Research has shown lower bone mineral density (BMD) among vegetarians compared with omnivores; however, the potential impact on osteoporosis risk is relatively small. Vegans and some vegetarians may consume less protein, vitamin D, vitamin B12, and calcium compared with omnivores, thus increasing osteoporosis risk; however, vegan and vegetarian diets also typically include higher levels of other nutrients that may have positive effects on bone. A study done in children concluded that a well-planned vegetarian diet that included dairy and egg intake did not lead to significantly lower bone mass and found some evidence that the lacto-ovo-vegetarian diet was protective against bone abnormalities.
Although previously mentioned as a risk factor, low to moderate consumption of wine and beer may be beneficial to bone health. High alcohol intake is associated with lower bone density, higher prevalence of osteoporosis, and increased risk of fracture, although associated with poor lifestyle factors and comorbid conditions increase the difficulty of interpreting results.
The relationship between consumption of caffeine to osteoporosis has not been clearly established. Whereas coffee intake was associated with a modestly increased risk of bone fracture in women, the opposite was true for men, where higher coffee intake was associated with a decreased risk in a meta-analysis of nine cohorts and six case-control studies. However, a systematic review concluded that up to 400 mg/day of caffeine in healthy adults is not associated with adverse health effects, including bone. Interpretation of the caffeine content of coffee or other beverages is difficult because of variation due to brewing, portion size, and other beverage additions.
Exercise to preserve bone health through adulthood, the American College of Sports Medicine recommends weight-bearing aerobic activity with high bone-loading force (such as intensive walking, jogging, or ascending/descending stairs) three to five times per week, resistance training two to three times per week, and balance exercises. Regular walking and swimming appear to have minor benefits on bone mineral density (BMD) in older individuals.
In a recent meta-analysis study, a high-sodium diet was found to increase osteoporosis risk. This association may be attributable to increased calcium excretion. Although the calciuric effect of sodium has been speculated, there seem to be no adverse effects with adequate calcium and vitamin D intake. On the opposite end of the spectrum, because sodium is found abundantly in bone, hyponatremia, or low serum sodium, may increase an older adult’s osteoporosis risk.
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