Original Article Posted on the Vegan RD site

Since eating Plant Based my only concern was getting enough Iron and B12, only found in animal products. Reading Protecting Bone Health got me thinking

Seems like the same guidelines that apply to someone not eating a plant based nutrition plan apply to those.

Eat Enough Protein

You can read more about protein on vegan diets here.

Get Adequate Calcium

It’s not at all hard to get adequate calcium from plant foods, but new vegans may not know where to look. Many foods that we, non-vegans alike, are fortified with calcium, so it can be a matter of reading food labels.  Calcium fortified plant milks, and tofu made with calcium sulfate.

Increasing the absorption from foods such as leafy green vegetables from the cabbage family like kale, bok choy and turnip greens.  Try to eat at least two cups per day of foods rich in well-absorbed calcium while adding a variety of beans, almonds, navel oranges, and tahini, other calcuim rich foods, in your diet .Read more about calcium absorption here.

Identify a Good Source of Vitamin D

Only a handful of foods are natural sources of vitamin D, so most people depend on fortified foods or supplements for this nutrient. Fortified foods usually contain vitamin D3 which is almost always derived from animals. The vegan form of vitamin D is vitamin D2 or ergocalciferol. The evidence suggests that it’s as effective as vitamin D3 when taken as a daily supplement for maintaining adequate vitamin D status (14). However, new research suggests that vitamin D2 may be less effective in reversing a vitamin D deficiency (15). If you are deficient in vitamin D and need to raise your blood levels, there is a vegan vitamin D3 derived from lichen and sold under the brand name Vitashine. The RDA for vitamin D, whether you are taking D2 or D3, is 600 IUs.

Eat Lots of Fruits and Vegetables

Diets rich in fruits and vegetables seem to help protect bone health.  Many of these foods provide vitamin C which is involved in formation of collagen, an important component of bones. It’s also an antioxidant which may be important since oxidative stress could contribute to bone loss (16).  Potassium and magnesium in fruits and vegetables may help to counter effects of the higher acid load associated with a protein-rich diet (17). Vitamin K (in many leafy green vegetables) has been linked to better bone health although the studies don’t consistently show a benefit (18,10).  Since fruits and vegetables vary greatly in their nutrient content, it’s a good idea to eat a variety of them.

Ensure Adequate Vitamin B12

Take supplements of vitamin D and vitamin B12 or use foods fortified with these nutrients.  Follow the guidelines here to ensure adequate vitamin B12 intake.

Engage in Weight-Bearing Exercise

Exercise that provides impact and that builds muscle mass and strength is crucial for keeping bones strong.  Finding a regular weekly routine of impact sports such as aerobics, running and playing as well as strengthing with heavy weights and mobility stability movements to improve balance and limit fractures due to falling

References

1. Frassetto LA, Todd KM, Morris RC, Jr., Sebastian A. Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol A Biol Sci Med Sci 2000;55:M585-92.
2. Bow CH, Cheung E, Cheung CL, Xiao SM, Loong C, Soong C, Tan KC, Luckey MM, Cauley JA, Fujiwara S, et al. Ethnic difference of clinical vertebral fracture risk. Osteoporos Int 2012;23:879-85.
3. Kerstetter JE, Allen LH. Dietary protein increases urinary calcium. J Nutr 1990;120:134-6.
4. Fenton TR, Lyon AW, Eliasziw M, Tough SC, Hanley DA. Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res 2009;24:1835-40.
5. Thorpe DL, Knutsen SF, Lawrence Beeson W, Rajaram S, Fraser GE. Effects of meat consumption and vegetarian diet on risk of wrist fracture over 25 years in a cohort of peri- and postmenopausal women.Public Health Nutr 2007:1-9.
6. Lousuebsakul-Matthews V, Thorpe DL, Knutsen R, Beeson WL, Fraser GE, Knutsen SF. Legumes and meat analogues consumption are associated with hip fracture risk independently of meat intake among Caucasian men and women: the Adventist Health Study-2. Public Health Nutr 2014;17:2333-43.
7. Kerstetter JE, O’Brien KO, Caseria DM, Wall DE, Insogna KL. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. J Clin Endocrinol Metab 2005;90:26-31.
8. Weaver CM. Should dairy be recommended as part of a healthy vegetarian diet? Point. American Journal of Clinical Nutrition 2009;89:1634S-1637S.
9. Weaver CM, Heaney RP, Connor L, Martin BR, Smith DL, Nielsen E. Bioavailability of calcium from tofu vs. milk in premenopausal women. J Food Sci 2002;68:3144-3147.
10. Weaver CM, Heaney RP, Nickel KP, Packard PI. Calcium bioavailability from high oxalate vegetables: Chinese vegetables, sweet potatoes and rhubarb. J Food Sci 1997;63:524-525.
11. Tang AL, Walker KZ, Wilcox G, Strauss BJ, Ashton JF, Stojanovska L. Calcium absorption in Australian osteopenic post-menopausal women: an acute comparative study of fortified soymilk to cows’ milk. Asia Pac J Clin Nutr 2010;19:243-9.
12. Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, Petruschke RA, Chen E, de Papp AE. Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005;90:3215-24.
13. Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, Hollis BW, Drezner MK. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab 2007;92:2130-5.
14. Holick MF, Biancuzzo RM, Chen TC, Klein EK, Young A, Bibuld D, Reitz R, Salameh W, Ameri A, Tannenbaum AD. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2008;93:677-81.
15. Tripkovic L, Wilson LR, Hart K, Johnsen S, de Lusignan S, Smith CP, Bucca G, Penson S, Chope G, Elliott R, et al. Daily supplementation with 15 mug vitamin D2 compared with vitamin D3 to increase wintertime 25-hydroxyvitamin D status in healthy South Asian and white European women: a 12-wk randomized, placebo-controlled food-fortification trial. Am J Clin Nutr 2017.
16. Hamidi M, Boucher BA, Cheung AM, Beyene J, Shah PS. Fruit and vegetable intake and bone health in women aged 45 years and over: a systematic review. Osteoporos Int 2011;22:1681-93.
17. New SA. Intake of fruit and vegetables: implications for bone health. Proc Nutr Soc 2003;62:889-99.
18. Braam LA, Knapen MH, Geusens P, Brouns F, Hamulyak K, Gerichhausen MJ, Vermeer C. Vitamin K1 supplementation retards bone loss in postmenopausal women between 50 and 60 years of age. Calcif Tissue Int 2003;73:21-6.
19. Cheung AM, Tile L, Lee Y, Tomlinson G, Hawker G, Scher J, Hu H, Vieth R, Thompson L, Jamal S, et al. Vitamin K supplementation in postmenopausal women with osteopenia (ECKO trial): a randomized controlled trial.PLoS Med 2008;5:e196.
20. McLean RR, Jacques PF, Selhub J, Fredman L, Tucker KL, Samelson EJ, Kiel DP, Cupples LA, Hannan MT. Plasma B vitamins, homocysteine, and their relation with bone loss and hip fracture in elderly men and women. J Clin Endocrinol Metab 2008;93:2206-12.
21. Gaddini GW, Turner RT, Grant KA, Iwaniec UT. Alcohol: A simple nutrient with complex actions on bone in the adult skeleton. Alcohol Clin Exp Res 2016;40:657-71