Diet and bone health – current concerns

Ms Elaine McGowan, CORU Registered Dietitian, Hermitage Medical Clinic, Dublin, gave a presentation on nutrition and bone health at the Irish Osteoporosis Society (IOS) 2025 Annual Medical Conference for Health Professionals.

Ms McGowan raised concern about the ongoing increase in referrals to her clinic of people on GLP-1 agonists, particularly tirzepatide, who have experienced significant muscle loss and are at risk of osteoporosis following rapid weight loss and inadequate calcium and protein intake while on these drugs.

She also outlined the risks to bone health of those who adopt poorly planned vegan diets, particularly during the crucial bone formation teenage years and who do not consume sufficient calcium, vitamin D, and protein.“Encourage your patient to consume protein with every meal to prevent sarcopaenia,” Ms McGowan stated, adding that the rise in plant-based milk is a particular concern in relation to calcium intake.

“Many people choose plant-based milks thinking they are the same as cow’s milk nutritionally. This is not the case,” Ms McGowan pointed out. “Plant-based milks often contain less protein and micronutrients compared to cow’s milk. It is important for your patients to study the nutritional content of the milks they choose.”

Ms McGowan also noted magnesium’s crucial role in bone health. International guidance recommends 300mg/day for men and 270mg/day for women, she said. “This can easily be met with a healthy diet. If magnesium supplementation is needed, no osteoporosis guideline specifies one form of magnesium as superior.”

Regarding vitamin D intake, Ms McGowan said that healthy children and adults aged one to 65 years with fair skin living in Ireland should take a vitamin D supplement from October to March. Those of darker-skinned ethnicity or those who are pregnant living in Ireland need to take a vitamin D supplement throughout the year, she added.

IOS President Prof Moira O’Brien recommends her patients to have a vitamin D level of minimum 70nmol/L, maximum 125nmol/L. She said that some patients require a higher level of vitamin D in order to keep their parathyroid normal.

She also mentioned that cortisol levels should be checked, as high stress levels can negatively affect vitamin D formation, and that lack of sleep and dehydration are other important contributors to bone loss and falls risk.

Also speaking during this session was Ms Aoife Ní Eochaidh, Chartered Physiotherapist and Clinical Specialist in Pelvic Women’s and Men’s Health Physiotherapy, IPPM, Bon Secours Consultants’ Clinic, Galway and Dublin.

She highlighted how common incontinence issues are, and the importance of pelvic floor exercises. Ms Ní Eochaidh reminded clinicians to ask their patients about continence issues, as some may feel too embarrassed to raise it or feel like there is nothing that can be done.

However, positive results can be achieved with a structured physiotherapy programme for most people. Pelvic floor training also leads to significant improvement in faecal incontinence, constipation, pelvic organ prolapse, and sexual dysfunction, and erectile dysfunction in men, she explained.