Visual representation of Osteoporosis and osteopenia nutrition- Medical nutrition therapy and how treatment can support bone density

Osteoporosis

Expert Osteoporosis & Osteopenia Dietitian in Melbourne

Protect your physical independence, maintain your active lifestyle, and strengthen your skeletal system with proactive, evidence-based medical nutrition therapy.

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What is Osteoporosis/Osteopenia?

Think of your bones as a constantly remodeling bank account. Your body is perpetually depositing new bone tissue and withdrawing old bone tissue. In your younger years, you deposit more than you withdraw, building a dense, strong structural “scaffolding.”

As we age, this process flips. We begin withdrawing more bone than we deposit.

As we age, this process flips. We begin withdrawing more bone than we deposit.

  • Osteopenia is the early warning stage. Your bone mineral density is lower than normal, but not yet severe enough to be classified as disease. It is the yellow traffic light.

 

  • Osteoporosis (literally meaning “porous bone”) occurs when bone density drops so low that the internal honeycomb structure of your bones develops large holes.
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Infographic with visual demonstration if different stages of bone mineral density loss and increasing in bone pore size from normal bone to severe osteoporosis. Osteoporosis is rarely caused by a single factor. It is usually the result of a compounding mix of hormonal changes, lifestyle habits, and nutritional gaps over several decades: The Menopause Transition: Estrogen is highly protective of bone mass. When estrogen levels rapidly drop during perimenopause and menopause, women experience a sharp, accelerated phase of bone loss. Chronic Under-fueling: Consistently eating too few calories or protein (common in chronic dieting or endurance athletes) starves the body of the building blocks it needs to repair bone. Lack of Mechanical Loading: Bones respond to physical stress. A lack of heavy resistance training or weight-bearing exercise tells your body that it doesn't "need" dense bones. Nutritional Deficiencies: A long-term lack of bioavailable Calcium, Vitamin D, and Magnesium severely impairs bone mineralization. Medications: Long-term use of certain medications, particularly corticosteroids (like prednisone) or some reflux medications (PPIs), can actively interfere with calcium absorption and bone rebuilding.a href=httpswww.freepik.comfree-vectorstages-osteoposis-vector_40859770.htm#fromView=search&page=1&position=1&uuid=ec479b5b-b68e-4253-b00d-90b907e676fa&query=osteoporosisImage by brgfx on Freepika

The bone becomes brittle, fragile, and highly susceptible to breaking from a minor bump or fall that a healthy bone would easily withstand.

What causes osteoporosis?

Osteoporosis is rarely caused by a single factor. It is usually the result of a compounding mix of hormonal changes, lifestyle habits, and nutritional gaps over several decades:

  • The Menopause Transition: Estrogen is highly protective of bone mass. When estrogen levels rapidly drop during perimenopause and menopause, women experience a sharp, accelerated phase of bone loss.

 

  • Chronic Under-fueling: Consistently eating too few calories or protein (common in chronic dieting or endurance athletes) starves the body of the building blocks it needs to repair bone.

 

  • Lack of Mechanical Loading: Bones respond to physical stress. A lack of heavy resistance training or weight-bearing exercise tells your body that it doesn’t “need” dense bones.

 

  • Nutritional Deficiencies: A long-term lack of bioavailable Calcium, Vitamin D, and Magnesium severely impairs bone mineralisation.

 

  • Medications: Long-term use of certain medications, particularly corticosteroids (like prednisone) or some reflux medications (PPIs), can actively interfere with calcium absorption and bone rebuilding.

Anatomy of pelvic skeleton and lower spice where osteoprorosis can often occur. Image by DC Studio on Freepik

What we can do

How is osteoporosis diagnosed?

Osteoporosis is diagnosed using a DEXA (Dual-Energy X-ray Absorptiometry) scan, which measures your Bone Mineral Density (BMD). The machine compares your bone density to that of a healthy 30-year-old and gives you a T-score.

  • A T-score between +1 and -1 is normal.

  • A T-score between -1 and -2.5 indicates Osteopenia.

  • A T-score of -2.5 or lower indicates Osteoporosis.

Common Diagnostic Mistakes:

Waiting for a fracture: The biggest mistake is assuming your bones are fine because they don’t hurt. Osteoporosis is silent. By the time a bone breaks, the disease is already highly advanced.

Confusing it with Osteoarthritis: Osteoarthritis is the wear-and-tear or damage to your joints (cartilage). Osteoporosis is the thinning of your bones. They are completely different conditions requiring different nutritional interventions.

Ignoring the Z-score: While the T-score compares you to a 30-year-old, the Z-score compares you to people your own age. If your Z-score is unusually low, it tells your doctor that something else (like undiagnosed Coeliac disease or a thyroid issue) might be actively stealing your bone density.

How common is osteoporosis?

Osteoporosis is incredibly common.

Over 1 million Australians are currently living with osteoporosis, and millions more have osteopenia. For people over the age of 50, it is estimated that 1 in 2 women and 1 in 4 men will experience an osteoporotic fracture in their lifetime.

At REAL Health & Nutrition, we view protecting your bone density as the ultimate key to “healthspan”, ensuring your later years are spent active and independent, not recovering in a hospital bed from a preventable hip fracture.

Tragically, up to 30% of older adults do not survive the first year following a hip (NOF) fracture, and long-term clinical data reveals that approximately 40% to 60% of patients will not survive past five years. – Tarallo, C., et al. (2024)

This stark reality makes proactive bone density protection a literal matter of life and death, rather than just an unavoidable part of aging

How is osteoporosis treated? (The REAL Nutrition Approach)

Most people assume osteoporosis treatment just means taking a calcium pill. This is an outdated and incomplete approach. Your bones are a complex matrix of protein and minerals.

Here is how our Accredited Practising Dietitians target bone health:

1. The Protein Matrix Optimisation

Nutrient dense protein foods to optimise protein intake, bone density, muscle mass and falls risk

Calcium gets all the attention, but your bone is roughly 50% protein by volume! If you do not eat enough high-quality protein, your body cannot build the flexible collagen matrix that calcium attaches to.

We ensure your diet hits optimal protein targets (often much higher than the standard baseline recommendations) to support both bone and muscle mass.

2. Bioavailable Calcium Strategies

Sources of dietary calcium, milk, cheese, egg shells, sardines, dairy products, nuts, dark leafy greens, fortified plant based milks. Image by freepik

You cannot build a brick wall without bricks.

We audit your diet to ensure you are getting 1,000 to 1,300mg of highly bioavailable calcium daily. We prioritise a “food-first” approach (dairy, fortified alternatives, bony fish, and specific greens) and only recommend high-quality supplementation when dietary gaps cannot be closed, preventing the risks of over-supplementation.

You would be surprised by the actual amount you need to eat to reach these requirements. 

3. Vitamin D & Magnesium Integration

Pepita seeds, pumpkin seeds for dietary magnesium and meeting requirements for optimal bone density and over 300 different coenzyme activities in the human body

Calcium is useless if your body cannot absorb it. Vitamin D acts as the “key” that unlocks the door in your gut, allowing calcium to enter your bloodstream. Magnesium helps route that calcium into your bones rather than your arteries.

We optimise these crucial micronutrients through diet, safe sun exposure guidelines, and targeted supplementation based on your pathology results.

Don’t make the mistake of thinking a supplement will tick the box. Be certain by booking a consultation with us

4. Supporting Mechanical Loading

A photo of a happy couple engaging in physical activity designed to build bone density and reduce the risk of osteoporosis

Nutrition provides the raw materials to build bone, but structured exercise provides the blueprint.

To safely and effectively stimulate bone growth, we highly recommend and fuel evidence-based, supervised training, such as the ONERO program or physiotherapy-led resistance protocols.

These highly specific, targeted interventions provide the precise mechanical stress your skeleton needs to safely deposit new bone, offering far better clinical outcomes than general activities like walking or gardening alone.

When should you see a Doctor?

You should see your GP to request a baseline DEXA scan if you are a woman over 65, a man over 70, or if you are over 50 with risk factors (such as early menopause, a family history of osteoporosis, or a history of long-term corticosteroid use).

You should also consult your GP if your DEXA scan reveals a T-score of -2.5 or lower, as prescription medications (like bisphosphonates or Prolia) are often highly effective and necessary to stop rapid bone loss while we implement nutritional strategies.

When should you see a Dietitian for osteoporosis?

The absolute best time to see a REAL Dietitian is the moment you are diagnosed with Osteopenia (the yellow flag). This is your window of opportunity to drastically slow down bone loss and even gain it, before it becomes osteoporosis.

You should also see an Accredited Practising Dietitian if you have already been diagnosed with osteoporosis, if you have suffered a fracture from a minor fall, or if you follow a dairy-free or vegan diet and are unsure if you are hitting your complex micronutrient targets.

We cut through the supplement marketing noise and build a realistic, zero-fad nutrition strategies that protects your physical independence.

Why Choose REAL for Supporting Your Bone Health?

At REAL Health & Nutrition, we believe protecting your bones shouldn’t mean a lifetime of restrictive diets or confusing supplement routines.

Our Accredited Practising Dietitians use evidence-based Medical Nutrition Therapy to help you navigate osteopenia and osteoporosis, giving you complete confidence in your long-term health and physical independence.

Realistic nutrition solutions

REAL Health & Nutrition was founded in Melbourne by Matthew Rigoni alongside a passionate team that provides evidence-based nutrition strategies that fit into your life.

Our diverse clientele includes individuals seeking to manage chronic disease, enhance their energy, and those aiming to improve their healthspan and longevity through sustainable health and nutrition strategies.

Matthew Rigoni, expert Dietitian and sports dietitian- REAL Health & Nutrition

Practitioners

Meet the team

Highly skilled and qualified Dietitians and Sport Nutritionists

  • Matthew Rigoni Accredited Practising Dietitian (APD), sport Nutritionist, Accredited Sport Dietitian (ASD)

    Matthew Rigoni

    Head Dietitian (APD) & Sports Nutritionist

    Matthew Rigoni is an Accredited Practising Dietitian and Sports Nutritionist supporting clients across Eltham, Diamond Creek and Melbourne’s North-East. He specialises in weight management, chronic disease care, IBS/low-FODMAP nutrition, and sports-performance nutrition. His approach focuses on evidence-based, realistic strategies tailored to each client’s health goals. Matthew also brings experience in strength training and rehabilitation, helping clients build long-term, sustainable habits.

  • Max Dennehy Dietitian, body building coach

    Max Dennehy

    Dietitian and Bodybuilding Coach

    Max Dennehy is a qualified Dietitian with strong expertise in sports nutrition, weight loss, muscle gain and body recomposition. He has more than seven years of hands-on experience in bodybuilding and strength training, blending clinical nutrition with practical performance coaching. Max supports clients managing chronic conditions, improving metabolic health, and achieving body-composition goals. His coaching style is structured and supportive, helping clients stay consistent and confident.

  • Emma Westlake Accredited Sports Nutritionist

    Emma Westlake

    Accredited Sports Nutritionist

    Emma Westlake is a Nutritionist and Accredited Sports Nutritionist with experience in athletic performance, endurance nutrition, injury recovery and rehabilitation. She brings a strong background in Biomedical Science and works with clients to improve energy, health and long-term wellbeing. Emma has supported athletes across AFL/AFLW, triathlon and running communities, offering clear and practical guidance. Her passion lies in helping active individuals optimise performance through personalised, evidence-based nutrition.

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Maintaining Excellence in Nutrition Care

This commitment ensures you always receive the most current, evidence-based nutrition guidance available.

Frequently Asked Osteoporosis Questions

Common questions for Osteoporosis

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    While you can make incredible improvements to your bone strength and significantly slow down the rate of bone loss, true “reversal” of severe osteoporosis back to normal bone density is extremely difficult with diet alone.

    Optimal macro and micronutrient intake can provide the “building blocks” that your body needs to then move into the bones with adequate stimulus. 

    That stimulus is where specific exercise (via your physiotherapist/ osteotherapist) is essential, and certain medications may be worth considering through a conversation with your GP.

    With only the stimulus/ exercise, there won’t be enough nutrients available to have an optimal internal enviornment for increasing bone density and reversing osteoprosis.

    Absolutely not. While dairy (milk, cheese, yogurt) is highly bioavailable and convenient, you can hit your calcium targets through fortified plant milks, calcium-set tofu, canned salmon or sardines (with bones), almonds, and specific leafy greens.

    A Dietitian can help you balance a dairy-free lifestyle safely and ensure you are getting an adequate amount of bioavailable calcium on a daily basis.

    There has been some conflicting research suggesting that taking massive doses of calcium supplements without adequate Vitamin D or Vitamin K2 may lead to calcium deposition in the arteries rather than the bones.

    This is exactly why we take a “food-first” approach and carefully calculate your supplement dose, avoiding harm to your health, so you take exactly what you need

     

    It is a matter of severity. Osteopenia means your bone density is lower than average, but your fracture risk is still relatively low (but is a great warning signal that things are likely to progress).

    Osteoporosis means the bone has degraded to the point where the structural integrity is severely compromised, making fracture risk very high.

    Caffeine does cause a very small increase in the amount of calcium excreted in your urine.

    However, if you are consuming adequate calcium in your diet throughout the day, a moderate coffee habit (1-3 cups a day) will not significantly impact your long-term bone density.

     

    While the baseline recommended dietary intake (RDI) for protein is around 0.8g per kilogram of body weight, modern longevity and bone-health research suggests older adults actually need closer to a minimum of 1.2g to 1.6g per kilogram of body weight to optimally preserve both bone density and the muscle mass required to prevent falls.

    For many Australians, yes. Despite our sunny climate, a huge percentage of the population is deficient in Vitamin D due to indoor jobs and necessary sun safety practices.

    Because your body physically cannot absorb dietary calcium without Vitamin D, optimising this level via a high-quality supplement is often a key step in optimal osteoporosis management.

Extra reading

Bliuc, D., Nguyen, N. D., Milch, V. E., Nguyen, T. V., Eisman, J. A., & Center, J. R. (2009). Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA, 301(5), 513–521. https://doi.org/10.1001/jama.2009.50

Healthy Bones Australia. (2021). Calcium and bone health. https://healthybonesaustralia.org.au/your-bone-health/calcium/

Rizzoli, R., Biver, E., Bonjour, J. P., Coxam, V., Goltzman, D., Kanis, J. A., Lappe, J., Rejnmark, L., Sahni, S., Weaver, C., Weiler, H., & Reginster, J. Y. (2018). Benefits and safety of dietary protein for bone health—An expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation. Osteoporosis International, 29(9), 1933–1948. https://doi.org/10.1007/s0198-018-4534-5

Royal Australian College of General Practitioners. (2017). Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age (2nd ed.). https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/osteoporosis

Watson, S. L., Weeks, B. K., Weisbrod, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 33(2), 211–220. https://doi.org/10.1002/jbmr.3284