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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/