Features September 2011 Issue

Nutrient-Dense Tops Energy-Dense Diet in Reducing Fracture Risk

Vegetables, fruits, and grains lower the chances of low-trauma bone breaks.

The evidence continues to build showing that certain foods have a direct effect on bone health, especially in older adults and specifically in older women.

A healthy portion of vegetables and fruits, plus proteins, can build bone strength and reduce fracture risk.

Earlier this year, the American Journal of Clinical Nutrition published a study that investigated the association between dietary patterns and fractures in more than 5,000 adults over the age of 50. A research team identified two eating patterns—one labeled “nutrient dense;” the other, “energy dense.” Nutrient dense refers to a diet high in vegetables, fruits, and whole grains, while energy-rich diets were heavy on meats, desserts, fries, chips, and soft drinks.
The nutrient-dense diet was associated with a reduced risk of fractures. Men had 17 percent fewer fractures,  women had a 14 percent reduction, and women over 70 had an 18 percent lower fracture rate.

Beyond Calcium
“Bones need more than calcium,” says Andrea Dunn, RD, LD, CDE, a nutritional therapist at Cleveland Clinic. “Eating nutrient-rich foods that provide vitamin D, fluoride, magnesium, phosphorus, protein, and other bone-strengthening help is the way to go. Most Americans get about 75 percent of their calcium needs, but only 28 percent of their vitamin D needs.”
“Foods good for bone health include vegetables, fruits, milk and fortified milk replacements, whole grains, salmon, calcium-fortified tofu, lean meats,” adds Dunn. “Decreasing processed foods (cakes, cookies, candy) makes way for more nutrient-rich foods on the plate.”
In June, the U.S. Department of Agriculture unveiled “My Plate,” the government’s newest icon that promotes healthy eating (ChooseMyPlate.gov). Fruits and vegetables cover half the plate; proteins and grains occupy the other half.
The new evidence regarding the importance of a nutrient-rich diet reinforces the need for calcium and protein. “Among the age groups of particular concern in terms of low calcium intake are adult women and all adults 51 years and older,” says Dunn.
The recommended daily allowance (RDA) of calcium depends on age and gender. For men and women age 19-50, it is 1,000 mg. For men age 51-70, it is 1,000 mg; for women age 51-70, it is 1,200 mg; and the recommended daily allowance (RDA) of calcium for everyone age 71 and over is also 1,200.
A May 24, 2011 study in the British Medical Journal concluded that increases in dietary calcium intake beyond a moderate amount does little to prevent fractures or osteoporosis later in life.
“We tend to over-supplement,” says Dunn, “with an attitude that if some is good, more is better. This study tells us that it might not be a good thing to get too much calcium from supplements.”

Don’t Forget Protein
A landmark study published in 2008 in the American Journal of Clinical Nutrition found that a low protein intake is often observed in patients with hip fractures. “Protein is needed for bone metabolism,” explains Dunn. “Muscle wasting is often seen in older adults, along with osteoporosis, so adequate protein is needed as we age. I encourage my patients to include a protein source at each meal.” Meat, fish, poultry, eggs, soy, and beans are good sources of protein.
The problem at the heart of the nutrient-dense vs. energy-dense issue may be a lack of variety in the American diet, particularly among older adults. Incorporating the fruits-vegetables-protein-grains-dairy plan illustrated by the new “My Plate” strategy could go a long way toward adding variety and preventing fractures.