Dear Doctor: What type of diet can help with bone health and improve bone density?

DEAR DR. ROACH: At 57, I slipped on ice and broke my right hip. During my hospital stay, I believe they gave me a Fosamax shot through IV. After surgery, I had a hip and spine bone scan, which showed osteoporosis. My endocrinologist determined I have hypothyroidism. I’m assuming this is what caused the osteoporosis.

My question is, what type of diet should I be eating? Some say keto, while others say gluten-free. Some say vegetarian. I am on 50 mcg of levothyroxine, one tablet a day. I also have very dry skin and constipation. — B.M.B

ANSWER: There are multiple medical causes for osteoporosis, but hypothyroidism (very low thyroid levels, most often caused by an autoimmune destruction of a person’s thyroid gland) is not one of them. However, hyperthyroidism (too much thyroid hormone, which can be caused by a different autoimmune disease) is a cause of osteoporosis.

Dry skin and constipation are common with low thyroid levels, but are nonspecific and may also be found in many people with normal thyroid levels. Your dose of 50 mcg is a very small amount of thyroid supplementation and unlikely to cause excess thyroid blood levels.

Treatment of osteoporosis so severe that it causes a hip fracture usually includes medication, at least initially. However, it could not have been alendronate (Fosamax), because that does not come in intravenous form. A related drug, zoledronic acid (Reclast), is often given for treatment of osteoporosis, as it can be given as infrequently as once a year.

Diet with osteoporosis deserves discussion. One concern is celiac disease, which can be a cause of osteoporosis, and it is appropriate to consider testing for celiac disease in people with compatible symptoms, which can be subtle. A gluten-free diet is essential in people with celiac disease and will likely help the osteoporosis in people with celiac disease.

In people without celiac disease, there is good evidence now that a high intake of fruit, vegetables, low-fat dairy products, whole grains, poultry, fish, nuts and legumes has been demonstrated to have a beneficial effect on bone health and provide improvements in bone density as well as a lower risk of fracture.

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