Three Strategies to Prevent Osteoporosis and Build Strong Bones

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Simple alternatives to osteoporosis drug therapies can keep your bones healthy and help to prevent bone fractures

An estimated 54 million Americans currently have osteoporosis or low bone mass with women (mostly postmenopausal) outnumbering men 2 to 1,[i] but both experience fractures, which lowers quality of life.[ii]

The World Health Organization's T-score measures of bone mineral density (BMD), using a DEXA scan, label patients "osteopenic" (T score between -1 and -2.5) or "osteoporotic" (T-score is -2.5 or below), but it is an imperfect way to predict bone health or bone fracture risk.

In fact, the majority of patients who sustain a low-trauma fracture do not meet the T-score definition of osteoporosis and younger individuals with BMD in the osteoporotic range but no other risk factors have relatively low fracture rates and yet are often questionably treated with osteoporosis drugs.[iii]

Adverse Effects of Osteoporotic Drugs

Common osteoporotic drugs -- bisphosphonates, like alendronate (Fosamax), risedronate (Actonel, Atelvia), ibandronate (Boniva) and zoledronic acid (Reclast) -- may cause adverse effects to the upper gastrointestinal tract, musculoskeletal pain, jaw osteonecrosis, ocular events,[iv] more risk of serious atrial fibrillation,[v] fever, musculoskeletal swelling and fatigue.[vi]

Alendronic acid showed no reduction in four-year fracture risks[vii] and a higher risk of gastric[viii] and esophagus ulcers;[ix] prolonged use (over four years) increased stress fractures (50%), pain (76%)[x] and bone micro-cracks.[xi]

Three Alternatives to Drugs for Bone Health

Three alternative strategies are essential to increase bone health and prevent fractures:

1. Exercise/Movement

Neuromuscular abilities such as walking and speed of gait are strong predictors of falling and hip fracture risk.[xii] When you exercise regularly, your bone adapts by increasing its quality and quantity, which enhances balance and coordination, and in turn helps prevent falls and broken bones.[xiii]

Some of the proven ways to exercise or move to increase bone health include Tai Chi,[xiv] dance,[xv] yoga[xvi] and non-weight and weight-bearing exercises.[xvii],[xviii]

2. Foods

The top categories of nutritional foods most helpful to bone health include:

  • Prunes (dried plums) are one of the richest bone-building foods.[xix],[xx] In a study of postmenopausal women, prunes (five prunes a day) prevented bone loss during a year-long trial and exhibited long-lasting bone protection in a five-year study.[xxi] Prunes improved BMD by suppressing the bone turnover rate in 237 postmenopausal women.[xxii]
  • Flavonoids (found in black tea, dark chocolate, fruits/veggies) were associated with disease prevention.[xxiii], [xxiv] Black tea, in particular, is a rich source of flavonols (myricetin, quercetin and kaempferol), which are potent antioxidants and good for your health.[xxv],[xxvi]

Higher intake of black tea/flavonoids was associated with a lower risk of fracture-related hospitalizations in 212 elderly high-risk Australian women.[xxvii] Since flavonoids are abundant in fruits and vegetables, it is not surprising that a meta-analysis (225,062 subjects) found a lower bone fracture risk was associated with an increase of one serving of fruits/veggies daily.[xxviii]

  • Soy isoflavones, particularly genistein (fermented soy, red clover, fava beans, coffee and kudzu), were superior to osteoporosis drugs (alendronate, raloxifene and estradiol) for increasing BMD and bone strength,[xxix] reducing bone resorption (loss of calcium) and increasing bone formation in postmenopausal women.[xxx] They significantly improved spine, hip and neck BMDs and three bone turnover markers in a meta-analysis of 52 articles.[xxxi]
  • Carotenoids (found in carrots, pumpkins, sweet potatoes, apricots and spinach),[xxxii] especially lycopene (found in guava, tomatoes, watermelon, grapefruit, red peppers, red cabbage, papaya and mangos), promote bone health.[xxxiii] In a 17-year study of 946 men and women suffering 100 total hip fractures, those eating the highest level of carotenoids experienced a lower risk of hip fractures and those with the highest lycopene intake had a lower hip and non-vertebral fracture risk.[xxxiv]
  • High vitamin foods -- Greater dietary vitamin C intake (found in broccoli, cantaloupe, cauliflower, kale, kiwi, oranges, papaya, peppers, sweet potato, strawberries and tomatoes)[xxxv] was associated with a 33% lower osteoporosis risk and reduced hip fracture risk, as well as higher neck and spine BMDs.[xxxvi] Subjects who ate more fish (vitamin D3) and green vegetables (K1 and K2 vitamins) also reduced fracture risks.[xxxvii]

3. Vitamins/Supplements

In a meta-analysis of 1,349 postmenopausal women, low magnesium (Mg) levels were an osteoporosis risk factor.[xxxviii] In a study of young adults, Mg supplementation had beneficial effects in reducing bone loss.[xxxix]

A vitamin D deficiency also can lead to osteoporosis and mineralization defects, associated with falls and fractures,[xl] but vitamin D and Mg should be taken together as vitamin D can deplete Mg levels.[xli]

In addition, vitamin K2 increased bone strength in the femoral neck and reduced the incidence of clinical fractures, increasing bone growth and decreasing bone loss.[xlii], [xliii] Vitamins K and D work synergistically together for bone health as well.[xliv] Vitamin C exerts a positive effect on bone formation of genes involved in skeletal health.[xlv]

Choosing Bone Health

Three options of exercise/movement, nutritional foods and vitamins/supplements are great for bone health and lower fracture risk, without harmful drug side effects. For the latest scientific research compiled by, see the research databases for osteoporosis and bone fractures.



[i] National Osteoporosis Foundation, 54 Million Americans Affected by Osteoporosis and Low Bone Mass,

[ii] Meng-Xia Ji and Qi Yu. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015 Mar; 1(1): 9-13. Published online 2015 Mar 21. doi: 10.1016/j.cdtm.2015.02.006. PMCID: PMC5643776, PMID: 29062981

[iii] Sanford Baim, William D Leslie. Assessment of fracture risk. Curr Osteoporos Rep. 2012 Mar ;10(1):28-41. PMID: 22274642

[iv] Peter D Papapetrou. Bisphosphonate-associated adverse events. Hormones (Athens). 2009 Apr-Jun;8(2):96-110. PMID: 19570737

[v] Rohit Bhuriya, Mukesh Singh, Janos Molnar, Rohit Arora, Sandeep Khosla. Bisphosphonate use in women and the risk of atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol. 2010 Jan 3. Epub 2010 Jan 3. PMID: 20051297

[vi] I R Reid, G D Gamble, P Mesenbrink, P Lakatos, D M Black. Characterization of and risk factors for the acute-phase response after zoledronic acid. J Clin Endocrinol Metab. 2010 Sep;95(9):4380-7. Epub 2010 Jun 16. PMID: 20554708

[vii] [No authors listed]. Alendronic acid in primary prevention: new indication. No reduction in fracture risk. Prescrire Int. 2000 Jun;9(47):70-2. PMID: 11010741

[viii] D Y Graham, H M Malaty. Alendronate and naproxen are synergistic for development of gastric ulcers. Arch Intern Med. 2001 Jan 8;161(1):107-10. PMID: 11146706

[ix] P Duques, R S Araújo, W P de Amorim. Esophagus-enteric anastomosis ulceration caused by alendronate. Arq Gastroenterol. 2001 Apr-Jun;38(2):129-31. PMID: 11793943

[x] Ernest Beng Kee Kwek, Seo Kiat Goh, Joyce Suang Bee Koh, Meng Ai Png, Tet Sen Howe. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008 Feb;39(2):224-31. Epub 2008 Jan 28. PMID: 18222447

[xi] Claude-Laurent Benhamou. Effects of osteoporosis medications on bone quality. Joint Bone Spine. 2007 Jan;74(1):39-47. Epub 2006 Nov 28. PMID: 17196423

[xii] P Dargent-Molina, F Favier, H Grandjean, C Baudoin, A M Schott, E Hausherr, P J Meunier, G Bréart. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet. 1996 Jul 20;348(9021):145-9. PMID: 8684153

[xv] Ario Federici, Silvia Bellagamba, Marco B L Rocchi. Does dance-based training improve balance in adult and young old subjects? A pilot randomized controlled trial. Aging Clin Exp Res. 2005 Oct;17(5):385-9. PMID: 16392413

[xvi] Yi-Hsueh Lu, Bernard Rosner, Gregory Chang, Loren M Fishman. Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Top Geriatr Rehabil. 2016 Apr ;32(2):81-87. Epub 2015 Nov 5. PMID: 27226695

[xviii] Shanshan Guo, Yiru Huang, Yan Zhang, He Huang, Shangyu Hong, Tiemin Liu. Impacts of exercise interventions on different diseases and organ functions in mice. J Sport Health Sci. 2020 Jan ;9(1):53-73. Epub 2019 Jul 13. PMID: 31921481

[xix] S Hooshmand, M Kern, D Metti, P Shamloufard, S C Chai, S A Johnson, M E Payton, B H Arjmandi. The effect of two doses of dried plum on bone density and bone biomarkers in osteopenic postmenopausal women: a randomized, controlled trial. Osteoporos Int. 2016 Feb 22. Epub 2016 Feb 22. PMID: 26902092

[xx] Bahram H Arjmandi, Dania A Khalil, Edralin A Lucas, Amanda Georgis, Barbara J Stoecker, Claudia Hardin, Mark E Payton, Robert A Wild. Dried plums improve indices of bone formation in postmenopausal women. Altern Ther Health Med. 2010 Mar-Apr;16(2):12-4. PMID: 11860726

[xxi] Bahram H Arjmandi, Sarah A Johnson, Shirin Pourafshar, Negin Navaei, Kelli S George, Shirin Hooshmand, Sheau C Chai, Neda S Akhavan. Bone-Protective Effects of Dried Plum in Postmenopausal Women: Efficacy and Possible MechanismsNutrients. 2017 May 14 ;9(5). Epub 2017 May 14. PMID: 28505102

[xxii] Shirin Hooshmand, Sheau C Chai, Raz L Saadat, Mark E Payton, Kenneth Brummel-Smith, Bahram H Arjmandi. Comparative effects of dried plum and dried apple on bone in postmenopausal women. Br J Nutr. 2011 May 31:1-8. Epub 2011 May 31. PMID: 21736808

[xxiii] Rajendran P, Rengarajan T, Nandakumar N, Palaniswami R, Nishigaki Y, Nishigaki I. Kaempferol, a potential cytostatic and cure for inflammatory disorders. Eur J Med Chem. 2014 Oct 30;86:103-12 Epub 2014 Aug 5. PMID: 25147152doi: 10.1016/j.ejmech.2014.08.011.

[xxiv] Martin Root, Erin Ravine, Anne Harper. Flavonol Intake and Cognitive Decline in Middle-Aged Adults. J Med Food. 2015 Dec ;18(12):1327-32. Epub 2015 Sep 1. PMID: 26325006

[xxv] Brasathe Jeganathan, P. A. Nimal Punyasiri, J. Dananjaya Kottawa-Arachchi, Mahasen A. B. Ranatunga, I. Sarath B. Abeysinghe, M. T. Kumudini Gunasekare, and B. M. Ratnayake Bandara. Genetic Variation of Flavonols Quercetin, Myricetin, and Kaempferol in the Sri Lankan Tea (Camellia sinensis L.) and Their Health-Promoting Aspects, Hindawi Publishing Corporation, International Journal of Food Science, Volume 2016 |Article ID 6057434, 1-9,

[xxvi] Bischoff SC. Quercetin: potentials in the prevention and therapy of disease. Curr Opin Clin Nutr Metab Care. 2008 Nov;11(6):733-40. PMID: 18827577, doi: 10.1097/MCO.0b013e32831394b8.

[xxviii] Juliana E Brondani, Fabio V Comim, Liziane M Flores, Lígia Araújo Martini, Melissa O Premaor. Fruit and vegetable intake and bones: A systematic review and meta-analysis. PLoS One. 2019 ;14(5):e0217223. Epub 2019 May 31. PMID: 31150426

[xxix] GreenMedInfo, Humble Food Extract Puts Bone Drugs to Shame. /

[xxx] Nunziata Morabito, Alessandra Crisafulli, Caterina Vergara, Agostino Gaudio, Antonino Lasco, Nicola Frisina, Rosario D'Anna, Francesco Corrado, Maria Antonia Pizzoleo, Maria Cincotta, Domenica Altavilla, Riccardo Ientile, Francesco Squadrito. Effects of genistein and hormone-replacement therapy on bone loss in early postmenopausal women: a randomized double-blind placebo-controlled study. J Bone Miner Res. 2002 Oct;17(10):1904-12. PMID: 12369794

[xxxi] Masoumeh Akhlaghi, Maryam Ghasemi Nasab, Maryam Riasatian, Fatemeh Sadeghi. Soy isoflavones prevent bone resorption and loss, a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2019 Jul 10:1-15. Epub 2019 Jul 10. PMID: 31290343

[xxxii] Opting Health, Foods High in Cartenoids.

[xxxiv] Shivani Sahni, Marian T Hannan, Jeffrey Blumberg, L Adrienne Cupples, Douglas P Kiel, Katherine L Tucker. Protective effect of total carotenoid and lycopene intake on the risk of hip fracture: a 17-year follow-up from the Framingham Osteoporosis Study. J Bone Miner Res. 2009 Jun;24(6):1086-94. PMID: 19138129

[xxxv] Web MD, What Foods Are Rich in Vitamin C? › cold-and-flu › what-foods-are-rich-in-vitamin-c

[xxxvii]Akiko Kuwabara. Foods rich in fat-soluble vitamins and bone health. Clin Calcium. 2009 Sep;19(9):1362-9. PMID: 19721210

[xxxviii] Jianmao Zheng, Xueli Mao, Junqi Ling, Qun He, Jingjing Quan, Hongbo Jiang. Association between serum level of magnesium and postmenopausal osteoporosis: a meta-analysis. Biol Trace Elem Res. 2014 Jun ;159(1-3):8-14. Epub 2014 Apr 12. PMID: 24728877

[xxxix] H P Dimai, S Porta, G Wirnsberger, M Lindschinger, I Pamperl, H Dobnig, M Wilders-Truschnig, K H Lau. Daily oral magnesium supplementation suppresses bone turnover in young adult males. J Biol Chem. 2002 Dec 27;277(52):50341-7. Epub 2002 Oct 16. PMID: 9709941

[xl] Lips P, van Schoor NM.  The effect of vitamin D on bone and osteoporosis. Best Pract Res Clin Endocrinol Metab. 2011 Aug;25(4):585-91. PMID: 21872800, DOI: 10.1016/j.beem.2011.05.002

[xli] Pramod Reddy, Linda R Edwards. Magnesium Supplementation in Vitamin D Deficiency. Am J Ther. 2017 May 3. Epub 2017 May 3. PMID: 28471760

[xlii] Jun Iwamoto, Yoshihiro Sato, Tsuyoshi Takeda, Hideo Matsumoto. High-dose vitamin K supplementation reduces fracture incidence in postmenopausal women: a review of the literature. Nutr Res. 2009 Apr;29(4):221-8. PMID: 19410972

[xliii] Masayoshi Yamaguchi, M Neale Weitzmann. Vitamin K2 stimulates osteoblastogenesis and suppresses osteoclastogenesis by suppressing NF-κB activation. Int J Mol Med. 2011 Jan;27(1):3-14. Epub 2010 Nov 11. PMID: 21072493

[xliv] Peter Weber. Vitamin K and bone health. Nutrition, Volume 17, Issues 11-12, November 2001, Pages 1024,

[xlv] Patrick Aghajanian, Susan Hall, Montri D Wongworawat, Subburaman Mohan. The Roles and Mechanisms of Actions of Vitamin C in Bone: New Developments. J Bone Miner Res. 2015 Sep 11. Epub 2015 Sep 11. PMID: 26358868

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