Osteoporosis (literally “porous bones”) is a serious problem for our elderly, primarily because of the increased risk of fracture. Osteoporosis-related fractures are more common than heart attack, stroke and breast cancer combined.

It is commonly assumed that osteoporosis is caused by a deficiency of calcium, because calcium is the primary mineral in our bones. Modern medical advice recommends getting a lot of calcium, both as supplements and in the diet, along with vitamin D.

There is a problem with that advice, however. It turns out that there is no connection between osteoporosis and the amount of calcium in a person’s diet. In fact, some research suggests just the opposite — that cultures whose diets are rich in calcium have more osteoporosis than those whose diets have less.

What is going on here? How could a diet with plenty of calcium contribute to osteoporosis?

It turns out the theory that low dietary calcium leads to osteoporosis is too simplistic. The problem isn’t calcium, it’s the overall quality of the diet. Bones are made of far more than calcium; there are other minerals, especially potassium, and a protein matrix that helps hold everything together. To focus only on the calcium content of bone is like saying the only part of a house you need to be concerned about is the wood. Of course, there are nails that hold the house together, plumbing, wiring, etc., that are all necessary parts of the structure.

We now know that osteoporosis is one of the many “diseases of civilization” such as cancer, high blood pressure, type 2 diabetes and obesity. These diseases are common in “civilized” cultures but uncommon in pre-industrial or native ones. There is no one nutritional problem with the “civilized” diet, but the combination of overly processed foods, increased carbohydrate intake, and reduced amounts of whole, intact food is likely the culprit. While our civilized diets happen to be higher in calcium, especially from grains and dairy products, this increased calcium is not enough to make up for the overall low quality of the diet.

For example, researchers have known that increased soda consumption is associated with fracture risk in women. If there is anything we eat that qualifies as a “nonfood,” it’s soda. Soda simply does not exist in native societies.

The most surprising dietary recommendation to prevent osteoporosis is to eat more fruits and vegetables, especially raw or lightly cooked. (Vegetable juices do not count, as they are highly processed.) Studies have shown that women who eat more of them tend to have less osteoporosis. We don’t think of produce as a good source of calcium for bone building, but elephants are able to make a much larger skeleton, all built exclusively from fruit, veggies and grass. In their whole, unprocessed state, fruits and vegetables have not only calcium, but also all the other nutrients you need to build strong bones.

USDA statistics about the American diet show that from 1900 to 1980, fresh fruit and vegetable consumption dropped from about 40 percent of the diet to less than 5 percent. While we ate less citrus fruit, our consumption of fruit juice jumped 2,500 percent. Just in the 20 years between 1960 and 1980, soft drink consumption increased 300 percent; they estimate each American consumes 38 gallons of soft drinks annually. (Someone is clearly getting my share. I no longer drink the stuff.)

Some nutritionists blame increased protein consumption, especially meat products, for higher levels of osteoporosis in developed societies. It is true that beef consumption in the U.S. has gone up an estimated 75 percent since 1900. However, there have been native cultures that ate almost exclusively meat and animal products that were largely free of these diseases of civilization, including osteoporosis. This includes some of the Native American tribes, especially in the West, as well as African tribes and Inuit (also known as the Eskimos.)

The research is mixed on calcium supplements, with some studies showing benefit and others showing side effects such as increased risk of heart attack and stroke. These side effects are probably due to the fact that our bodies are not designed to get our nutrients in a highly refined form, but rather as a part of our whole, intact foods.

It turns out the diet to prevent osteoporosis is the same diet to prevent diabetes, heart disease, cancer and all the diseases of civilization. First and foremost, consume less processed food of all types. This includes the obvious examples such as soda, chips, sugar and white flour, but also includes factory-farmed meats, genetically modified foods, reduced-fat foods, etc. Do your shopping at the farmers market as much as you can. Avoid prepared foods, especially prepared whole meals. As always, increase vegetable consumption.

In my years of reviewing my patients’ diets, I have yet to see a patient who ate too many vegetables.

Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.