What is the role of a personalised dietitian consult when treating osteoporosis, osteoarthritis and RED-S?

Exercise is powerful.

But exercise does not work in isolation.

The body adapts when the training signal is supported by the internal environment. That means nutrition, sleep, hormones, recovery, medical history and overall health all matter.

At Bone Health Studio, we are very focused on loading.

We want people lifting, moving, building capacity, getting stronger and feeling more confident in their bodies.

But if the goal is bone health, joint health, muscle function or athletic recovery, then nutrition cannot be an afterthought.

This is where a personalised dietitian consult becomes incredibly valuable.

Not because everyone needs a complicated meal plan.

But because many people need clarity.

Osteoporosis: you cannot build bone on poor inputs

With osteoporosis, resistance training provides the mechanical signal.

Nutrition provides the building blocks.

Bone health is influenced by many factors, including calcium, vitamin D, protein, energy intake, hormones, age, medications, medical conditions and training history.

Australian and New Zealand bone health guidance commonly recommends achieving adequate calcium intake, preferably through food where possible, with supplementation considered when dietary intake is insufficient or clinically indicated. ANZBMS recommends total calcium intake of approximately 1000–1300 mg per day depending on age and sex.

Vitamin D also matters because it supports calcium absorption and muscle function. New Zealand osteoporosis guidance notes that many healthy adults may not require vitamin D supplementation, but people at risk of deficiency may need supplementation under medical guidance.

Protein is also important.

People often think about calcium for bone, but bone is not just mineral. It also has a protein matrix. And from a functional perspective, muscle is one of the best friends bone has.

Stronger muscles help load bone.
Better muscle function improves balance.
Better balance reduces falls risk.
Reduced falls risk reduces fracture risk.

So the dietitian’s role is not just “eat more calcium”.

It is to look at the whole picture.

Are you eating enough protein?
Are you getting enough calcium?
Is your vitamin D status appropriate?
Are you under-eating?
Are you losing weight unintentionally?
Are your meals supporting training adaptation?
Are supplements needed, or is food enough?

That level of specificity matters.

Osteoarthritis: nutrition is not about miracle anti-inflammatory diets

Osteoarthritis attracts a lot of nutrition noise.

Avoid this.
Take that.
Cut out nightshades.
Drink collagen.
Never eat gluten.
This supplement will rebuild cartilage.

We need to be careful.

There is no magic diet that simply “cures” osteoarthritis.

But nutrition can still be very important.

For knee and hip osteoarthritis, weight management can be clinically meaningful where someone is overweight or obese. The 2019 American College of Rheumatology/Arthritis Foundation guideline strongly recommends exercise and also strongly recommends weight loss for people with knee or hip osteoarthritis who are overweight or obese.

That does not mean everyone with osteoarthritis needs to lose weight.

And it definitely does not mean we reduce the person to their body weight.

It means that for some people, reducing joint load and improving metabolic health can help symptoms and function.

A good dietitian can help with this in a way that is sensible, sustainable and not fear-based.

This matters because under-eating is not the answer either.

If someone with osteoarthritis is trying to get stronger, they still need enough protein, enough energy and enough micronutrients to adapt to training.

The goal is not simply weight loss.

The goal is better function.

RED-S: the dietitian is central

With RED-S, the dietitian’s role becomes even more important.

RED-S occurs when there is not enough available energy to support both training and normal body function. The IOC describes RED-S as a syndrome of impaired physiological and/or psychological functioning in athletes exposed to low energy availability.

In this situation, exercise prescription without nutrition support can miss the main driver.

If an athlete is under-fuelled, adding more training is not always the answer.

Sometimes the athlete does not need more discipline.
They need more energy availability.

A sports dietitian can help identify:

• whether the athlete is eating enough for their training load

• whether carbohydrate intake supports the work being done

• whether protein intake supports repair and adaptation

• whether timing of meals is helping or hurting recovery

• whether fear of weight gain is influencing choices

• whether menstrual function, injury history or fatigue suggest low energy availability

• whether medical referral is needed

This is not about forcing food.

It is about restoring the conditions for adaptation.

Personalised beats generic

The reason personalised dietitian input matters is that three people with the same diagnosis may need completely different strategies.

A 68-year-old woman with osteoporosis, low appetite and low protein intake needs one plan.

A 52-year-old man with knee osteoarthritis, high stress, poor sleep and gradual weight gain needs another.

A 21-year-old runner with recurrent bone stress injuries, irregular menstrual function and high training load needs another.

The diagnosis gives us a category.

The person gives us the answer.

That is the difference.

Nutrition supports training adaptation

At Bone Health Studio, the training session is not an isolated event.

It is a signal.

Resistance training says to the body: “Build.”

But the body still needs resources.

The International Society of Sports Nutrition position stand notes that people engaged in regular exercise generally require higher protein intakes than sedentary individuals, with 1.4–2.0 g/kg/day often sufficient for building and maintaining muscle mass in exercising individuals.

Now, not every client needs to count grams.

But many do need to understand whether they are even close.

This is especially true for older adults, athletes, people dieting, people with low appetite, and people recovering from injury or surgery.

If we want strength adaptation, we need to support it.

The best plan is the one the person can actually follow

A dietitian consult should not feel like a lecture.

It should feel like someone helping you make sense of your current habits and your current needs.

What are you already doing well?
What is missing?
What is realistic?
What needs to change first?
What can wait?
What is the simplest next step?

For some people, that might mean adding protein at breakfast.

For others, it might mean improving calcium intake through food.

For an endurance athlete, it might mean fuelling before and after training instead of trying to “earn” food.

For someone with osteoarthritis, it might mean building a sustainable pattern that supports gradual body composition change without compromising strength.

Small changes, done consistently, can be powerful.

The bigger picture

The role of the dietitian is not to replace the coach, physio, doctor or biomechanist.

It is to complete the picture.

For osteoporosis, nutrition supports bone and muscle adaptation.

For osteoarthritis, nutrition may support body composition, symptom management, metabolic health and training recovery.

For RED-S, nutrition is often central to restoring health and performance.

The common thread is this:

The body adapts best when the signal and the support match.

Training gives the signal.
Nutrition provides the support.

When those two things work together, people do not just exercise.

They rebuild capacity.

And that is the whole point.

References

Mountjoy M et al. 2023 International Olympic Committee’s consensus statement on Relative Energy Deficiency in Sport — REDs. British Journal of Sports Medicine, 2023.

Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis. Arthritis Care & Research, 2020.

ANZBMS. Position statements: calcium and vitamin D recommendations for bone health.

Osteoporosis New Zealand. Guidance on the Diagnosis and Management of Osteoporosis in New Zealand.

Jäger R et al. International Society of Sports Nutrition Position Stand: protein and exercise. Journal of the International Society of Sports Nutrition, 2017.