Table 1.

Nutritional and physical activity recommendations for bone and muscle health and reduction/maintenance of body weight^*

Affected tissue	Condition	Possible nutritional interventions/treatment	Possible exercise interventions/treatment	Underlying mechanism of benefit
Bone	Osteopenia or osteoporosis	• Calcium (RDA for ≥51 years) – 1,200 mg/d101 • Magnesium: meet RDA (320 mg/d for women)102 • Vitamin D: 800 IU/d103 • Vitamin D: serum level >20 ng/mL103 • Protein >1 g/kg/d72,73 • Omega-3 PUFA (especially long chain EPA and DHA) – at least 1 g/d EPA + DHA and >1 g ALA62,77	• Weight-bearing (resistance exercise) physical activity 2–3 times/wk82,83 • Comprehensive exercise program should include aerobic, strength, flexibility and balance training82,83 • Take preventive steps to reduce risk of fall (balance training, tai chi, yoga, etc.)104 • Exercise according to ability – as ability, the intensity of exercise can increase104	• Prevents bone loss by reducing osteoclastogenesis and adipogenesis and increasing osteoblastogenesis in the bone105 • Reduces inflammation106
Muscle	Sarcopenia	• Protein diet: 1.4–1.6 g/kg/d74,107 • Vitamin D: 800 IU/d103 • Vitamin D: serum level >20 ng/mL103 • Omega-3 PUFA long chain >1 g/d62,77	• Weight-bearing physical activity 2–3 times/wk82,83 • Exercise to match ability – as ability improves intensity of exercises can increase104	• Increases muscle protein synthesis99 • Improves muscle function99 • Reduces anabolic resistance108
Adipose	Overweight or obesity	• Calcium (RDA for ≥51 years) – 1,200 mg/d101 • Magnesium: meet RDA (320 mg/d for women)102 • Omega-3 PUFA: ~1 g/d62,77 • Fiber: meet RDA (25 g/d for women)64	• 300 minutes moderate- intensity exercise per week (60 min ×5 days/wk) to optimize the impact of exercise on weight109 • Comprehensive exercise program should include aerobic, strength, flexibility and balance training82,83 • Improve balance to reduce risk of fall (balance training, tai chi, yoga, etc.)82,83 • Exercise to match ability – as ability improves the intensity of exercises can increase104	• Improves weight loss and maintenance109 • Reduces risk of metabolic syndrome110 • Lowers cholesterol110 • Reduces fat infiltration by stimulating muscles to oxidize interstitial fat111 • Reduces inflammation106
Bone, muscle and adipose tissue	Osteosarcopenic obesity	• Calcium: 1,200 mg/d101 • Magnesium: meet RDA (320 mg/d for women)102 • Vitamin D: 800 IU/d103 • Vitamin D: serum level >20 ng/mL103 • High protein diet: 1.4–1.6 g/kg/d • Omega-3 PUFA (especially long- chain EPA and DHA) – at least 1 g/d EPA + DHA and >1 g ALA62,77 • Fiber: meet RDA (25 g/d for women)64	• Comprehensive exercise program should include aerobic, strength, flexibility and balance training and 300 minutes moderate-intensity exercise per week (60 min ×5 days/wk) to optimize the impact of exercise on weight82,83 • Weight-bearing physical activity 2–3 times/wk82,83 • Exercise to match ability – as ability improves the intensity of exercises can increase104 • 300 minutes moderate-intensity exercise per week (60 min ×5 days/wk) to optimize the impact of exercise on weight109	• Bone, muscle mass/quality and adipose tissue are interrelated. Bone loss (osteoporosis or osteopenia) can be accompanied with an increase in the fat mass (obesity) or fat’s infiltration into the bone and similarly, sarcopenia can be accompanied with increase in infiltration of fat into muscle1

Notes:

^*The recommendations are given for each basic condition: osteoporosis, sarcopenia and overweight/obesity, from which osteopenic obesity and sarcopenic obesity could be extrapolated. The osteosarcopenic obesity contains the most comprehensive recommendations encompassing those for each condition.

Abbreviations: RDA, recommended dietary allowances; PUFA, polyunsaturated fatty acids; EPA, eicosapentaenoic acid; DHA, docosahexaenoic acid; ALA, alpha linolenic acid.