Bone Health Matters: Preventing Osteoporosis

Osteoporosis is one of the silent diseases. There are no signs of this bone-thinning condition until it progresses to a point where it can no longer be ignored. Its voice is a fracture.

Half of all Caucasian and Asian women over 50 years of age will suffer a fracture caused by osteoporosis. African-American women, Mexican-American women and men of all races have lower rates of osteoporosis, but bone loss can still occur in these individuals if additional risk factors are present. These risk factors include weight under 127 pounds, being a smoker, poor lifelong calcium intake, family history of osteoporosis, or having a chronic condition such as asthma, rheumatoid arthritis, lupus, thyroid disease or inflammatory bowel disease. Additional risk factors include long-term use of the steroid medication prednisone and early menopause.

Low bone mass or osteoporosis can result in non-traumatic fractures; the most devastating of these involve the fracture of a hip. It is estimated that 300,000 hip fractures occur per year in the United States. Of the individuals sustaining an osteoporotic hip fracture, 12% to 20% will die from complications of the fracture event within the first year, says Monica Erb Meyer, RN, MS, CNS, FNP, of the Osteoporosis Clinic in the Division of Rheumatology at Froedtert & Medical College. Fractures adversely affect people in several ways - through pain, loss of mobility, and decreased quality of life.

Peak bone mass is achieved at approximately 30 years of age. It is therefore especially important to have a diet rich in calcium from infancy through early adulthood, according to Marlys Swanson, RN, BSN, Program Coordinator for the Total Health for Midlife Women Program at Froedtert & Medical College. Calcium consumed in later life will help maintain bone mass, but cannot reverse the consequences of poor lifetime calcium intake.

The following facts and tips from Erb Meyer and Swanson will help you learn some of the many ways in which you can build and maintain bone mass throughout life.

Ingest Calcium Throughout the Day

• Calcium is absorbed slowly and the body cannot take in more than 500 mg at once. Naturally occurring calcium is more effectively absorbed than supplemental calcium.
• Snack your way to reaching a daily intake of 1200 mg of calcium. In the morning, measure out one cup of cereal such as Total or Harmony then use it as a snack during the day. These cereals are fortified with high levels of calcium.
• If you're over the age of 40, you should get 1200 to 1500 mg of calcium per day. Daily dietary consumption of products rich in calcium is preferred to supplement use, as food products contain a variety of other important nutrients. Dietary sources rich in calcium include milk, yogurt, orange juice fortified with calcium, Total cereal, canned sardines with bones, collard greens, soybeans and almonds.
• When it comes to cheese, the harder the better. A half-cup of cottage cheese, for example, contains 60 mg of calcium while an ounce of cheddar packs 200 mg.
• Learn this simple trick for reading a food label. If a label reads that a serving supplies 25% of daily calcium, you can easily convert this to milligrams by simply adding a 0, so 25 percent is equivalent to 250mg; 50 percent equals 500mg.

Food Dos and Don'ts

• Do limit sodas. Soft drinks displace milk, the best single source of calcium at 300 mg per 8 ounce serving.
• Do drink that milk pool at the bottom of your cereal bowl. Some of the fortified cereal's calcium supplements wash off when milk is poured on top of it, leaving a pool of calcium-rich milk on the bottom.
• Don't follow fad diets. Yo-yo dieting sets up the body for significant bone loss.

Calcium and Bone Issues to Discuss with Your Doctor

• Talk to your doctor about calcium and bone density evaluation if you have or had any of the following conditions: asthma, diabetes, seizures, thyroid disease, parathyroid disease, lupus, rheumatoid arthritis, an eating disorder, lactose intolerance, colitis, Crohn's disease, kidney stones, kidney disease, an irregular menstrual cycle or an early hysterectomy.
• Medications known to affect bone health include steroids, thyroid supplements, antacids, seizure medications, diuretics and inhalers. Talk to your doctor if you have taken any of these medications for a significant amount of time, now or during childhood or adolescence.
• Talk to your doctor if you are concerned that you have a medical condition that may interfere with calcium consumption (lactose intolerance) or vitamin D absorption.
• Be aware that taking calcium at the same time that you take Synthroid, the synthetic thyroid hormone, blocks the absorption of this medication. If you are taking Synthroid for a thyroid condition, do not take it at the same time as a calcium supplement or naturally occurring calcium.
• Do not suddenly discontinue hormone replacement therapy. Women who abruptly quit HRT lose bone more rapidly.

Over-the-Counter and Prescription Supplements

• Use supplements if you don't ingest 1200 mg/day of calcium through dietary intake. The antacid TUMS (calcium carbonate) is the least costly over-the-counter remedy and contains 300 mg per tablet. TUMS must be taken with meals. Some people experience gas or constipation from calcium carbonate sources such as TUMS. Citracal (calcium citrate) serves up 350 mg per tablet. While it's more costly than TUMS, Citracal does not cause gas or constipation, nor does it have to be taken with food. (When using supplements it is important to read the serving size on the package label.) Multivitamins generally contain less calcium than supplements (around 200 mg), but they are a decent choice as they also deliver vitamin D, which is necessary for calcium absorption.
• If your bone density is considerably low, your doctor may recommend a prescription drug such as Actonel, Evista or Fosamax to help maintain and reduce further bone loss.
• Do not take coral reef calcium. This supplement might contain lead and other toxins.

Help Your Children Prevent Osteoporosis

• Calcium deficiency is rampant among American children as juice and soft drinks take the place of milk. What determines a person's chances of osteoporosis at age 60 is the peak bone mass they achieved by the age of 30 years.
• Prevention begins in childhood. If you have children, work now to help them prevent osteoporosis. By age 17, 90% of adult bone mass has been formed. From birth to age 11 - when about 45% of bone mass is created - children are consuming only about half the appropriate calcium requirement for their age, according to the American Academy of Orthopaedic Surgeons. Male teens consume about 50% of what they need, while females typically consume just 14% of the recommended levels of calcium for their age. Children ages 1 to 3 should get 500 mg of calcium per day; ages 4 to 8 should get 800 mg per day; 9 to 18 should get 1300 mg per day.

Osteoporosis is a major public health threat for 44 million Americans. Undetected osteoporosis can progress painlessly until a bone breaks. The foundation for strong, healthy bones begins in childhood and must be maintained throughout the adult years.

For more information on this topic, see the HealthLink article Bone Health: Are You at Risk for Osteoporosis? or visit the website of the National Osteoporosis Foundation.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.