), and

  • medications (glucocorticoids such as prednisone; some diabetes medications; proton pump inhibitors for acid reflux)

Diagnosis: requires a DEXA scan to assess bone density. Although this tool is similar to an X-ray it’s important to note that X-rays are not intended to assess bone density, but rather are used to determine if a fracture has occurred.

Dietitian's Intermission: I once saw a patient that received a DEXA scan and was diagnosed because she had fractured two ribs just by sneezing. Another patient underwent investigation after he fractured his ribs by bending over to pick up a pen off the floor. Bones can become extremely delicate and yet the individual does not even know they have this condition until a fracture has occurred.

T-Score: The DEXA scan measures your bone mineral density which is reported as a ‘T-Score’. Your T-score reveals your bone mineral density in comparison to a young healthy adult free from osteoporosis. If you have a positive (+) T-score, your bone mineral density is better than the average young, healthy adult. If you have a negative (-) T-score, your bone density is less than that of a young, healthy adult.

Reduced Bone Mass (Osteopenia) vs. Osteoporosis: Low bone mass, formerly known as ‘osteopenia’, differs from osteoporosis in the amount of bone lost:

  • Individuals with reduced bone mass have a T-score of: -1.0 to -2.0

  • Individuals with osteoporosis have a T-score of: -2.5 or lower (more negative)

Regardless of the bone mineral density results it's never too late to begin dietary intervention to minimize bone loss, whether one has osteoporosis, reduced bone mass or entirely healthy bones.

Startling Statistics

  • Osteoporosis can be diagnosed at any age!

  • Osteoporosis affects BOTH genders with:

  • Women: 1 in 3 suffering from an osteoporotic fracture at some point in their life

  • Men: 1 in 5 suffering from an osteoporotic fracture at some point in their life

Dietitian's Addition: there appears to be this belief that osteoporosis is a woman-specific disease. I have observed male patients visit the clinic convinced they were mis-diagnosed. In my opinion, osteoporosis is larger under-diagnosed, particularly in the male population.

  • Maximum bone density, or peak bone mass, is achieved at approximately:

  • Women: 16-20 years of age

  • Men: 20-25 years of age

  • After peak bone mass is attained bone density very gradually declines until approximately 40 years of age

  • Women: In the several years before menopause, women experience an accelerated bone loss of ~2-3% per year (at the spine) due to a 90% decline in estrogen production by the ovaries. This rapid loss lasts roughly five years and is followed by a slower loss of approx. 0.5% per year.

  • Men: Although men experience a gradual rather than accelerated loss, they experience larger loss after 70 years of age compared to women.

  • In individuals that have fractured their hip, there is a 1 in 3 chance they will suffer another fracture within a year. Over 50% will re-fracture within five years.

  • Nearly 30% of women and nearly 40% of men who suffer a hip fracture will die within the following year. This is similar to the life-expectancy statistics of patient’s one year after diagnosis with metastatic lung cancer!

  • Osteoporotic fractures are more common than heart attack, stroke, and breast cancer combined.


  1. Osteoporosis is a mobility-limiting and life-altering condition. Although there are numerous non-modifiable risk factors (eg. heredity; gender; age), there are a large number of modifiable risk factors (eg. dietary choices; supplementation if needed; smoking cessation; appropriate physical activity).

  2. Even if you don’t have osteoporosis and are not at high risk, the dietary interventions discussed in the following articles are beneficial to you. Spread the word and become an advocate for osteoporosis awareness and prevention in your social circles, because let’s be honest… there is nothing “humerus” about osteoporosis.

Want to learn more?

Read the next article in this series called