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While diet is important for all-around good health, it is especially important for individuals with osteoporosis, and even more so for those recovering from osteoporotic fragility fractures.

Several nutrients are pivotal for bone density, and people with osteoporosis should be sure to include adequate amounts in their diet. Some osteoporosis patients may also benefit from supplements. A consultation with a registered dietitian is advisable to assess your individual dietary and supplement needs.

Calcium is the major structural component of bone, providing strength and structure. Although calcium is present in many foods and is the body's most abundant mineral, it is easily excreted in the urine and needs replenishing. Calcium is also difficult to break down and absorb in the gut.

Enter vitamin D: this crucial fat-soluble vitamin substantially boosts the efficiency of calcium absorption; without it, the amount of calcium absorbed is reduced.

Key bone-friendly nutrients include the following:

Calcium

Abundant in dairy products such as milk, yogurt, kefir, cheese (especially the hard type), this mineral is also present in calcium-fortified products such as tofu, cereals, juices, and soy and almond beverages. Canned sardines and salmon (bones in) are also good sources of calcium.

Other dietary sources include papaya and oranges, Brazil nuts and almonds, and sesame and sunflower seeds. Legumes such as beans and black-eyed peas deliver calcium, and other good sources are dark leafy greens such as kale, broccoli, and bok choy. The calcium in spinach, however, is poorly absorbed, since it is bound to a compound called oxalic acid, which is also present in rhubarb, beet greens, and some dried beans.

Even popping an over-the counter antacid can deliver a fast 500 mg of calcium. The general recommendation for calcium intake is 1,000 mg/day for men ages 51-70 or 1,200 mg/day for women 51 and older and men 71 and older. Most experts recommend dietary sources over routine use of supplements.

Vitamin D

This vitamin is crucial for the absorption of bone-building calcium and phosphorus. Vitamin D is made in the skin from exposure to ultraviolet (UV) light from the sun. Darker skin pigment, sunscreen, and older skin limit vitamin D production from sunlight. Vitamin D2 (ergocalciferol) is found in plants, fungi, and yeast; vitamin D3 (cholecalciferol) comes from animal sources. Furthermore, people living in northern regions with long dark winters generally do not get enough annual sunlight exposure to manufacture enough vitamin D, which is produced by a cholesterol-like substance in the skin upon contact with the UV rays of the sun. The widespread use of sunscreens and protective skin covering to lower the risk of skin cancer compounds the problem.

Vitamin D is added to commercial cow's milk and some fortified plant-based beverages. Look for it on nutrition labels. Fatty fish such as tuna, salmon, mackerel, herring, and sardines contain vitamin D, as do cod liver oil, eggs, and beef liver.

Recommendations from various organizations for vitamin D intake range from 600 to 1,000 international units (IU) a day for adults. Some experts, however, recommend 2,000 IU a day for all adults and especially osteoporosis patients.

A safe upper limit for vitamin D has been determined as 4,000 IU/day for most adults. Since it is often difficult to get enough vitamin D from diet alone, osteoporosis patients should have their vitamin D levels tested to see if supplementation may be needed.

Vitamins K1 and K2

Vitamin K, which has two types, is also good for bones, especially vitamin K2. A diet rich in leafy greens and some vegetable oils will deliver vitamin K1. Sources of vitamin K2 are chicken breast and chicken liver, aged blue cheese, and egg yolk, as well as fermented foods such as kefir, sauerkraut, and kimchi.

Some research suggests that supplements of vitamin K2 may be beneficial to bone. The exact benefits and risks have not yet been definitively assessed.

Protein

Protein is essential for building bone and healing fracture and is widely present in animal and plant foods. Yet the diets of many Americans -- even those who seem healthy or are overweight -- are protein-deficient.

A registered dietitian can assess the dietary protein intake of osteoporosis patients and help adjust their diets accordingly. Good sources of protein are lean meats, fish, lower-fat dairy products, eggs, whole grains, and legumes such as lentils and beans.

Substances to Avoid

People with osteoporosis should avoid excess amounts of the following:

• Alcohol: Alcohol is harmful to bone cells and can increase the excretion of calcium in the urine and promote bone loss.

• Sodium: Foods high in salt can increase calcium excretion and lead to bone loss. People with osteoporosis, therefore, should limit high-sodium foods such as canned, processed, and convenience foods and salty snacks – and use the salt shaker sparingly. They should read labels carefully and aim to keep sodium intake to no more than 2,300 mg a day.

• Caffeine: While the negative impact of caffeine on calcium absorption and retention is unclear -- especially if a person is eating a diet with adequate calcium -- it's probably best to consume caffeine in moderation by limiting intake of coffee, tea, and colas.

• Phosphorus: Colas and other soft drinks and some processed foods may also contain added phosphorus or phosphoric acid. This mineral is an important component of bone but may contribute to bone loss if consumed excessively. A buildup of phosphorus can reduce the amount of calcium in the blood. Some experts believe the real problem with such beverages is that they replace more nutritious calcium-rich alternatives such as milk and fortified juices. Fortunately, the calcium loss associated with these drinks can be counterbalanced by adequate calcium in the diet. A latte may be a way to get your caffeine but offset it with a good dose of calcium.

Further information about nutrition, diet, and osteoporosis, is available from the .

Read previous installments in this series:

For Your Patients: Osteoporosis -- the 'Silent Thief'

For Your Patients: What to Know About Osteoporosis Diagnosis and Treatment

For Your Patients: Osteoporosis and Fractures

For Your Patients: Men Get Osteoporosis, Too

For Your Patients: Medical Conditions That Raise Your Risk of Osteoporosis

For Your Patients: Talking to Your Doctor About Osteoporosis

For Your Patients: What to Know About Osteoporosis and Oral/Dental Health

For Your Patients: Exercising With Osteoporosis

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.