The Better Bones Blog

by Dr. Susan Brown, PhD.

Mediterranean diet

Is the Mediterranean diet good for bones?

There is an amazing amount of research on the Mediterranean diet and its benefits for health, so naturally I get some questions about whether it’s good for bone health, too.

A brand new meta-analysis suggests that we can emphatically say it’s molto buoni [very good] for bones as well as the rest of the body (Benetou et al., 2018). The study looked at the relationship between adherence to a Mediterranean diet and hip fracture in over 140,000 US and European adults over age 60 (82% of whom were women). It found that those who have moderate to high adherence to a Mediterranean diet had a significant decrease in hip fracture risk compared to those with low adherence.

Mediterranean diet = Alkaline for Life® Diet

This finding is no surprise, because the Mediterranean diet is based on very similar principles as the Alkaline Diet — a focus on alkalizing plant foods and healthy fats, with limits on meat intake and simple carbohydrates. In many ways, the Mediterranean diet is simply one interpretation of Alkaline eating based on foods and meal patterns common to a certain part of the world.

A look at the extensive literature on Mediterranean diet and health highlights just a few important features:

• As a largely plant-based diet, it’s not only an alkaline option, it also offers health-supporting polyphenols that many studies agree are valuable in fighting cancer, inflammation, and oxidative stress — all factors that contribute to poor bone health (Estruch et al. 2013; Medina-Remon et al. 2017; Terra et al. 2009; Anderson & Nieman 2016; Martinez-Gonzalez et al. 2015).

• It contributes to maintenance of healthy weight and — important for bone health — muscle mass. One recent meta-analysis found that older adults who closely follow a Mediterranean diet had a lower risk of becoming frail and were better able to maintain muscle strength, activity, weight and energy levels (Kojima et al., 2018).

• A key component of the Mediterranean diet, olive oil, is associated with increased serum osteocalcin and P1NP concentrations, suggesting a protective effect on bone (Fernandez-Real et al., 2012) — and recent studies found higher consumption of olive oil corresponds to higher bone density (Savanelli et al., 2017).

More benefits to Mediterranean-style eating

It’s pretty clear that the Mediterranean diet is beneficial to bones. So what other health benefits does it offer? Here are just a few:

• The Mediterranean Diet is specifically associated with improvements in blood pressure, insulin sensitivity, lipid profiles, inflammation, oxidative stress, and atherosclerosis (Martinez-Gonzalez et al. 2015).

• Researchers have found repeatedly that those eating a Mediterranean diet experienced about a 30–60% reduction in cardiovascular risk (Estruch et al. 2013; Bonaccio et al., 2017; Carlos et al. 2018).

• Individuals following the Mediterranean diet experienced half as much age-related brain shrinkage as those who did not (Luciano et al. 2017).

• A recent study of over 22,000 Spanish men and women noted benefits in terms of type 2 diabetes, weight gain, metabolic syndrome, depression, cognitive decline, and nephrolithiasis (Carlos et al., 2018).

So if you’ve been wondering if infusing your alkaline diet with more Mediterranean flavor and flair would help you support your bone health, wonder no more — it will do that and more!

woman walking in nature

Walking on Earth

“The foot feels the foot when it feels the ground.” – The Buddha

Now that winter is finally over — after what seems like forever — more and more of us are getting outside and being active. It’s a time that I like to go for walks to watch the world wake up from its long sleep.

Walking is one of the most useful exercises we have because it offers us so many key health benefits, as enumerated by many, many studies:

  • Even one hour a week walking at the average pace reduce hip fracture risk by 6% in postmenopausal women, while walking for at least four hours a week was associated with a 41% lower risk of fracture (Feskanich et al., 2002)
  • Walking reduces the tendency to high blood pressure, the risk of blood clots and stroke, and multiple cardiovascular risk factors (Murtagh et al., 2015).
  • In older adults, walking more correlates to lower risk of depression and greater quality of life (Arrieta et al., 2018).
  • Brisk walking improves oxygen uptake and cardiovascular fitness as well as muscle tone—while alkalizing the body.

But I would argue that simply hopping on a treadmill for 10–15 minutes every other day, while it gathers all those benefits and more, somewhat misses the point. Walking outdoors gives us a chance to reconnect with the world around us — ideally in a soothing natural environment like a park or trail, or at the very least a tree-lined sidewalk. (Interestingly — and something that resonates with the Earth Day anniversary coming up — research shows that people who walk in parks tend to get more benefits due to less interruptions in walking from traffic or other hazards they must negotiate [Sellers et al., 2012]).

When we walk outside, we can enjoy the breeze, the rain, the sun, the leaves — all that the world has to offer.  And it reconnects us to ourselves in a very useful way: Walking upright on two legs is the trait that defines the human lineage. Even though we’ve become used to sitting more than standing nowadays, regular walking on two legs is considered a uniquely human trait. Taking the time to walk — to put our feet on the ground and feel them, as the Buddhist saying goes — can offer us a type of internal realignment that very few other exercise methods provide.

As we approach Earth Day, we have the opportunity to celebrate all the positives that walking offers us. If you can, take that opportunity in a park or garden path; let your feet touch the ground, mindful of all the good things walking in the open air can bring you.

But if you can’t, no worries! No matter how you like to do it—in groups, by yourself, fast or slow, listening to music or meditating—just walk. Do it on a regular basis. Do it 30 minutes a day, and your bones and entire body will thrive.


Arrieta H, Rezola-Pardo C, Echevarria I, et al. Physical activity and fitness are associated with verbal memory, quality of life and depression among nursing home residents: preliminary data of a randomized controlled trial. BMC Geriatr. 2018 Mar 27;18(1):80. doi: 10.1186/s12877-018-0770-y.

Feskanich D1, Willett W, Colditz G. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA. 2002 Nov 13;288(18):2300-2306.

Murtagh EM, Nichols L, Mohammed MA, et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015 Mar;72:34-43.

Sellers CE, Grant  PM, Ryan CG, et al. Take a walk in the park? A cross-over pilot trial comparing brisk walking in two different environments: park and urban. Prev Med. 2012 Nov;55(5):438-43.


Bisphosphonates make bones weaker, not stronger

I’ve argued for years that bisphosphonates — the knee-jerk bone drugs  recommended for those with osteoporosis regardless of their actual fracture risk — quite often offer no benefit to those who are prescribed them, and for many, do more harm than good. That’s why I was alarmed, but not surprised, by a recent study that found bisphosphonate drugs may be leaving bones weaker — not stronger — at the microscopic level (Ma et al, 2017).

In the study, researchers obtained samples of trabecular bone from three groups of subjects: (1) normal, healthy older adults who had no fractures, (2) individuals who had fractured a bone after at least 1 year of treatment with bisphosphonates, and (3) individuals who’d had fractures but were not being treated for osteoporosis.

They first examined the bones’ microstructure and identified areas of osteoclast activity (“perforations”) versus microscopic fractures (“microcracks”). Then they subjected each sample to load-controlled tensile testing to determine how much strain the bone could withstand.

The results were revealing. The first group (no fractures) had the least amount of either perforations or microcracks. Both the second (untreated with fractures) and third (bisphosphonate-treated with fractures) groups had roughly equivalent amounts of perforations and microcracks. But the big difference was the volume of perforations versus microcracks: the untreated group had a significantly higher volume of perforations while the bisphosphonate group showed a significantly higher volume of microcracks.

Bisphosphonates and bone fracture risk

I’ve always maintained that the greatest issue when it comes to bone health isn’t thin bones — it’s weak ones. In healthy bone, microfractures stimulate bone turnover, which ultimately renews bone and makes it stronger — unless the activity of bone-building osteoblasts is outstripped by bone-removing osteoclasts.

It’s pretty clear that the untreated patients who’d had fractures were undergoing high bone turnover — that’s why they had more (and larger) osteoclastic perforations. But bisphosphonates-treated group had significantly larger microcracks — which suggests that in the bisphosphonate group, either the bone is much less resilient and more prone to cracking under strain than normal bone, or the usual repair mechanisms aren’t working up to standard. Or both at the same time!

More to the point, it suggests that people treated with bisphosphonates have bones that are significantly weaker and more prone to fracture than either healthy people or people with high bone turnover.

The tensile strength testing performed on all three groups’ samples confirmed this: Where the normal group had a tensile strength (measured in megapascals) of 1.62 MPa, the untreated fracture group’s tensile strength was decreased by about 47% (to 0.86 MPa) — and the bisphosphonate group’s tensile strength was an astonishing 64% (0.58 MPa) below the normal group’s level.

This means that people treated with bisphosphonates have much weaker bones than even people at high risk of fracture due to high bone turnover!

If using bisphosphonates leaves patients with slightly denser but significantly weaker bones, increasing the likelihood of a catastrophic fracture (never mind the other side effects). So all this leaves us asking, “What exactly is their benefit?


Ma S, Goh EL, Jin A, et al. Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties. Sci Rep 2017;7:43399; DOI: 10.1038/srep43399.

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