A bone fracture is a medical condition characterized by a break in the continuity of the bone. This can result from a high-force impact or stress, or from a trivial injury due to medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta. Nutrition is one factor that can affect how quickly a broken bone heals. Dietary intake also plays a significant role in protecting the skeleton by maintaining healthy tissues to cushion the force of a fall. Each stage of the fracture healing process brings increased nutritional demands. The foods you eat play a surprisingly important role in bone health.
Understanding Bone Health and Healing
Bones are living tissues that constantly grow and change throughout our lives. They provide our body shape, protect our internal organs, and help us perform every movement we make every day. Bone is living tissue that your body constantly builds up and breaks down. Bones are made of minerals, most notably calcium and phosphorous. Nearly all the calcium and phosphorous in the food you eat ends up in your bones. It's normal for bone to break down and rebuild itself in a continuous process called remodeling. Our bone mass reaches its peak when we're around age 30, and it remains steady for about the next two decades. But after menopause, we lose bone more quickly than our bodies can replace it.
Two types of cells maintain your bones: Osteoblasts build bone, and osteoclasts break down bone. “Breaking down bone might sound bad, but it’s necessary,”. Bones are just like any other body part,” explains registered dietitian Julia Zumpano, RD, LD. “We grow, build and support our bones with the food we eat. And we can damage them by the food we eat. It can certainly go both ways.”
Key Nutrients for Bone Fracture Healing
Several nutrients are essential for bone health, including calcium, vitamin D, vitamin K, magnesium, vitamin C, omega-3 fatty acids, protein, zinc, iron, and potassium. Some are bigger hitters than others, but really maximizing all of your nutrients is important. These vitamins and minerals work together to help protect your bones.
Calcium
Calcium is one of the main bone-forming minerals, and an appropriate supply to the bone is essential at all stages of life. Since calcium is the primary mineral in the composition of human bone, it plays a central role in recovery from bone fractures or other bone injuries. It supports bone growth and integrity. Calcium is the primary mineral component of bones, providing strength and structure. It also plays a crucial role in muscle function and nerve transmission, while also helping release hormones. Adults need 700mg of calcium a day. The National Academy of Medicine recommends 1,000 mg daily for women 50 and under and 1,200 mg each day for women 51 and older.
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Good sources of calcium include dairy products such as milk, cheese, and yogurt; almonds; green leafy vegetables, pulses, and soy products; and cruciferous vegetables, including broccoli, kale, collard and mustard, and turnip greens. Vegans can obtain calcium from fortified soya, rice, and oat drinks; soybeans; 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; and green leafy vegetables such as kale, cabbage, and broccoli. The average calcium content in several foods is shown in Table 1. The absorption of calcium is about 30%. Calcium is derived from dairy and fortified foods (e.g., orange juice, tofu, and soy milk) and is nearly twice as high from certain green vegetables (bok choy, broccoli, and kale). The absorption of calcium is generally increased, when calcium is well solubilized and is inhibited in the presence of agents that bind calcium or form insoluble calcium salts.
Vitamin D
Vitamin D plays an important role in drawing calcium from your blood into the bones. Without adequate doses of vitamin D, dietary calcium can have difficulty finding its way into the bones that need the mineral to heal. It helps absorb calcium into your body and maintains a balance of calcium and phosphate levels in your blood. Vitamin D also regulates bone remodeling, where old bone is replaced by new bone tissue. This is why vitamin D deficiency can lead to weakened bones and increase your risk of fractures. Adults need 10 micrograms (400 International Units or IU) of vitamin D a day. It's difficult to get all the vitamin D we need from our diet, and we get most of our vitamin D from the action of the sun on our skin.
From late March or early April to the end of September, you can make vitamin D from sunlight by having short daily periods of sun exposure without sunscreen. However, everyone should consider taking a daily vitamin D supplement during the autumn and winter when we cannot make vitamin D from sunlight. Some groups of the population are at greater risk of not getting enough vitamin D, and the Department of Health and Social Care recommends that these people should take a daily 10 microgram (400IU) vitamin D supplement all year round. The vegan diet contains little, if any, vitamin D without fortified foods or supplements, but, for everyone, sunlight on the skin in spring and summer is the main source of vitamin D.
Good food sources of vitamin D include oily fish, such as salmon, sardines, and mackerel; egg yolks; and fortified foods, such as some fat spreads and breakfast cereals. Optimal bioavailability of calcium is achieved through concomitant intake of vitamin D. The administration of calcium and vitamin D supplements in later life helps reduce fractures [1]. Vitamin D deficiency decreases calcium absorption from the intestinal tract and the kidneys, increases parathyroid hormone (PTH) concentration, and leads to osteolysis, which over time may lead to fracture [11].
Vitamin K
Vitamin K is necessary for the synthesis of osteocalcin, a protein that helps strengthen bones. It is a key player in strengthening osteocalcin, a protein component of bone, without increasing the mineral density of bone. It helps activate a protein that binds with calcium to build strong bones and improve bone density. Vitamin K exists in various foods but in small quantities with the exception of leafy vegetables that have dark green color.
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Vitamin C
Vitamin C helps with the synthesis of collagen, a protein that forms the structure of bones, cartilage, and connective tissues. Think of collagen as the part of your bones that keeps them flexible, not just strong. A key player in the production of collagen is essential to bone healing. A good amount of vitamin C can also go a long way in helping your bone health. Specifically, vitamin C helps with the synthesis of collagen, a protein that forms the structure of bones, cartilage and connective tissues. Think of collagen as the part of your bones that keeps them flexible, not just strong.
Magnesium
Magnesium is an important nutrient that improves bone stiffness and increases osteoblasts (cells responsible for bone formation) and osteoclasts (cells responsible for removing old and damaged bones). It also helps maintain bone density and strength. Magnesium is essential for the absorption of Vitamin D.
Omega-3 Fatty Acids
Omega-3 fatty acids have anti-inflammatory properties and may help reduce the risk of osteoporosis by promoting bone formation and preventing bone decay.
Protein
Dietary protein will increase muscle mass and calcium absorption and suppress parathyroid hormone. Protein is needed to heal wounds, repair broken bones, build healthy blood cells, keep your immune system strong, and support muscle protein growth and strength. You should aim to eat 1 to 1.2 grams of protein per kilogram body weight.
Zinc
Zinc is required for normal skeletal growth. It also promotes bone regeneration. Zinc is a cofactor for many metalloproteins involved in bone development. Incompetence during the period of growth can cause a reduction of peak bone density [18].
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Iron
You need iron to make collagen to rebuild your bones. It also helps your bones heal by getting oxygen into them. Iron helps your body make collagen to rebuild bone. It also plays a part in getting oxygen into your bones to help them heal. If you have iron-deficiency anemia -- when you don't have enough healthy red blood cells -- you may heal more slowly after a fracture.
Potassium
You won't lose as much calcium when you pee if you consume enough potassium in your diet.
Foods to Incorporate for Bone Fracture Healing
Adopting a balanced diet, rich in nutrients, minerals, and vitamins, can contribute significantly to bone health. A healthy diet contains vegetables, fruits, lean protein and water.
Dairy Products
Dairy products are a go-to option for bone health. Because dairy is abundant in nutrients like calcium and vitamin D, you’re strengthening your bones with every spoonful of yogurt or sip of milk. This includes foods like cottage cheese, yogurt, cheese, and milk. If you don’t tolerate the lactose in dairy products, consider lactose-free varieties or choose plant-based fortified dairy alternatives.
Fruits and Vegetables
If it’s green and leafy, your bones will probably love it. Leafy vegetables are a rich source of calcium, magnesium and vitamin K. In addition, fruit can help by supporting collagen production, which can help keep bones strong. Especially those with tons of vitamin C like oranges, lemons, grapefruit, red bell peppers, and strawberries. Some of the nutrients contained in fruits and vegetables such as potassium, magnesium, iron, and zinc have been associated with increased bone density in premenopausal women and in the elderly of both genders as well as with the reduction of bone loss in elderly men [28]. Also, a number of other nutrients such as vitamin C and niacin have been associated with increased bone density in the forearm region in postmenopausal women, while components such as proteins, phosphorus, and folic acid have been associated with reduction of postmenopausal bone loss.
Fatty Fish
Vitamin D is abundantly found in fish. Studies have also shown that fish can help strengthen bone quality and possibly prevent bone decay. But you’ll want to focus more on cold-water fish. This includes fish like salmon, mackerel, herring, sardines, tuna and trout. Fish is also a phenomenal source of protein, as well as vitamin D. So, you’re getting both benefits. Fish with dark flesh, such as salmon, sardines, swordfish, and mackerel, are a rich source of vitamin D and are recommended as a safe way to increase the intake of vitamin D and reduce the risk of hip fracture [26]. In addition, fish are also a rich source of calcium (particularly the grinding of the fish product which contains bones) and omega-3 fatty acids such as eicosapentaenoic (EPA: 20 : 5, omega-3) and docosahexaenoic (DHA: 22 : 6, omega-3). In particular fish with dark flesh contain about 2.5 grams of EPA and DHA per 100 grams [27].
Nuts and Seeds
They’re small but they make a big impact. When it comes to bone health, many nuts and seeds provide calcium, magnesium and even a good dose of healthy fats. Some of the best nuts to eat for bone health include almonds, sesame seeds, sunflower seeds, pistachios, and chia seeds. Nuts can be a great healthy snack or a perfect topping for a salad, soup or even dessert.
Tofu and Soy Products
Soy products are rich in calcium and protein, making them beneficial for bone health, especially if you’re following a plant-based or non-dairy diet. Soy products you can work into your diet include tofu, edamame, or boiled soybeans, soy milk, tempeh, and natto, or fermented soybeans.
Prunes
The study, published in the October 2022 issue of The American Journal of Clinical Nutrition, found that eating five or six prunes a day helped women past menopause to preserve bone mineral density in their hips, which could translate to fewer bone breaks. After menopause, women tend to lose bone density quickly and are far more likely than men to develop bone-weakening osteoporosis.
Canned Salmon
A 3-ounce serving has 180 mg of calcium. It's so rich in the mineral because canned salmon includes tiny, soft bones that you likely won't even notice.
Plant Milks
Milk made from almonds, rice, or soy is typically fortified to reach a calcium level similar to its dairy counterpart: 8 ounces contains 350 to 400 mg.
White Canned Beans
Each cup of these soup- and chili-enriching legumes - which encompass navy, cannellini, great northern, and lima beans - contains about 190 mg of calcium. Beans are a smart source of protein as well.
Foods to Avoid During Bone Fracture Healing
Just like certain foods promote bone healing, some hinder it. These foods, known as bone robbers, hinder your body's ability to absorb calcium and vitamins. In some cases, they may cause your body to pull nutrients from the bones.
High Sodium Foods
Excessive sodium intake can increase the amount of calcium you remove from your body through waste, which may lead to bone loss over time. High salt intakes affect calcium metabolism and are, therefore, it is recommended to avoid foods with a high salt content e.g. salted chips, packet soups, Pickles, Processed and packaged foods, Ketchups, sauces, etc. Processed foods, canned soups, fast food and salty snacks are common sources of high sodium. It’s important to limit how much salt you consume and opt for low-sodium alternatives.
Sugar
A diet high in sugar has been shown to increase inflammation and insulin, reduce calcium intake, and increase urinary excretion of calcium and magnesium. Avoid sugar-sweetened beverages, specifically soda with phosphoric acid, which can produce an imbalance of phosphorus compared to calcium. Soda intake has been correlated with increased risk of bone fractures.
Caffeine
High intake of caffeine, found in coffee, tea, energy drinks and some sodas, may expel calcium quicker from your body, which can affect bone density (especially if you don’t consume a lot of calcium to begin with). While moderate caffeine consumption is generally considered safe, excessive intake should be avoided. Calcium excretion via the urine is accelerated by consuming caffeinated beverages, such as coffee, cola, and tea.
Alcohol
Excessive alcohol consumption can interfere with calcium absorption and disrupt the balance of hormones involved in bone health. Chronic heavy drinking can lead to decreased bone density and increase the risk of fractures. If you choose to drink alcohol, try to do so in moderation, following recommended guidelines. It is best to abstain from alcohol while healing a broken bone. Patients, who smoke, have a much longer average time to healing.
Foods High in Vitamin A
Some research has suggested a link between too much vitamin A and an increased risk of bone fractures.
Other Considerations for Bone Health
Bone Density Testing
Osteoporosis, a disease in which bones become weak and brittle, strikes four times as many older women as men, a disparity due in part to our loss of bone-protecting estrogen after menopause. One weapon can stave off that painful scenario, however: bone density testing. The x-ray technology, known as a DEXA scan, measures the density of calcium and other minerals in bones. It can detect osteoporosis before a dangerous fracture happens. Bone density testing is recommended for all women starting at age 65 and every two years thereafter.
Supplements
Assess your nutrition first. But don't go overboard. Strong evidence suggests women taking calcium-vitamin D combination supplements have a higher risk of developing kidney stones. Also, be wary of other supplements that claim to have bone benefits. It's much better to get the nutrition you need from your plate, not from a pill. If you don't get enough sun exposure to produce the vitamin D they need, so this is one exception where you may need a supplement.