Bone Health

GENERAL INFORMATION ABOUT OSTEOPOROSIS:            

After age 35 or so, almost everyone loses bone.

Factors that speed up bone loss include a low calcium diet, excessive elimination of calcium in the urine, sedentary life style, cigarette smoking, being underweight, early menopause, and over-treatment with medications such as thyroid hormone and cortisone.

Osteoporosis is defined as 1) reduced bone density and 2) weakening of the internal architecture of bone, resulting in bones that are unusually susceptible to fracture. Defined this way, osteoporosis is a potential problem: an indication that one’s risk for fracture is increased. Osteopenia and low bone density are other terms used by experts for patients whose bone density is low but who have not yet had fractures.

Bone density cannot be determined by standard x-rays, but can be measured by several techniques such as dual-energy x-ray absorptiometry, also known as DEXA. This test can determine if bone density is abnormally low for age and sex. The results are extremely important for diagnosing osteoporosis (identifying patients at risk for future fractures) and in following the response to treatment.

Fractures represent a complication of osteoporosis. Frequently, the diagnosis of osteoporosis is not made until at least one fracture has occurred. Common locations for these fractures include the vertebrae (spine), the hip, and the wrist. The tendency to fracture is partly the result of weakening of the bones, but other factors (including injuries such as falling or lifting) also contribute to fractures.

There are ways to prevent or slow the progression of bone loss and medications that at least partially reverse the process. Medications and life style changes can help in dealing with the complications of this disease. If you already have osteoporosis, don’t despair. With proper treatment, you can reduce your risk of further fracture and improve chronic pain.

WHAT YOU CAN DO TO RETARD FURTHER CALCIUM LOSS

CALCIUM

The recommended intake of calcium is 1200 mg daily for adults over age 50.

This is a target for your daily calcium intake. If your diet does not contain enough calcium, you should take a calcium supplement. The next page will help you estimate your dietary calcium intake and allow you to determine the proper amount of supplement, if you need one.

VITAMIN D

The recommended vitamin D supplement is 400 to 800 IU per day.

If you are young and healthy, you probably get enough vitamin D in your diet and from sun exposure. You may not need a vitamin D supplement.

                If you have osteoporosis or are at risk, you should be on the safe side and take a standard supplemental multivitamin containing 400 IU of vitamin D (such as One-A-Day® brand, Theragran®, Centrum®, etc.). I suggest the least expensive one. If you prefer not to take a multivitamin, you can purchase plain vitamin D through pharmacies and health food stores.

If you are over age 70, have a chronic disease, or are on medications such as cortisone or prednisone, you should increase your vitamin D supplement to 800 IU per day. The best way to do this is by taking one multivitamin (400 IU daily) and a combination calcium plus vitamin D supplement (typical combinations contain 500 to 600 mg of calcium and 200 IU vitamin D).

ACTIVITY

If possible, walk regularly, 30-40 minutes per session, at least 4 sessions per week.

Muscle action helps to keep calcium in the bones. The best activity for this purpose is weight-bearing exercise such as walking. If you have not been active on a regular basis, start slowly (5 minutes a day) and build up over 4 to 6 weeks. If you have a history of heart or circulatory problems, check with your physician before considering any increase in activity. If you are not able to perform weight-bearing activity, do the best you can. Buoyant exercise, such as water aerobics, is better than no exercise at all. Whatever activities you choose, be careful not to injure yourself.

DO NOT SMOKE

ARE YOU GETTING ENOUGH CALCIUM?

At First, you need to estimate the amount of calcium you get from your diet each day. Foods rich in calcium include:

DAIRY PRODUCTS

approximate calcium content:

Milk (all forms) 300 mg in 1 cup

Ice cream 160 mg in 1 cup

Dairy yogurt 400 mg in 1 cup

Frozen yogurt 200 mg in 1 cup

Cottage cheese 125 mg in 1 cup

Cheese: American cheddar Swiss 160 mg in 1 ounce 200 mg in 1 ounce 270 mg in 1 ounce

CALCIUM-FORTIFIED ORANGE JUICE 200 mg in 8 ounces

GREEN LEAFY VEGETABLES

Broccoli, collards, mustard or turnip greens 150-250 mg/cup

CERTAIN SEAFOODS

CALCIUM SUPPLEMENTS

Calcium in pill form has no negative effect and it is just as good for your bones as calcium in milk and other foods, and without the calories! Calcium supplements come in different forms (calcium carbonate, calcium lactate, etc.). Have your pharmacist be sure you get one with the right amount. Antacids such as Tums® provide an inexpensive source of calcium (as calcium carbonate) that is usually well tolerated. (Each regular Tums® tablet contains 200 mg of calcium, Tums-EX® 300 mg, and Tums Ultra®, 400 mg). If calcium carbonate causes gas or constipation, calcium citrate (Citracal® or Nutravescent®) are good substitutes. Viactiv, a soft, flavored, chewable calcium is available.

Calcium supplements are best absorbed when taken with food and best taken no more than 500 mg per dose (for example, 500 mg two or three times daily).

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