Osteoporosis and osteopenia are diseases of the bones which cause weakness and thinning, putting patients at high risk for fractures. A major osteoporotic fracture can be life-changing and ultimately can contribute to major setbacks in lifestyle and a downward spiral of good health. A hip fracture can make a very independent person a dependent one in a split second. Vertebral osteoporosis can lead to decrease in height and painful back fractures.
Prevention of osteoporosis should be a significant concern to peri-menopausal women, since declining estrogen levels accelerate the progression of the disease. The best time to maximize bone mass and health is in the early decades. Think of building bone in one’s youth as saving money in the bank, and its storage can be relied upon in retirement. Men are at risk of osteoporosis as well, and although the incidence is lower than in female patients, the messages in this post are applicable to men, especially in the face of a perfect storm of factors which are proving to accererate the disease.
“A Perfect Storm”
There are a constellation of common reasons that put many at risk of osteoporosis. I call them the perfect storm.
1. Diets deficient in calcium
Many of our diets are deficient in calcium. Lack of adequate calcium intake can manifest into weak bones. Current recommendations for calcium supplements range between 1000mg-1500mg. A diet rich in calcium is the optimal way to get this mineral. Talk to your physician regarding supplements. A full days calcium cannot be absorbed at one time. It is recommended to be divided into three doses or meals.
2. Vitamin D Deficiency
Vitamin D is needed to absorb calcium from our guts. Since sunlight converts vitamin D into its active metabolite, avoidance of the sun may be good for prevention of skin cancer, but may leave us vulnerable to vitamin D deficiency. In addition, the winter months give us less hours of sunlight and the cold temperatures make being outside less desirable. Incorporate vitamin D rich foods or foods that are supplemented with Vitamin D. Talk to your doctor if you need Vitamin D supplements.
3. Bone Unhealthy Foods
Foods high in sodium can wasting of calcium through the kidneys. Sodas high in phosphoric acid, such as colas, interfere with the absorption of calcium. Caffeinated drinks and foods steals calcium from bones. Chronic alcohol contributes to low bone mass, and alcohol consumption can be linked to increase of falls, which can increase fractures. Food with oxalates, such as green spinach, prevent the absorption of calcium. Be educated about these foods and limit bone unhealthy foods.
4. Sedentary Lifestyle
Since bone remodeling is stimulated by weightbearing exercise and torque on the bones, a sedentary lifestyle does the opposite.
5. Family History
We inherit risk factors from our family history. A family history may put us at risk for increased incidence of osteoporosis.
6. Imperfect Drugs
Although many categories of drugs work well to increase bone density, there have been widely publicized concerns for drug side effects ranging from rare atypical femoral fractures as well as GI symptoms and hypotension. Additional medications carry risk for blood clots. There are most certainly indications for starting these medications; however, the best medicine is prevention and focusing on bone health early. Discuss best strategies with your physician.
Bone Building Strategies
1. Incorporate Calcium Rich Super foods
Although dairy foods are a rich source of calcium, milk, yogurt and cheese are only part of the solution of incorporating calcium-rich foods in ones diet. Think beyond dairy. Knowing that an 8 ounce glass of milk contains 300 mg calcium, use the following references to compare additional dietary sources of calcium. Also, refer to the specific foods on the list published by The International Osteoporosis Foundation.
- Collard Greens (268mg per 1 cup cooked)
- Tofu (434mg ½ cup)
- Broccoli (100mg in 2 cups raw)
- Kale 100mg (1 cup raw)
- Bok Choy (74 mg 1 cup shredded)
- Figs (121mg ½ dried)
- Oranges (74mg 1 orange); Fortified OJ (350mg cup)
- Sardines (351 mg 3.75 ounce can)
- Salmon (232 mg medium portion)
- White beans (63mg in ½ cup cooked)
- Okra (82mg in 1 cup)
2. Recognize how to get vitamin D
Get moderate sunlight during non-peak hours for limited periods of time; walk outside, do yard work. You can still wear sunscreen on your face. Vitamin D rich foods include: oily fish including salmon, trout, mackerel, herring, portobello mushrooms, fortified foods such as milk and cereal, tofu, egg yokes and pork.
3. Skip the Cola
Avoid cola, sweets, excessive salt, and the foods listed above in #3. Spinach is fine to eat, but not as a source of calcium.
4. Go for a walk, every day
Walk with light weights, do yoga, start weight-bearing activity, build muscle mass.
5. Search for clues from the past
If your parents or relatives suffered a hip or vertebral fracture, you may be at risk as well. Research family history if possible. Caucasian and Asian populations are at highest risk for osteoporosis.
6. Meet with your doctor
Discuss bone building strategies with your doctor. Know your T-score, the measurement determined by the DEXA or bone density test, which compares your bone density to those of a healthy young adult.
To learn more about osteoporosis, calcium and diet, click here to view recent slides from lecture I gave on bone health.