The importance of nutrition for musculoskeletal health

Written by: Dr Erin Clarke & Hailey Donnelly                                                                 

Nutrition plays an important role in managing and preventing musculoskeletal conditions, particularly osteoarthritis,  osteoporosis, frailty and sarcopenia. Importantly, while there are many non-modifiable factors that impact musculoskeletal health, diet is a key modifiable risk factor that people can manipulate to help reach their weight and health goals.

Key nutrients that are important to consider for musculoskeletal health include vitamin D, calcium, and protein. Vitamin D and calcium work together to support musculoskeletal health. The primary source of vitamin D is from sunlight, and can be hard to reach recommendations through diet alone. Calcium is readily available in dairy products and can also be found in almonds, tofu and fish with bones. A meta-analysis of observational studies showed that total dairy intake was protective against osteoporosis and hip fractures. While it is known that vitamin D and calcium are important for musculoskeletal health, there are no definitive results that vitamin D or calcium supplementation promote musculoskeletal health, therefore, a food-first approach is recommended.

Dietary protein intake is important for maintaining skeletal muscle structure. Protein is found in meats, fish, dairy products, legumes, nuts and seeds. A recent meta-analysis of 16 randomised controlled trials and 13 cohort studies identified that higher protein intakes, compared to lower protein intakes, resulted in a 16% reduction in hip fractures. Interestingly, there was no significant difference if protein sources were plant or animal-based.

The Mediterranean diet focuses on the inclusion of fruits, vegetables, nuts, wholegrains, legumes, and extra virgin olive oil, and encourages a higher intake of fish and poultry over red meat. A systematic review has shown the Mediterranean diet is beneficial for musculoskeletal health as it reduces hip fracture risk, with olive oil aiding in the prevention of frailty, and fruits and vegetables protecting against frailty, sarcopenia and functional disability. Moreover, high-quality protein from lean meat and fish, promoted in the Mediterranean diet, also aid in the prevention of sarcopenia, frailty and osteoporosis. Whilst the Mediterranean diet has demonstrated effectiveness in the prevention of musculoskeletal conditions, evidence suggests it can also improve bone mineral density, muscle mass, lower extremity function, mobility and walking speed. Therefore, the Mediterranean diet could be considered as a dietary pattern to support musculoskeletal health.

Osteoarthritis, obesity and sarcopenia are pro-inflammatory conditions that affect musculoskeletal health. Diet can play a role in modulating inflammation in the body. Unhealthy diets, i.e. those high in saturated fats, processed foods, sugar and refined grains, have been referred to as a pro-inflammatory diet and shown to be associated with an increased risk of fractures and low bone mineral density. Healthy diets that are rich in fruits, vegetables, wholegrains, lean proteins and unsaturated fat have been shown to have anti-inflammatory effects. Anti-inflammatory diets have been shown to reduce osteoarthritis progression and pain. Although anti-inflammatory diets, such as the Mediterranean diet, have positive effects on muscle mass and function, few studies examined the relationship with sarcopenia; therefore, more evidence is required for the relationship between diet and sarcopenia. While anti-inflammatory diets could be considered, weight loss interventions also show promise in improving inflammation, with research showing small to moderate improvements in pain, disability and weight loss in those with osteoarthritis.

For personalised nutrition advice that can support individuals to prevent and manage their musculoskeletal health, or guidance on appropriate weight management, refer to a dietitian. Find a Dietitian

References:

1. https://pubmed.ncbi.nlm.nih.gov/36278278/
2. https://www.mdpi.com/2673-396X/6/1/10#:~:text=A%20balanced%20diet%20and%20regular,for%20preventing%20falls%20and%20fractures.
3. https://www.tandfonline.com/doi/abs/10.1080/10408398.2019.1590800
4. https://www.mdpi.com/2673-396X/6/1/10#B57-endocrines-06-00010
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10092134/
6. https://pubmed.ncbi.nlm.nih.gov/28686536/
7. Mediterranean diet | Dietitians Australia
8. Nutrition and Physical Activity in Musculoskeletal Health
9. Nutritional strategies to optimise musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein – ScienceDirect
10. Mediterranean Diet and Musculoskeletal-Functional Outcomes in Community-Dwelling Older People: A Systematic Review and Meta-Analysis – ScienceDirect
11. https://www.mdpi.com/2072-6643/15/10/2405
12. https://www.sciencedirect.com/science/article/pii/S216183132200388X
13. https://pubmed.ncbi.nlm.nih.gov/36904104/
14. Effectiveness of Weight-Loss Interventions for Reducing Pain and Disability in People With Common Musculoskeletal Disorders: A Systematic Review With Meta-Analysis | Journal of Orthopaedic & Sports Physical Therapy
15. Find a Dietitian

Bio – Dr Erin Clarke

Dr Erin Clarke is an early career researcher in School of Health Sciences at The University of Newcastle. In addition, she maintains her role as an active clinician as an Accredited Practising Dietitian. She completed her Bachelor of Nutrition and Dietetics (Honours Class I) in 2016 and a PhD in Nutrition and Dietetics in 2021.

Dr Clarke’s research expertise includes dietary assessment, which harnesses technology, dietary biomarkers the relationship between diet quality and health. Her interest areas include the relationship between diet and heart health, diabetes, and chronic health conditions. Since graduating, she has expanded her research to focus more on precision and personalised nutrition, including investigating the interplay between diet and genetics, and the dietary metabolome.

 Bio – Hailey Donnelly

Hailey is a PhD candidate in the School of Health Sciences at The University of Newcastle and is an Accredited Practising Dietitian working in the local community health service. She completed her Bachelor of Nutrition and Dietetics (Honours Class I) in 2021. Hailey’s expertise and interest areas include diabetes, diabetes-related complications and the role of nutrition in prevention and management of chronic disease.