Food for strong bones

A healthy balanced diet will help you build strong bones from an early age and maintain them throughout your life.

You need sufficient calcium to strengthen your bones and vitamin D to help your body absorb calcium.

Poor bone health can cause conditions such as rickets and osteoporosis and increase the risk of breaking a bone from a fall later in life.

Most people should be able to get all the nutrients they need for healthy bones by eating a healthy balanced diet.

"Many nutrients contribute to bone health, not just calcium and vitamin D," says Sarah Leyland of the National Osteoporosis Society.

"The best advice for bone health is to eat a healthy balanced diet with plenty of variety as set out by the eatwell guide."

A good diet is only one of the building blocks for healthy bones, which also includes physical activity and avoiding certain risk factors.

The latest National Diet and Nutrition Survey suggests that most of us are getting enough calcium but not enough vitamin D.

General population

Adults need 700mg of calcium a day. You should be able to get all the calcium you need by eating a varied and balanced diet.

Good sources of calcium include:

• milk, cheese and other dairy foods
• green leafy vegetables, such as broccoli, cabbage and okra, but not spinach
• soya beans
• tofu
• soya drinks with added calcium
• nuts
• bread and anything made with fortified flour
• fish where you eat the bones, such as sardines and pilchards

Although spinach might appear to contain a lot of calcium, it also contains oxalic acid, which reduces calcium absorption, and it is therefore not a good source of calcium.

It is difficult to get all the vitamin D we need from the diet and we get most of our vitamin D from the action of the sun on our skin.

Short daily periods of sun exposure without sunscreen from late March/April to the end of September are enough for most people to make enough vitamin D.

However, everyone is advised to consider taking a daily vitamin D supplement.

Good sources of vitamin D:

• oily fish, such as salmon, sardines and mackerel
• eggs
• fortified fat spreads
• fortified breakfast cereals
• some powdered milks

If you've been diagnosed with osteoporosis, your doctor may prescribe calcium and vitamin D supplements as well as osteoporosis drug treatments if they have concerns that your calcium intake may be low. Find out more in treating osteoporosis.

At-risk groups

Some groups of the population are at greater risk of not getting enough vitamin D, and the Department of Health recommends that these people should take daily vitamin supplements. These groups are:

• all babies and young children, from birth to one year of age, exclusively or partially breastfed from six months to five years old – unless they are having 500ml or more a day of infant milk formula
• all children aged one to four years old
• people who are frail or housebound
• people who are confined indoors, such as a care home
• people who usually wear clothes that cover up most their skin when outdoors
• people with dark skin such as those of African, African-Caribbean and South Asian origin

Find out more about taking vitamin D supplements.

Menopause

Women lose bone more rapidly for a number of years after the menopause when their ovaries almost stop producing oestrogen, which has a protective effect on bones. There are no specific calcium or vitamin D recommendations for the menopause, however a healthy balanced diet, including calcium and vitamin D, will help slow down the rate of bone loss.

Vegans

Non-vegans get most of their calcium from dairy foods (milk, cheese and yoghurt), but vegans can get it from other foods.

Good sources of calcium for vegans include:

• fortified soya, rice and oat drinks
• calcium-set tofu
• sesame seeds and tahini
• pulses
• brown and white bread (in the UK calcium is added to white and brown flour by law)
• dried fruit such as raisins, prunes, figs and dried apricots

The vegan diet contains little, if any, vitamin D without fortified foods or supplements so try to get sufficient sunlight exposure during the UK summer.

Vegan sources of vitamin D are:

• exposure to summer sunshine – remember to cover up or protect your skin before it starts to turn red or burn (see sunlight and vitamin D)
• fortified fat spreads, breakfast cereals and soya drinks (with vitamin D added)
• vitamin D supplements

During pregnancy and when breastfeeding, women who follow a vegan diet need to make sure they get enough vitamins and minerals for their child to develop healthily. Read vegetarian and vegan mums-to-be for more information.

If you're bringing up your baby or child on a vegan diet, you need to ensure they get a wide variety of foods to provide the energy and vitamins they need for growth. Read vegetarian and vegan babies and children for more information.

Too much vitamin A

Some research has suggested a link between vitamin A and osteoporosis. As a precaution, people who regularly eat liver (a rich source of vitamin A) are advised not to eat liver more than once a week, or take supplements containing retinol (animal form of vitamin A).

People at risk of osteoporosis, such as postmenopausal women and older people, are advised to limit their retinol (including those containing fish liver oil) intake to no more than 1.5mg a day by eating less liver and avoiding supplements containing retinol.