Bones give us strength, but are the foundation of our stature; they anchor our muscles in place and protect our vital organs. Our bones are a living organ, constantly being built up and broken down as are other organs in the body. Even though signs of bone breakdown don?t appear until our later years, maintaining the strength and integrity of our bones to prevent osteoporosis is a lifelong process?one that is never too early to begin.
Often referred to as the silent disease, osteoporosis is a debilitating disease in which bones become fragile and are more likely to break. Often there no warning signs, no symptoms until a bone fracture occurs. In fact, according to the National Osteoporosis Foundation, each year in the U.S. this disease leads to 1.5 million fractures and osteoporosis affects more than 28 million Americans, 10 million who know they have the disease and another 18 million with low bone mass, placing them at increased risk. Although this disease can affect both men and women, it tends to be more common in women. This is because women generally have less bone mass than men, tend to live longer than men, tend to get less dietary calcium and need the hormone estrogen to keep their bones strong. But, men please be aware that 25% of all cases of osteoporosis are in men, although the risk factors are a bit different.
In addition to being female, there are other important risk factors to be aware of, like small, thin body stature; family history of osteoporosis; early menopause; having (or having a history of) an eating disorder; low calcium intake; lack of weight-bearing exercise; smoking and excessive alcohol consumption. Chronic usage of steroid hormones is another big risk factor, for both men and women. Osteoporosis in males tends to be associated with excessive alcohol usage and the resultant liver disease as well as other chronic intestinal disorders. So if any of these risk factors apply to you, you?re at risk for osteoporosis and building and maintaining strong bones should be an integral part of your lifelong health. Taking steps to keep your bones strong and healthy will also ensure your independence as you age. Some of the most important steps you can take now are to get plenty of calcium and other bone health nutrients, exercise regularly, don?t smoke and limit alcohol consumption.
Calcium and Other Bone Health Nutrients
Most women know that getting an adequate amount of dietary calcium is important for reducing the risk of osteoporosis. However, many may not know that to maximize bone health, adequate calcium intake needs to occur throughout life and the amount of calcium you need to stay healthy changes over the course of your lifetime. Your body's need for calcium is greatest during childhood and adolescence when your skeleton is growing rapidly. Many women do not get the amount of calcium needed when they are young and therefore don't maximize their peak bone mass. Your need for calcium increases again during pregnancy and breastfeeding to ensure you're meeting the needs of your growing infant without compromising your own calcium needs. Then due to hormonal changes that come along with menopause, calcium needs increase again.
How much calcium do you need? Well during the adolescent years, young girls (and boys) should get 1300 mg a day. During your childbearing years 1000-1200 mg is recommended and after menopause women should ideally get 1200 -1500 mg a day. Men should consume 800 mg per day ages 18-50 and 1000 mg per day after age 50. To meet your calcium needs throughout life, start by improving your diet and choosing calcium rich foods every day. Low fat dairy products are always a good choice, but so are other foods like calcium-fortified soy protein, almonds, broccoli, cooked kale, canned salmon with the bones and tofu. And if you find it hard to get enough calcium from your diet, calcium supplements are a must.
Look for a calcium supplement with a minimum of 1000 mg of elemental calcium from highly bioavailable sources like calcium carbonate and calcium citrate. And don?t forget that getting enough vitamin D is just as important as getting adequate amounts of calcium. Not only does vitamin D improve bone health by helping with calcium absorption but it may also improve muscle strength and protect against certain types of cancers. Although most people get vitamin D from sunlight exposure, this may not be a good source if you live in parts of the country that get less sunlight, you are housebound or you regularly use sunscreen to reduce the risk of skin cancer (which we all should do). Drinking milk and eating other dairy products fortified with vitamin D will help boost your intake, but taking a calcium supplement with added vitamin D is also a great way to optimize your vitamin D intake. The recommended dietary intake for vitamin D is 400 IU (International Units) a day, but both men and women over the age of 65 should get twice that much (800 IU a day) and some researchers recommended even higher intake levels for optimal health.
Other essential nutrients support bone health. For example, the essential mineral magnesium appears to enhance bone strength. Although magnesium is found in foods like dark leafy green vegetables, whole grains, nuts and even chocolate, food consumption surveys show that 80% of Americans don?t get enough magnesium from their diets. The trace minerals zinc, copper, manganese and boron are also important because they assist with the development of optimal bone matrix or structure needed for proper bone strength. Eating a diet rich in plant foods ? whole grains, beans, and nuts can boost your intake of these essential minerals and supplementing your diet with dietary supplements containing these trace minerals is a wise choice.
In addition, protein and calcium can work synergistically on bone, despite the long-held belief that eating animal protein increases the risk of osteoporosis. Increasing evidence suggests that a diet adequate in protein, either of plant or animal origin, protects against osteoporosis in men and women. And research on diets rich in soy isoflavones has shown long-term bone-sparing effects but the magnitude of the effect is presently unclear. These estrogen-like plant compounds may help maintain bone density and offset bone loss that occurs during the menopausal years when estrogen levels drop. Further research is needed to clarify the conditions where soy isoflavones may be helpful in retaining bone mineral density or lowering fracture risk.
Some nutrients consumed in high levels are not so good for your bones. Excessive amounts of vitamin A appear to trigger an increase in osteoclasts, the cells that break down bone, but note that this only occurs with pre-formed vitamin A or retinol, and adverse effects in bone have not been linked to beta-carotene.
Like muscle, bone is living tissue and responds to exercise by getting stronger. Not only does exercise improve your bone health, it increases muscle strength, coordination and balance and leads to better overall health. If you exercise when you?re young it helps build bone mass (increases bone density and strength) which in turn can prevent bone loss as you age. The best exercise for bone health is the weight-bearing kind. Activities that force you to work against gravity include lifting weights, walking, hiking, jogging, dancing and playing tennis. Although great for cardiovascular fitness, exercises like swimming and cycling are not weight bearing and, therefore not the best ways to exercise your bones. Learning how to stretch properly, strengthen muscles safely and correct poor posture habits can also be helpful. Ideally, you should exercise for at least 30 minutes a day most days of the week. If you're over age 40, have other health issues such as diabetes, heart disease, high blood pressure or obesity always check with your doctor before beginning a regular exercise program. If you have osteoporosis, be sure to ask your doctor about which activities are safe for you.
Cigarette smoking was first identified as a risk factor for osteoporosis more than 20 years ago. Although not all studies indicate that smoking increases the risk of bone fractures we do know that the longer and the more cigarettes you smoke, the greater your risk of fracture in old age. Smokers who do have a bone fracture may take longer to heal than non-smokers and are more likely to develop complications during the healing process. Significant bone loss has also been found in older women and men who smoke and at least one study suggests that exposure to second hand smoke during childhood and the early adult years may increase the risk of developing low bone mass. The good news? Quitting smoking may reduce the risk of low bone mass and fractures after several years of being smoke-free.
Limit Alcohol Consumption
Chronic alcohol consumption (more than 2 drinks a day) has been linked to an increase in fractures of the hip, spine and wrist. That?s because drinking too much alcohol interferes with the balance of calcium in the body. It also affects the production of hormones which protect bone and of vitamins which we need to absorb calcium. Excessive alcohol consumption can also lead to more falls increasing the risk of breaking a bone during those falls.
Be Good To Your Bones
Although osteoporosis is a serious and debilitating disease, it's never too early or too late to improve your bone health. If you are over age 60, or have more than 3 risk factors, you should ask your doctor about getting a bone density test. They're safe, quick and painless. If you think your diet is falling short of bone health nutrients, try improving your food choices and choosing a dietary supplement with key bone support nutrients. Look for a supplement with 100% of the RDA for calcium, vitamin D and magnesium plus other trace minerals like manganese, zinc, copper, and boron. Start a weight training program, go dancing, or engage in other weight-bearing activities. And, if your lifestyle involves less healthy behaviors like excessive drinking or smoking, work on cutting back your alcohol intake and talk to your doctor about a smoking cessation program today!
Dr. Jamie McManus MD, FAAFPChairman, Medical Affairs, Health Sciences and Education
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