Calcium, Bone Health & Osteoporosis - Introduction

University of Georgia Cooperative Extension Service

What Is Osteoporosis? Porous bones

Bones have lost calcium & other minerals

Bones are fragile Spine, hip and wrist fractures

are common

Life of Bones Functions

Gives structure to body Protects internal organs Stores essential minerals

Types Cortical bone

Outer layer Trabecular bone

Spongy inner layer

Life of Bones Living, active tissue Bone remodeling

Osteoclasts Dissolve or break down bone tissue Stimulated by low calcium intake

Osteoblasts Rebuild bone tissue Stimulated by exercise

Bone Architecture

Normal Bone

Osteoporotic bone

National Osteoporosis Foundation, http://www.nof.org/osteoporosis/bonehealth.htm

Prevalence & Cost of Osteoporosis More than 44 million Americans

affected 10 million have osteoporosis 34 million have low bone mass

Called osteopenia More than 1.5 million fractures

each year $17 billion in health costs in 2001

Osteoporosis in Georgia 1/3 people > age 50 affected

by osteoporosis 75 fractures occur daily $323 million in health costs

in 2000 $570 million in estimated health

costs by 2025

Glimpse of Osteoporosis Fractures

One out of two women > age 50

One out of eight men > age 50

Nearly 1/2 million hospitalized with fractures each year

One out of five dies within 1 year Half never live independently again

Glimpse of Osteoporosis Men

80,000 hip fractures/ year Women of all ethnic backgrounds

One in twenty African-American women One in ten Mexican-American women

People of all ages Increasing number of women in 20s-30s

Risk Factors Female gender

Increasing age Thin, small-boned - BMI < 19 Caucasian or Asian ethnicity Family history of fractures or

osteoporosis

Risk Factors Abnormal menstrual history

Late menarche Menstrual interruptions/irregularities Early menopause (< age 45)

Past menopause Low testosterone levels (men) History of eating disorder/strict

dieting

Risk Factors Medical conditions

Bone fracture(s) after age 40 Rheumatoid arthritis Thyroid disorder Parathyroid disorder Poorly controlled Type 1 diabetes Lactose intolerance Digestion disorders

Risk Factors Medication use

Long-term corticosteroid use High doses thyroid hormone Anti-seizure or epilepsy medications Certain diuretics Excessive aluminum-containing antacids Gonadotrophin-releasing hormone

agonist

Lifestyle Risk Factors Inactive lifestyle Diet low in calcium

Little sun exposure and diet low in vitamin D

Consume few fruits and vegetables Drink excess alcohol (> 7 drinks/week) Current or former smoker Consume large amounts of caffeine

5 Steps to Strong Bones

Avoid harmful habits

BMD testing & medications

Active lifestyle

Regular sunshine

Healthydiet

Step 1: Eat a Healthy Diet for Bones Diet rich in calcium & vitamin D

2 – 4 servings milk/dairy foods Calcium-fortified foods Calcium/vitamin D supplements

Foods rich in other bone healthy nutrients 5 or more servings vegetables & fruits

Potassium, magnesium, zinc, copper Vitamin K & vitamin C

Building Bones Building bones = building

a bank account Calcium is “deposited”

During childhood, teen & young adult years When consume enough calcium & vitamin D

Calcium is “withdrawn” During older adult years When do not consume enough calcium &

vitamin D

Calcium & Vitamin D Matter at Any Age Children

For bone growth Teens and young adults

For bone growth Maximizing bone mass

Adults Maximizing bone mass Minimizing bone loss

Calcium Recommendations

Age Calcium (mg/day) 1 – 3 years

500 mg

4 – 8 years

800 mg

9 – 18 years

1,300 mg

19 – 50 years

1,000 mg

51 years

1,200 mg

Pregnant/lactating women < 18 years

1,300 mg

Pregnant/lactating women > 18 years

1,000 mg

1997 National Academy of Sciences

Choose Calcium-rich Foods Milk, yogurt, buttermilk, ricotta cheese, hard cheeses Calcium-fortified foods

Orange juice, soy drinks Breakfast cereals, cereal bars

Tofu made w/ calcium sulfate Canned salmon w/bones

Include Foods = 1/2 Calcium-rich Source 2 servings = 1 calcium-rich food

1/2 cup pudding 1/2 cup frozen yogurt or ice cream 1/2 cup mustard or turnip greens 1/2 cup cooked rhubarb 1/3 cup almonds 1 piece cornbread

Include Foods = 1/4 Calcium-rich Source 4 servings = 1 calcium-rich food

1/2 cup cottage cheese 1/2 cup broccoli, kale, or okra 1 cup romaine lettuce 1/2 cup cooked beans 1 medium orange 2 dried figs 3 oz fresh fish or seafood 1/2 English muffin

Show Me the CalciumFood Calcium

1 cup plain nonfat yogurt 450 mg

1 cup fruited yogurt 315 mg

1 cup fat free milk (skim) 300 mg

1 cup chocolate milk (1%) 285 mg

1 ½ ounces cheddar cheese 300 mg

½ cup pudding 150 mg

½ cup frozen yogurt 100 mg

½ cup ice cream 80 mg

½ cup cottage cheese 75 mg

Show Me the CalciumFood Calcium

1 cup calcium-fortified soymilk

250 – 300 mg

1 cup calcium fortifiedorange juice

300 mg

3 oz canned salmonw/edible bones

205 mg

1 Tbsp blackstrap molasses 170 mg

½ cup cooked greens 50 - 100 mg

1 medium orange 50 mg

2 Tbsp almonds 50 mg

½ cup cooked broccoli 45 mg

½ cup cooked pinto beans 40 mg

Calcium Check Up How many servings do you eat?

Calcium-rich foods Servings x 1 =

1/2 calcium-rich foods Servings ÷ 2 =

1/4 calcium-rich foods Servings ÷ 4 =

Are you getting enough calcium? Is your total = 3 or 4?

Do You Need Calcium/vitamin D Supplements? Lactose intolerant or allergic to

milk? Avoid milk/dairy foods? On a strict weight-loss diet? Over age 50, consume little milk

and/or do not get sun exposure? On long-term steroid therapy?

Upper Limits Calcium: 2500 mg/day

Vitamin D: 2000 IU/day

1997 National Academy of Sciences

Vitamin D Two sources

Diet Fluid milk (100 IU/8 ounces) Fatty seafood, fish oils, eggs Other fortified foods, supplements

Regular sunlight exposure Skin produces own vitamin D

Step 2: Get Regular Sun Exposure Helps you meet vitamin D

needs Expose arms and/or legs for 10 - 15

minutes daily, without sunscreen Apply sunscreen after this time

Vitamin D Recommendations

Age Vitamin D (IU/day)

1 – 50 years 200 IU

51 – 70 years 400 IU

> 70 years 600 IU

1997 National Academy of Sciences

Step 3: Maintain an Active Lifestyle Regular weight-bearing exercises

Strength-training exercises

Balance & stretching exercises

Weight-bearing Exercises 30 minutes daily, > 3 times weekly

Walking, running or jogging Stair climbing, jumping rope, skating Aerobics, tennis Basketball, soccer, volleyball

Strength Training Exercises 2 times weekly

Lifting weights Dumbbells (free weights),

weight machines Resistance exercises

Push ups, leg lifts Stomach curls/crunches Standing calf & toe raises Squats, lunges

Balance & Stretching Exercises 3 times weekly (or every day)

Improve balance & flexibility Help reduce risk of falling

Do stretches after other exercises

Step 4: Get a Bone Mineral Density (BMD) Test . . . All women age 65 and older

All postmenopausal women < age 65 with risk factors or current fracture(s)

Men/women with history of fracture(s), loss of height, and/or chronic back pain

Men/women with significant risk factors

BMD Testing Women considering medication

therapy for BMD Women with long-term use of

HRT/ERT Men/women being treated for

osteoporosis

. . . & Talk to Doctor Your About Medications Calcium/vitamin D supplements Hormone replacement therapy

Estrogen only (ERT) Estrogen + progesterone (HRT) Birth control pills Selective estrogen receptor

modulators (SERMs) Raloxifene (Evista®)

Medications Bisphosphonates

Alendronate (Fosamax®) Risedronate (Actonel®)

Calcitonin (Miacalcin®) Parathyroid hormone (PTH) Testosterone

Step 5: Avoid Harmful Habits

Smoking Strict dieting

Heavy drinking (alcohol) High caffeine consumption

Diet low in calcium and vitamin D Inactive lifestyle

Extra Advice for Older Adults Fall prevention

Reduce household hazards Keep floors safe Improve lighting Install handrails Reorganize furniture Remove clutter

Improve balance & strength Exercises

Review medicines

It’s Up To You Now! What are you going to do to have

strong bones that last a lifetime?

Thank You.

Prepared by Marilyn O. Wright, MS, RD, LD

Family Nutrition Program SpecialistUniversity of Georgia

College of Family & Consumer SciencesCooperative Extension Service

References Nelson, M.E. (2000) Strong Women, Strong Bones. Berkley Publishing

Group (Perigee), New York. http://www.strongwomen.com Nelson, M.E. (1997) Strong Women Stay Young. Bantam, New York. National Academy of Science Institute of Medicine (1999) Dietary

Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D & Fluoride. National Academy Press, Washington, D.C. http://www.nap.edu/catalog/5776.html

National Osteoporosis Foundation, http://www.nof.org/ NIH Osteoporosis & Related Bone Disease National Resource Center,

http://www.osteo.org/ Duyff, R.L. (1996) The American Dietetic Association’s Complete Food

& Nutrition Guide. Chronimed, Minneapolis. USDA Nutrient Data Laboratory,

http://www.nal.usda.gov/fnic/foodcomp/ Picado, C. & Luengo, M. (1996) Corticosteroid-induced bone loss.

Prevention & management. Drug Saf, 15(5): 347-59.

Resources National Osteoporosis Foundation

www.nof.org Bonebuilders (Arizona)

http://www.bonebuilders.org/ National Institutes of Health

http://www.osteo.org/ American Society for Bone Mineral

Research http://www.asbmr.org/

Resources Strong Women Stay Young

http://www.strongwomen.com/ Powerful Bones

http://www.cdc.gov/powerfulbones/ NOAHNet

http://www.arches.uga.edu/~noahnet/ NICHD (NIH) – Milk Matters

http://www.nichd.nih.gov/milk/milk.cfm Georgia Osteoporosis Initiative

http://www.gabones.net/

Resources Pharmaceutical

http://www.merck.com/ http://www.oscal.com/ http://www.tums.com/ http://www.citracal.com/ http://www.caltrate.com/ http://www.calciuminfo.com/

index.htm

Resources National Dairy Council (800) 426-8271

http://www.nationaldairycouncil.org/ Other dairy councils/industry

http://www.dcwnet.org/index_flash.html http://www.southeastdairy.org/ http://www.oregondairycouncil.org/ http://www.dairycouncilofca.org/ http://www.whymilk.com/ http://www.eatsmart.org/

Resources Yogurt

http://www.stonyfield.com/ http://www.dannon.com/

Cheese http://www.ilovecheese.com/

Soy http://www.whitewave.com/ http://www.soyfoods.com/ http://www.genisoy.com/

Milk-replacement beverages http://www.Vitamite100.com/