Question: My mother had osteoporosis and suffered a devastating fall in her early 60’s from which she never recovered. I am 42 years old and want to be proactive about my bone health. What tests do I need and what supplements are necessary to optimize my bone health? What factors can help me maintain strong bones as I age?
Reply: Osteoporosis is a disease that causes bones to thin and lose strength. When bones become weak, sudden fractures can occur, even with minimal trauma. A calcium-rich diet is important for maintaining optimal bone health and preventing osteoporosis. So is vitamin D, which helps the body absorb calcium that is deposited in the bones. The amount of calcium and vitamin D needed to optimize bone health increases with age.
Circulating estrogen is also beneficial for the bones. Consider the analogy that calcium and vitamin D are the building blocks of bone and estrogen is like the cement that holds it all together. Although both men and women are at risk of developing osteoporosis as they age, women are at higher risk because they begin to lose bone mass after menopause due to declining estrogen levels. Women can lose bone mass rapidly up to 10 years after the onset of menopause.
Many factors contribute to bone loss and increase the risk of osteoporosis, including:
■ Family history of osteoporosis or osteoporosis-related fractures.
■ Nutrition, specifically an inadequate intake of calcium and vitamin D.
■ Body weight. A lower and lighter body weight can increase the risk of decreased bone mass.
■ Exercise. A sedentary lifestyle increases the risk of osteoporosis. Weight-bearing exercises, such as walking, jogging, tai chi, and weight lifting, can increase bone strength.
■Use medications. Certain medicines can thin the bones if used for a long time.
■Racial differences. People of Asian and Caucasian descent are at higher risk, but African-Americans tend to have more serious bone fractures.
Osteoporosis is usually detected using a bone mineral density test, which is quick and painless. This test is also known as dual X-ray absorptiometry, or DXA. This test accurately measures the amount of calcium in the bone and determines the density of the bones, usually in the hip, spine, wrist, or heel.
Checkup is often guided by age, family history, and other factors, such as a previous fracture or cancer treatment. Your health care team can help you determine when you are eligible to start bone densitometry and how often it should be done.
Some women may also be recommended menopausal hormone therapy to defend their bones from rapid thinning. In addition, various medications may be considered to stop ongoing loss or rebuild lost bone mass.
Regardless of whether you’ve already been diagnosed with osteoporosis, it’s important to remember that a healthy lifestyle, exercise, a balanced diet, and optimal levels of calcium and vitamin D can help prevent bone loss.
These are the daily recommendations for calcium and vitamin D:
■ Calcium: People age 50 and younger should take 1,000 milligrams a day. Those over 50 should take 1,200 milligrams a day.
■ Vitamin D: People age 50 and younger should consume between 400 and 800 international units per day. Those over 50 years of age should consume between 800 and 1,000 international units a day.
Daily calcium intake goals include the total amount of calcium from food or supplements combined. Some people may need more daily units if vitamin D deficiency is detected.
When it comes to what to eat or drink to meet your daily intake goals, keep these recommendations in mind:
■ Traditional dairy products, such as milk, yogurt, and cheese. For example, an eight-ounce serving of skim, low-fat, or whole milk contains about 300 milligrams of calcium.
■ Plant-based milk, such as almond, cashew, or oat milk.
■ Some vegetables, such as broccoli, kale, and spinach.
■ Whole salmon.
■ Certain cereals, juices, and breads with added calcium. See “Nutrition Facts” labels for details.
It can be difficult to meet your daily calcium needs through diet alone. In this case, it is best to take a supplement that compensates for what is not obtained with the diet. Be careful not to exceed the daily dose, as this could cause unwanted side effects.
When shopping for supplements, be sure to look for the United States Pharmacopeia (USP) or “purified” stamp on the label. Most calcium supplements should be taken with food for best absorption. The label will tell you if it is necessary.
The intestine can only absorb a limited amount of calcium at one time: 500-600 milligrams or less. Therefore, it is important to distribute calcium intake throughout the day.
When exposed to sunlight, the skin can produce vitamin D, but amounts vary depending on climate, skin pigmentation (darker pigmentation limits vitamin D absorption), age, season, and other factors. Few foods contain vitamin D, but the most common sources include wild fish, such as salmon, mackerel, and tuna, as well as dairy products, juices, and fortified cereals.
It is difficult to meet vitamin D needs with food and sunlight alone. Most people will need to take a vitamin D supplement. These supplements can be taken with or without food, and the entire daily dose can be taken at one time.
With the right lifestyle changes, you should be able to maintain strong, healthy bones as you age.