Osteoporosis is the thinning of the bones and it affects both women (1 in 3) -occurring after the age of 45, and men (1 in 12). It is exacerbated by menopause, due to the hormonal changes that occur in women. Bones are at their strongest around the age of 35, but their strength is also influenced by genetics, exercise, hormones and diet.

Who would require the diet?

There should be no 'special' diet for osteoporosis, as every individual should be eating a diet that is healthy and provides enough of the vital mineral calcium to help achieve strong bones. However there are some indicators that would suggest an increased risk of osteoporosis.

These are:

• Early menopause.
• Early hysterectomy.
• Missed period for more than 6 months due to excessive dieting or over exercise.
• Long term use of steroid medicines.
• Maternal hip fracture.
• Malabsorption due to bowel disease and/or gastric surgery.
• Smoking.
• Long term immobility or lack of exercise.
• Excessive alcohol.

What is the diet and how does it work?

It is never too late to eat a diet rich in calcium, but there is no doubt that the foundations start in childhood, where a combination of a diet with adequate calcium and exercise will help to achieve strong bones. The National Osteoporosis Society (NOS) recommend levels of dietary calcium higher than the UK Dietary Reference Values, making it more difficult to achieve the recommended intake. However, NOS suggest that they are a guide and nobody should be too anxious if they don't reach their recommended amount.

	NOS (mg)	DRV (mg)
Children 7-10 years	800	550
Teenagers 13-19 years	1000	1000
Men 20-60 years	1000	700
Women 20-45 years	1000	800
Pregnant & nursing women	1200	1350
Pregnant & nursing teenagers	1500	None given
Women over 45	1500	700
Women over 45 with HRT	1000	700
Men over 60	1500	700

The richest sources of calcium are dairy products, milk - all types, cheese (there is relatively little calcium in cottage cheeses and cream cheeses), yoghurts and fromage frais (choose low fat varieties if weight is a concern). Tofu and calcium-enriched soya milk are excellent vegetarian sources.

Including breakfast cereal with milk, teas or coffees with milk or a milky drink and a yogurt in the diet will provide a very good basis for bone health.

Other useful sources of calcium are bread (especially white), baked beans, spinach, oranges, tinned fish and ice cream. However, most foods contain some calcium, so by eating a sensible varied diet that is rich in calcium it is possible to achieve good intakes.

Calcium content by serving

The following list of foods gives their calcium content. Its aim is to give a range of foods with calcium contents. Milk and milk-based foods are the richest sources, other foods have much lower amounts. The list is to help assess how much calcium is consumed.

Because a food is not listed it does not mean that is has no calcium. (All figures rounded to the nearest 5mg.)

Foodstuff	Quantity of Calcium (mg)
Milk, whole, 1/3rd pint (200ml)	250 in teas/coffees 50
Milk, semi-skimmed, 1/3rd pint (200ml)	250 in teas/coffees 50
Milk, fully-skimmed, 1/3rd pint (200ml)	250 in teas/coffees 50
Cheese, Cheddar 1oz (25g)	200
Cheese, Cottage 1 small tub (112g)	120
Cheese, Brie 1oz (25g)	150
Cheese, Edam1oz (25g)	215
Cheese, Feta 1oz (25g)	100
Cheese, Parmesan 1 tbs. (10g)	120
Yogurt, whole, plain, small tub (150g)	240
Yogurt, whole, fruit large tub (200g)	320
Yogurt, low fat, plain, 1 small tub (150g)	285
Yogurt, low fat, fruit, 1 small tub (150g)	225
Yogurt, low fat, fruit, 1 small tub (150g)	225
Yogurt, diet, fruit, 1 small tub (125g)
Fromage Frais, all varieties 1 tub (60g)	40
Fruit Mousse, 1 tub (60g)	70
Ice creams (1 scoop)	85
Cornetto, 1	60
Arctic Roll, average portion	85
Rice Pudding, serving (200g)	185
Custard, made with milk, average (150g)	210
Creams, all per tablespoon	15
Eggs - each	35
Sardines, canned in tomato sauce	110
Cod in parsley sauce	85
Fish fingers, each	25
Salmon, grilled, med. Portion	25
Cod, portion	10
Sesame seeds, 1 tbsp	80
Macaroni cheese, ½ large can	210
Pot savouries	150
Bread, white, 1 med slice	40
Bread, wholemeal, 1 med slice	25
Orange, 1 med.	75
Bananas, 1 med.	5
Lamb, roast, average portion	15
Chicken, roast, average portion	15
Beef, roast, average portion	10
Pork, roast, average portion	10
Turkey, roast, average portion	10
Chocolate, milk, fun size bar	40
Baked beans, 1/3rd large tin	105
Beans, french, average portion	50
Pizza, cheese topped, average portion	425
Potatoes, boiled, average portion	10
Peas, boiled, average portion	25
Chapati, 1 average	35
Rice, boiled, average portion	30
Pasta, boiled, average portion	95

Will the diet harm me?

There are many calcium supplements available that are targeted at menopausal and post-menopausal women containing calcium and vitamin D. Anyone who takes these supplements should ensure that they are not taking excessive intakes of vitamin D, since this is a fat-soluble vitamin and stored in the liver. Other supplements that are likely to contain vitamin D, are Cod Liver Oil supplements and multivitamin supplements.

Avoid taking large doses of calcium supplements in one go, it is better to divide the dose into 2, and always drink plenty of liquids as not all the calcium is absorbed. Renal stones could be a potential problem if there is a poor fluid intakes.

What else do I need to know?

Hormone replacement therapy (HRT) helps to prevent osteoporosis in women following the menopause. Women who wish to consider HRT therapy should speak to their doctor.

Exercise strengthens bones and should be undertaken regularly as a preventative measure for osteoporosis.

Individuals who avoid milk are at risk of low calcium intakes and should take extra care to ensure their diet has adequate calcium. An example of a suitable milk substitute is calcium-enriched soya milk.

Women who eat adequate calcium, but have little access to daylight or are covered up with clothing, perhaps for religious reasons, may also have weak bones as they have inadequate supplies of vitamin D. Most of the vitamin D is obtained from synthesis of sunlight on the skin.

High intakes of protein and salt (see low salt diet) should be avoided as they reduce mineralisation of the bone.

Large consumption of carbonated drinks can also affect bone mineralisation due to the large amounts of phosphates present. This is important, as children tend to drink colas and other carbonated drinks, rather than milk.