Be Bone Healthy

Osteoporosis is caused by a gradual decrease in bone strength. If not prevented or treated, osteoporosis can grow painlessly worse until bones start to break. Though osteoporosis can occur in both men and women, it usually shows itself in women after menopause. Osteoporosis can cause serious fractures. Most serious are spinal and hip fractures. Osteoporosis is a major public health issue for over 28 million Americans, 80% of whom are women.

Half of women and one quarter of men over the age of 50 will have an osteoporosis-related fracture in their lifetime. In the United States, around 10 million people already have osteoporosis and over 34 million probably have low bone density, placing them at risk for osteoporosis. Four out of five people affected by osteoporosis are women.

Although osteoporosis is often thought of as a disease that affects mainly the elderly, it can also affect younger people who have hormonal difficulties, particularly women with anorexia, bleeding, or menstrual abnormalities in their 20s.

Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, 700,000 vertebral fractures, and 250,000 wrist fractures. The estimated U.S. cost for osteoporosis is over $17 billion a year.

Fortunately osteoporosis is preventable. Even when not prevented, osteoporosis can be detected and successfully treated.

Building and Losing Bone

Most men and women build up 98% of their bone by age 20. Exercise, diet, and calcium[1] and Vitamin D supplementation are very important for building strong bones. Additional bone is made up until about age 32. After age 32 most people start to lose bone.

Women lose a large amount of bone during and after menopause. Osteoclasts[2] are specialized cells that absorb and degrade bone. These cells become more active because of the decrease in estrogen that occurs during and after menopause.

Exercise and supplementation with calcium and vitamin D can reduce this bone loss. Prescription medicines can also help stop bone loss.

Medication Options in the Prevention and Treatment of Osteoporosis

Risk of Osteoporosis

Known risk factors for osteoporosis:

• Being female
• Thin or small frame
• Family history of osteoporosis
• Postmenopausal, including surgical menopause (i.e., hysterectomy including ovariectomy)
• History of anorexia or bulimia
• Prolonged amenorrhea (absence of menstrual periods)
• Low calcium diet
• Lack of exercise
• Cigarette smoking
• Excessive alcohol use
• Excessive caffeine use
• Detection of osteoporosis

Osteoporosis usually has no symptoms, other than loss of height. The lack of symptoms points out the need for advertising to alert people to the need for osteoporosis awareness and treatment. Osteoporosis is detected either by bone fracture, or by regular bone density measurements. Early detection of osteoporosis is extremely important in the prevention of osteoporotic fractures.

Other important risk factors for osteoporosis include:

• Long-term corticosteroid use
• Being of white or Asian descent
• Certain diseases such as Hyperthyroidism, Cushing's Disease, Crohn's Disease, and Celiac Disease
• History of stomach surgery (including weight-loss surgery)
• The use of certain medications such as proton pump inhibitors (PPIs), antacids, some anti-depressants, Methotrexate, and anti-seizure medications

Bone Nutrition

Calcium is the mineral that is critically important for bone health and in the treatment of osteoporosis. While calcium is essential throughout your entire life, it is especially important for children to get enough calcium through diet or supplementation during their growing years in order to build strong bones. During midlife, not quite as much calcium is needed to maintain bone health. As you age, it is recommended that you increase calcium consumption in order to prevent bone loss.

Recommended Calcium Intake 

Infants 0 to 6 months: 200 mg/day

Infants 6 to 12 months: 260 mg/day

1 to 3 years old: 700 mg/day

4 to 8 years old: 1,000 mg/day

9 to 13 years old: 1,300 mg/day

14 to 18 years old: 1,300 mg/day

19 to 30 years old: 1,000 mg/day

31 to 50 years old: 1,000 mg/day

51 to 70 years old (males): 1,000 mg/day

51 to 70 years old (females): 1,200 mg/day

70+ years old: 1,200 mg/day

Pregnant/Breastfeeding Teens 13 to 18 years old: 1,300 mg/day

Pregnant/Breastfeeding Women 19 to 50 years old: 1,000 mg/day

Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2010

Calcium Rich Foods

Fortified Oatmeal, 1 Packet: 350 mg

Sardines, Canned in Oil with Edible Bones, 3 oz.: 324 mg

Cheddar Cheese, 1.5 oz.: 306 mg

Non-fat Milk, 1 cup: 302 mg

Cottage Cheese, 1% Milk Fat, 1 cup: 138 mg

Low-fat Yogurt (Plain), 1 cup: 300 mg

Ready-to-Eat Cereal, Fortified with Calcium, 1 cup: 100-1,000 mg

Soybeans, Cooked, 1 cup: 261 mg

Tofu (Firm) with Calcium, 1/2 cup: 204 mg

Instant Pudding made with 2% Milk, 1/2 cup: 153 mg

Baked Beans, 1 cup: 142 mg

Turnip Greens (Boiled), 1/2 cup: 99 mg

Broccoli (Raw), 1 cup: 90 mg

Source: The 2004 Surgeon General's Report on Bone Health and Osteoporosis: What it Means to You. U.S. Department of Health and Human Services, Office of the Surgeon General, 2004, pages 12-13

Vitamin D is essential for the absorption of calcium in your body. Without vitamin D, your body does not form enough of the hormone calcitriol, which is necessary for efficiently absorbing calcium. Vitamin D can come from many sources, including through the skin, from the diet, or from supplementation. By spending 15 minutes in the sun a few times each week, your body will be able to produce and store the amount of vitamin D that is needed for the absorption of calcium. If the sun is not an option, vitamin D can also be obtained through the diet and supplementation.

The Institute of Medicine recommends adults aged 19-70 get 600 IU's, and adults older than 70 get 800 IU's of vitamin D daily. There are very few foods that contain vitamin D naturally; among the few are fatty fish such as tuna, sardines, mackeral, salmon and herring. Small amounts of vitamin D can also be found naturally in cheese, egg yolks, and beef liver.

Other minerals are also important for bone strength. Trace minerals important in the prevention of osteoporosis include zinc and magnesium. Fortified cereals, red meat and poultry, and legumes are good sources of zinc. Most magnesium in our diet comes from milk and dark green leafy vegetables.

Phosphorous is a mineral that is important in the formation of bones and teeth, although too much phosphorous may be bad for bones. Because phosphorous is so readily available in our food supply there is generally no deficiency of phosphorous. Phosphorous is found most commonly in dark-colored soft drinks, so cutting back on these can help avoid unnecessary amounts of phosphorous. In a 1994 study, girls who consumed greater amounts of cola had a higher incidence of fractures than those who consumed low amounts. Fortunately, a high calcium intake was protective against fractures, particularly among girls who had high physical activity.

Dietary Recommendations

Obtain as much calcium, magnesium and other trace minerals from your diet as possible by drinking milk and eating dark green leafy vegetables, broccoli, nuts, and seeds. Eliminate or reduce the use of colas and other soft drinks in order to decrease phosphorus intake. If you have trouble tolerating (digesting) milk, try lactose reduced milk, lactase tablets or take a supplement with calcium and possibly vitamin D. Talk with your physician to find out if supplements are right for you.

The Importance of Exercise

Exercise is effective in preventing and treating osteoporosis. In one study, women who added exercise to their medical therapy increased spinal bone density by 4.4%, while women receiving only bone-restoring medicines showed an increase in spinal bone density of just 1.6%. Weight-bearing exercises are recommended for at least 30 minutes most days of the week. In addition, try to walk 4 miles per day, or approximately 10,000 steps 5 days per week. Pedometers are an inexpensive and convenient way to keep track of steps.

Exercise for Osteoporosis

Conclusions and Recommendations

There are a variety of solutions to the problem of osteoporosis. Whatever choices you make should be made in consultation with your family doctor or a specialist. Avoiding osteoporosis may require changes in lifestyle and diet, possibly nutritional supplementation and even drug therapy. It is worth making these changes because osteoporosis is both preventable and treatable.

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