The Mediterranean Diet and Osteoporosis: Does It Help?

Box of stretch bands
You’ve heard of the Mediterranean diet’s long list of health benefits, but here’s what you need to know if you’re looking to support optimal bone health.
Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Well Guide contain information from peer-reviewed research, medical societies and governmental agencies; however, these articles are not a substitute for professional medical advice, diagnosis, or treatment.

Trying to keep tabs on popular diets can feel like a full-time job. Every time you turn around, a new diet enters the scene and promises to be the key to long-term health.

But one diet continues to win whenever it's pitted against the competition: the Mediterranean diet. Even better? The emphasis on fresh fruits and vegetables, lean protein, healthy fats, and whole grains (and yes small amounts of wine) makes the Mediterranean diet delicious and easy to follow.

Recently there has been more interest in whether or not the Mediterranean diet helps with osteoporosis prevention. Osteoporosis is a condition that causes bones to become weak and brittle, making them more susceptible to fractures.

In this article, we'll take a closer look at the Mediterranean diet, bone health, and osteoporosis so you can decide if it's right for you.

Essential Micronutrients For Your Bones

Before diving into the specifics of the Mediterranean diet, let's step back and discuss the nutrients you need for healthy bones.

Bones are living tissues that require essential micronutrients—vitamins and minerals—to stay strong and healthy (Kitchen, 2003). Ensuring you get enough of these nutrients through your diet could help protect against osteoporosis and bone fractures (Okubo, 2006).

The most important nutrients for bone health include:

  • Calcium
  • Vitamin D
  • Magnesium
  • Vitamin K
  • Potassium
  • Phosphorus

What Foods Are High In Bone-Building Nutrients?

The best way to get these essential nutrients for bone health is through food. Here are some examples:

  • Calcium: Dairy products (milk, cheese, yogurt), leafy greens, and salmon or sardines with bones.
  • Vitamin D: Fatty fish (salmon, mackerel, tuna) and eggs.
  • Magnesium: Leafy green vegetables, whole grains, nuts, and legumes.
  • Vitamin K: Leafy green vegetables, cabbage, yogurt, and aged cheese.
  • Potassium: Fruits and vegetables, especially bananas, sweet potatoes, avocado, and tomatoes.
  • Phosphorus: Dairy products (milk, cheese, yogurt) and poultry.

Each of these nutrients plays a different role in bone health, but they work together to form strong bones, measured by bone mineral density (BMD).

For example, calcium is the main structural component of bones, while vitamin D helps the body absorb calcium (NIH Osteoporosis and Related Bone Diseases, 2018). Magnesium, vitamin K, and phosphorus are essential for calcium absorption and bone metabolism and formation (Pepa, 2016).

If you lack one or more of these essential nutrients, it can increase the risk of bone loss and osteoporosis.

What Is The Mediterranean Diet?

The Mediterranean diet is inspired by the traditional cuisine of countries in the Mediterranean region, such as Italy, Greece, and Spain. It's high in fresh fruits and vegetables, whole grains, legumes, nuts, and olive oil. Moderate amounts of dairy products, fish, and red wine are also highlighted.

Many of the foods listed above are high in nutrients, antioxidants and polyphenols, which help protect your cells from free radical damage and inflammation (Pandey, 2009). This is one of the many reasons the Mediterranean diet provides so many health benefits (Tresserra-Rimbau, 2014).

Not only is the food included in the Mediterranean diet delicious and varied enough to keep meals interesting, study after study points to the fact that the Mediterranean diet may lower the incidence of many chronic diseases such as cardiovascular disease (Fung, 2009), obesity, and certain types of cancer (Schwingshackl, 2016). One study even found that the Mediterranean diet can help reduce the risk of death from all causes (Sofi, 2010).

Still not convinced of its benefits? A recent study from the American Journal of Clinical Nutrition found that people who follow a Mediterranean diet were less likely to experience frailty with aging for both men and women, likely because of the high intake of carotenoids found in the diet pattern (Miller, 2022). Carotenoids are a type of antioxidant found in brightly colored produce.

Does the Mediterranean Diet Provide Essential Nutrients for Bone Health?

The short answer is yes, the Mediterranean diet provides essential nutrients for bone health. The Mediterranean diet is filled with foods that contain the nutrients needed for healthy bones, such as:

  • Whole grains
  • Fresh produce
  • Small amounts of dairy
  • Nuts and seeds
  • Legumes

Interestingly fish, which is a focal point of the Mediterranean diet, is linked to stronger bones. A study examining premenopausal Spanish women found that increased fish intake was linked to higher vitamin D levels and higher bone density (Calderon-Garcia, 2012)

Olive oil is also a primary fat source in the Mediterranean diet. Olive oil contains polyphenols which, like many of the foods mentioned earlier, link it to better bone health (Chin, 2016).

If you are a fan of olive oil, this is good news: One study found that adding extra olive oil to a Mediterranean diet increased bone formation and reduced markers of bone breakdown (Fernandez-Real, 2012). Intake of olive oil is also associated with improved BMD (Roncero-Martin, 2018).

Further, the Mediterranean diet focuses on whole, minimally processed foods that are linked to better bone health. It's also important to keep in mind what not to eat. Some research suggests that diets high in processed foods like sugar are linked to lower BMD (Hardcastle, 2011).

The Mediterranean Diet and Osteoporosis

By now you probably recognize that, when it comes to osteoporosis, there are many benefits to following the Mediterranean diet. But here are a few more fascinating research studies about how this diet can help people with osteoporosis:

  • Lowers the risk of developing osteoporosis. The Mediterranean diet may be an effective strategy for lowering the risk of osteoporosis and fractures. Researchers hypothesize that one reason osteoporosis rates may be lower in Mediterranean countries is related to commonly eaten foods in those areas (Perez-Ray, 2019).
  • Reduces inflammation. In addition to providing the above nutrients for bone health, it may help by reducing inflammation in the body through its high antioxidants and other anti-inflammatory nutrients. Inflammation may contribute to the development of osteoporosis (Ginaldi, 2005).
  • Improves bone mineral density. Following the Mediterranean diet is linked to better BMD in multiple studies (Perez-Ray, 2019, Malmir, 2018).
  • Reduces the risk of fractures. It also may help reduce the risk of fractures (Malmir, 2018). A large observational study of more than 90,000 women published in JAMA also found a significant link between those who followed the Mediterranean diet more closely and a lower risk of hip fractures (Haring, 2016). Similar results were seen for men who had a 7 percent reduced risk when they followed the diet (Benetou, 2012).
  • May slow bone loss. The Mediterranean diet may help slow bone loss once you've been diagnosed with osteoporosis. A study on older European men and women found that following the Mediterranean diet and taking a vitamin D supplement helped to slow down bone loss in certain areas (Jennings, 2018).

Diet is Key for Supporting Bone Health

The research is clear: The Mediterranean diet may be a contributing factor to support bone health. Still, osteoporosis is a complex disease with multiple risk factors, including genetics and lifestyle choices.

The best way to prevent osteoporosis is to maintain a healthy lifestyle that includes a nutritious diet, regular physical activity, and avoids smoking and excessive alcohol consumption.

If you aren't sure where to start with the Mediterranean diet, a registered dietitian can help you create a plan that fits your individual needs.

Explore related exercises

No items found.
stay tuned

We're launching soon.

Join our waitlist to get early access to a personalized exercise program built for women with osteoporosis and osteopenia.
* We don't share your data. See our Privacy Policy
Check mark
Thank you! Your submission has been received!
We will contact you shortly.
Oops! Something went wrong while submitting the form.

References

  1. Kitchin B, Morgan S. Nutritional considerations in osteoporosis. Curr Opin Rheumatol. 2003;15(4):476-480. doi:10.1097/00002281-200307000-00017
  2. Benetou V, Orfanos P, Pettersson-Kymmer U, et al. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int. 2013;24(5):1587-1598. doi:10.1007/s00198-012-2187-3
  3. Calcium and Vitamin D: Important at Every Age. NIH Osteoporosis and Related Bone Diseases National Resource Center. Accessed July 7, 2022. https://www.bones.nih.gov/health-info/bone/bone-health/nutrition/calcium-and-vitamin-d-important-every-age.
  4. Calderon-Garcia JF, Moran JM, Roncero-Martin R, Rey-Sanchez P, Rodriguez-Velasco FJ, Pedrera-Zamorano JD. Dietary habits, nutrients and bone mass in Spanish premenopausal women: the contribution of fish to better bone health. Nutrients. 2012;5(1):10-22. Published 2012 Dec 27. doi:10.3390/nu5010010
  5. Chin KY, Ima-Nirwana S. Olives and Bone: A Green Osteoporosis Prevention Option. Int J Environ Res Public Health. 2016;13(8):755. Published 2016 Jul 26. doi:10.3390/ijerph13080755
  6. Fernández-Real JM, Bulló M, Moreno-Navarrete JM, et al. A Mediterranean diet enriched with olive oil is associated with higher serum total osteocalcin levels in elderly men at high cardiovascular risk. J Clin Endocrinol Metab. 2012;97(10):3792-3798. doi:10.1210/jc.2012-2221
  7. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women [published correction appears in Circulation. 2009 Mar 31;119(12):e379]. Circulation. 2009;119(8):1093-1100. doi:10.1161/CIRCULATIONAHA.108.816736
  8. Ginaldi L, Di Benedetto MC, De Martinis M. Osteoporosis, inflammation and ageing. Immun Ageing. 2005;2:14. Published 2005 Nov 4. doi:10.1186/1742-4933-2-14
  9. Hardcastle AC, Aucott L, Fraser WD, Reid DM, Macdonald HM. Dietary patterns, bone resorption and bone mineral density in early post-menopausal Scottish women. Eur J Clin Nutr. 2011;65(3):378-385. doi:10.1038/ejcn.2010.264
  10. Haring B, Crandall CJ, Wu C, et al. Dietary Patterns and Fractures in Postmenopausal Women: Results From the Women's Health Initiative. JAMA Intern Med. 2016;176(5):645-652. doi:10.1001/jamainternmed.2016.0482
  11. Jennings A, Cashman KD, Gillings R, et al. A Mediterranean-like dietary pattern with vitamin D3 (10 µg/d) supplements reduced the rate of bone loss in older Europeans with osteoporosis at baseline: results of a 1-y randomized controlled trial. Am J Clin Nutr. 2018;108(3):633-640. doi:10.1093/ajcn/nqy122
  12. Kitchin B, Morgan S. Nutritional considerations in osteoporosis. Curr Opin Rheumatol. 2003;15(4):476-480. doi:10.1097/00002281-200307000-00017
  13. Malmir H, Saneei P, Larijani B, Esmaillzadeh A. Adherence to Mediterranean diet in relation to bone mineral density and risk of fracture: a systematic review and meta-analysis of observational studies. Eur J Nutr. 2018;57(6):2147-2160. doi:10.1007/s00394-017-1490-3
  14. Millar CL, Costa E, Jacques PF, et al. Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: Results from the Framingham Offspring Study [published online ahead of print, 2022 May 12]. Am J Clin Nutr. 2022;nqac130. doi:10.1093/ajcn/nqac130
  15. Noori M, Jayedi A, Khan TA, Moradi S, Shab-Bidar S. Mediterranean dietary pattern and bone mineral density: a systematic review and dose-response meta-analysis of observational studies [published online ahead of print, 2022 Feb 16]. Eur J Clin Nutr. 2022;10.1038/s41430-022-01093-7. doi:10.1038/s41430-022-01093-7
  16. Okubo H, Sasaki S, Horiguchi H, et al. Dietary patterns associated with bone mineral density in premenopausal Japanese farmwomen. Am J Clin Nutr. 2006;83(5):1185-1192. doi:10.1093/ajcn/83.5.1185
  17. Pandey KB, Rizvi SI. Plant polyphenols as dietary antioxidants in human health and disease. Oxid Med Cell Longev. 2009;2(5):270-278. doi:10.4161/oxim.2.5.9498
  18. Pepa GD, Brandi ML. Microelements for bone boost: the last but not the least. Clin Cases Miner Bone Metab. 2016;13(3):181-185. doi:10.11138/ccmbm/2016.13.3.181
  19. Pérez-Rey J, Roncero-Martín R, Rico-Martín S, et al. Adherence to a Mediterranean Diet and Bone Mineral Density in Spanish Premenopausal Women. Nutrients. 2019;11(3):555. Published 2019 Mar 5. doi:10.3390/nu11030555
  20. Roncero-Martín R, Aliaga Vera I, Moreno-Corral LJ, et al. Olive Oil Consumption and Bone Microarchitecture in Spanish Women. Nutrients. 2018;10(8):968. Published 2018 Jul 26. doi:10.3390/nu10080968
  21. Schwingshackl L, Hoffmann G. Does a Mediterranean-Type Diet Reduce Cancer Risk?. Curr Nutr Rep. 2016;5:9-17. doi:10.1007/s13668-015-0141-7
  22. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189-1196. doi:10.3945/ajcn.2010.29673
  23. Tresserra-Rimbau A, Rimm EB, Medina-Remón A, et al. Polyphenol intake and mortality risk: a re-analysis of the PREDIMED trial. BMC Med. 2014;12:77. Published 2014 May 13. doi:10.1186/1741-7015-12-77
  24. Zaretsky J, Griess-Fishheimer S, Carmi A, et al. Ultra-processed food targets bone quality via endochondral ossification. Bone Res. 2021;9(1):14. Published 2021 Feb 26. doi:10.1038/s41413-020-00127-9