The Faces of Osteoporosis
Nutrition for Bone Health and Osteoporosis Prevention
Calcium, Vitamin D and Vitamins for Bone Health
You can download a printer friendly version of American Bone Health's BONESENSE on Calcium and Vitamin D.
Calcium is a mineral that helps build strong bones and teeth. While you need calcium throughout your life, the amount you need changes over time. Calcium is critical for kids during their growing years to build strong bones, a bit less is required during the middle years to keep bones strong, and much more calcium is needed later in life to prevent bone loss.
Your body stores 99% percent of its calcium in your teeth and bones. The other 1% is circulating in your blood and soft tissue. If you do not consume enough calcium through your diet or supplements, your body will take the calcium it needs from your bones. If your body continues to take calcium from your bones, over time, you will develop osteoporosis. Osteoporosis is a serious disease in which bones become fragile and therefore more likely to break.
The best way to get the right amount of calcium is to eat enough calcium-rich foods every day. Dairy products and calcium-fortified foods are the best sources of calcium. Certain fruit juices, cereals and breads have added calcium. Non-fat and low-fat dairy products have more calcium than whole milk.
What's your calcium intake? Try out Dairy Council of California's calcium quiz.
There is increasing evidence of an epidemic of vitamin D deficiency. Sun is a primary source of vitamin D for most individuals. Fifteen to 20 minutes of sun exposure on the face and arms is adequate for most people to produce sufficient amounts of vitamin D. But, the use of sunscreen with a sun protection factor (SPF) of eight or higher will decrease the skin production of vitamin D by 95%.
American Bone Health has recently published BONESENSE on Vitamin D and the Sun knowing that sun may not be the best source of vitamin D. DOWNLOAD THE PDF.
The best way to determine if you are vitamin D deficient is by measuring 25-hydroxyvitamin-D level. In fact, if you have a fracture, you should be tested and if low or deficient, be treated prior to initiation of a medication for osteoporosis.
For severely vitamin D deficient patients, many doctors are prescribing 50,000 IU 1 to 2 times per week for 3 to 4 weeks and then retesting to determine if the megadose got their vitamin D level in the normal zone. Once replete, these patients typically get 1,000 to 2,000 IUs per day.
Vitamin D and the Sun
Vitamin D is critical for bone health because it helps the intestines absorb calcium – a major building block for bone. One of the best ways to get vitamin D is through sun exposure since our skin has a unique way of transforming ultraviolet rays to a precursor form of vitamin D. The body also regulates vitamin D production so we don’t reach unhealthy levels.
However, the sun brings many potential dangers such as wrinkling, sun burn, and skin cancer (www.skincancer.org). Sun burn, especially in kids, increases their risk of melanoma, the most serious form of skin cancer. and overall excessive sun exposure increases basal cell cancer risk substantially over a lifetime.
Some research suggests that small amount of sun exposure is enough to meet daily vitamin D requirements. However, the sun’s rays vary dramatically depending on the time of day, the season and the latitude.
Fortunately, vitamin D can be easily acquired through safe and affordable supplements. American Bone Health recommends that most adults take a minimum of 1,000 but not more than 2,000 international units of vitamin D per day. Children also need vitamin D and you should discuss the appropriate dose with your pediatrician.
Look for foods www.nutrition.gov that are fortified with vitamin D and if you are in the sun, see the guidelines from the National Council on Skin Cancer for sun exposure and prevention tips from the Skin Cancer Foundation.
Talk to your doctor about whether you should be tested for vitamin D deficiency.
Milk and dairy products are one of the best sources of dietary calcium. However, some people have trouble digesting milk products because their body lacks lactase, the enzyme that digests milk. People who are lactose intolerant experience gas, bloating or stomach cramps when they eat dairy foods. As many as 50 million Americans are lactose intolerant and this condition occurs more often in certain ethnic groups. In fact, up to 75 percent of all adult African Americans and Native Americans and 90 percent of Asian Americans consider themselves lactose intolerant.
There are a number of ways to meet calcium requirements if you are lactose intolerant:
- incorporate non-dairy, calcium-rich foods or lactose-reduced dairy products into the diet
- take calcium supplements
- use lactase pills or drops which make milk products digestible
Tips for Tolerance
New research finds that most people who are lactose intolerant can enjoy some dairy foods daily. Try these tips to help you comfortably consume dairy foods.
- Reduce it - Look for lactose-reduced or lactose-free milk in the dairy case at your store. These products have all the nutrients of regular milk.
- Start small - Try small portions of dairy foods and gradually increase the serving size. This allows whatever lactase is present to do its job of digesting the lactose before it starts causing problems. When you notice symptoms, that may be your personal limit for the amount of lactose you can tolerate at one sitting.
- Pair the Dairy - Drink milk with other foods, rather than on an empty stomach. Solid foods slow down the digestive process and allow your body more time to digest the lactose – which helps decrease or eliminate symptoms.
- Now you’re cooking - Start adding milk to your favorite recipes for soups and sauces. Research has shown that your body actively adjusts to the presence of lactose, and symptoms will gradually decrease over as little as 10 days.
- Older is wiser - That’s true with cheese! When milk is processed into cheese, most of the lactose is removed in the whey, or liquid. Aged hard cheese, such as Cheddar, Colby, Swiss and Parmesan are particularly low in lactose.
- Get a little “culture” - Look for cultured milk products such as yogurt or buttermilk. These products contain friendly bacteria that help digest lactose.
- Make it easy - Look for dairy digestive supplements (lactase caplets). These supplements can help you digest lactose easily. Then you can enjoy dairy foods, in any amount, and get all the nutrients they provide.
- Go to the pros. These tips may not apply to everyone. Talk to your doctor or a registered dietician if you are unsure or want more information better suited to your personal needs.
Text adapted from the National Dairy Council.
It is always best to try to get your nutrition in the foods you eat. However, that is not always possible. If you do not get your recommended daily calcium and vitamin D from food, you may need to supplement your diet.
What’s the best calcium supplement to take? The simple answer is…pick a supplement that you will take regularly! Getting daily calcium is the key. Calcium carbonate and calcium citrate are the most common types of calcium supplements. Calcium carbonate may be less expensive and requires the acid in your stomach to break it down. So be sure to take it with food. Calcium citrate absorbs more easily and is generally more expensive.
Some people experience constipation with calcium. Be sure to drink adequate amounts of water. Taking a calcium that includes magnesium may help. There are many chewable forms of calcium available that may be more convenient for children and older adults. Supplements are sold under brand names and as generics. Many common antacids also contain calcium.
Read the label for the amount of “elemental calcium” per tablet. Elemental calcium is the actual amount of calcium in the supplement that will be made available to your body. This will help you determine how many tablets you need to take to get your daily dose. Also, look for the USP mark to make sure the supplement meets governmental standards for purity and quality.
The key is to follow a healthy, calcium rich diet and take a supplement as needed -- the food you eat together with your supplement can meet your total daily calcium requirement.
The Other Bone Health Vitamins
Vitamin A is a fat-soluble vitamin that is important to building strong, healthy bones. Both osteoblasts (bone building cells) and osteoclasts (bone breaking down cells) are influenced by vitamin A. Despite it good effects, most clinical research links higher vitamin A levels with lower bone density and fractures.
One source of vitamin A is retinol, found in meat and fish, fortified breakfast cereals, and vitamin supplements. Remember that Vitamin A is fat-soluble and stored in our livers. So the liver of fish and animals are particularly rich in vitamin A.
Another source of vitamin A is beta-carotene, found in dark green and orange fruits and vegetables. Beta-carotene is generally considered safe. According to the National Institutes of Health, the RDA for men age 19+ is 3,000 International Units (IUs) and 2,330 IUs for women in the same age range.
Too much vitamin A (more than 3,000 mcg or 10,000 IU/day) will give you a headache and has been linked to bone loss. Pay particular attention to this possibility if you eat liver or take supplements.
Sources of vitamin A: Cantaloupe, carrots, cheese pizza, eggs, fatty fish, fat-free milk, kales, liver, mangoes, sweet potatoes, and spinach
Vitamin B12 appears to have an effect on bone building cells.
A March 2005 Tufts University study done by Katherine Tucker and her colleagues showed that low levels of vitamin B12 are linked to a higher risk of osteoporosis in both men and women. Vitamin B12 is found in meat and fish, making vegans, who don't eat meat or dairy, at risk for bone loss.
People who have had a gastric bypass or have gastrointestinal disorders that cause poor absorption of fat lose the ability to absorb B12. Elderly people in their 80s and 90s may develop changes in the linings of the stomach that prevents them from absorbing iron and B12. In these cases where absorption is an issue, doctors may give injections of B12, bypassing the digestive tract, so patients get the benefits of the vitamin.
Sources of Vitamin B12: Dairy products, eggs, fish, fortified breakfast cereal, meat, milk, poultry, shellfish, supplements
Vitamin C is important for healthy gums and healthy bones. Vitamin C is essential to the formation of collagen, the foundation that bone mineralization is built on. Studies have associated increase vitamin C levels with greater bone density.
Vitamin C is water-soluble and the most common reason for low levels is poor intake. Some people with poor absorption will have lower levels of this vitamin. The elderly who are in nursing home tend to have lower levels of vitamin C. Smokers also tend to have lower blood levels of vitamin C because their intestines do not absorb vitamin C normally. (Yet another reason to stop smoking!)
Sources of Vitamin C: broccoli, bell pepper, cauliflower, kale, lemons, oranges, papaya, strawberries
Vitamin K is important to normal bone growth and development. This vitamin helps attract calcium to the bone. Low blood levels of vitamin K are associated with lower bone density and possibly increased fracture risk. However, clinical trials have not shown vitamin K supplementation to be helpful in improving bone density.
Vitamin K deficiency is uncommon in healthy adults probably because it is found in many of the foods that we eat every day. People on a blood thinner should not be taking vitamin K.
Sources of Vitamin K: Broccoli (cooked), Brussels sprouts, cabbage, Canola oil, kale, olive oil, parsley (raw), spinach, and Swiss chard