Osteoporosis is a lifestyle disease, caused by a lifetime of inactivity, poor eating habits and hormonal imbalance. But it is never too late to make positive changes in your lifestyle. Improving your diet and lifestyle can make a difference in preventing this problem, even if these changes are made later in life.

Osteoporosis is a common problem; fractures because of osteoporosis are more common than heart attack, stroke and breast cancer combined.

We are told osteoporosis is caused by a deficiency of calcium, because calcium is the primary mineral in our bones. Modern medical advice is to get a lot of calcium, as supplements and in the diet. 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 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 is the overall quality of the diet. Bones are made of far more than calcium. There are other minerals 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, a foundation, a roof, etc., that are all necessary parts of the structure.

We now know osteoporosis is one of the many diseases of our civilization, including cancer, high blood pressure, Type 2 diabetes and obesity. These are diseases that are common in developed 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 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 “non-food,” it is 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. (Juices do not count, as they are highly processed.)

Studies have shown that women who eat more fruits and vegetables are less likely to develop osteoporosis. In their whole, unprocessed state, fruits and vegetables not only have calcium but also all the other nutrients you need to build strong bones.

U.S. Department of Agriculture 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. And while we ate less whole 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.)

It turns out that 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 and especially prepared whole meals.

And, as always, increase veggie consumption. In my years of reviewing my patient’s diets, I have yet to have a patient who ate too many vegetables.

And as much as possible, maintain an activity level that supports bone strength. Inactivity can also weaken bones — the body operates on a “use it or lose it” basis when it comes to bone density.