Women

Osteoporosis & Recommendations for Strong Bones

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Osteoporosis, meaning “porous bones,” is a common, progressive condition in which bones become more brittle and fragile, resulting in increased risk of fracture. Most often it is a disease of aging. Bone strength and eventual loss is primarily determined by genetics, then affected by lifestyle and other medical conditions.

Risk factors for osteoporosis include excessive alcohol use, smoking or increased caffeine intake, family history of osteoporotic fractures, low body weight, low calcium or vitamin D intake, low level of physical activity, personal history of fracture, and Caucasian or Asian ethnicity. Initially, osteoporosis is silent. But eventually osteoporotic fractures cause significant pain, disability and even death. The International Osteoporosis Foundation estimates 10 million women worldwide have osteoporosis. Men can also have osteoporosis, although typically rare, they often have worse health outcomes.

Diagnosing

Osteoporosis is diagnosed radiographically through dual energy x-ray absorptiometry (DEXA) of the hip and lumbar spine beginning at age 65 measuring bone mineral density. There is also a screening tool that estimates a 10 year fracture risk and women less than 65 years with increased risk factors should have a DEXA earlier. DEXA screening should be done every 2 years unless new health risks develop.

Treatment

Treatment of osteoporosis consists of lifestyle measures and medications. The focus of this article will target treatments in regard to lifestyle, dietary and vitamin supplementation.

Lifestyle measures aim to reduce bone loss and include adequate calcium and vitamin D, exercise, smoking cessation, counseling on fall prevention and avoidance of heavy alcohol use.

Role of Calcium/Vitamin D and other dietary recommendations in osteoporosis:

 Post-menopausal women who are getting adequate calcium from dietary intake alone (about 1,200 mg daily) do not need to take a calcium supplement. Pre-menopausal women need 1,000 mg of calcium per day. Women with inadequate dietary intake should take calcium supplements (generally 500-1,000 mg/day), in divided doses at mealtime, such that their total calcium intake (diet plus supplements) approximates 1,000-1,200 mg/day depending on pre/postmenopausal. Men ages 19-70 should get 1,000 mg of calcium per day and 71+ should get 1,200 mg.

Food sources and Calcium Content:

  • Skim milk, low fat, whole 1 cup=300 mg
  • Cottage cheese ½ cup=30 mg
  • Ice cream ½ cup=100 mg
  • Sour cream 1 cup=250 mg
  • Yogurt 1 cup=450 mg
  • Hard cheese (cheddar, jack) 1 oz=200 mg
  • Blackstrap Molasses 1 Tbsp=135 mg 
  • Plant-based milk, calcium fortified 8 ounces (oz)=100-450 mg
  • Orange juice, calcium fortified 8 oz=300 mg
  • Collard greens, 1 cup 50 mg
  • Turnip greens, cooked 1 cup=80 mg
  • Kale, raw 1 cup=55 mg
  • Spinach, cooked 1 cup=240 mg
  • Soybeans, cooked 1/2 cup=100 mg
  • Navy Beans, cooked 1/2 cup=70 mg
  • Almond butter 2 Tbsp=100 mg
  • Almonds, whole 1 oz=80 mg
  • Broccoli, cooked 1 cup=180 mg

In addition, women should take a total of 800 international units (iu) of vitamin D daily.

Protein can be overlooked as a component of healthy bones. Research has shown that higher intake of protein was associated with a 16% reduction in hip fracture compared to low intake regardless of the whether the protein source was animal or plant.

Magnesium is another important vitamin that is readily present in many foods within a healthy diet. Yet, much of the population, especially the older adult, have inadequate intake. Good sources of magnesium include nuts and seeds, soybeans, dark green leafy vegetables, and dairy products. Deficiency is associated with altering calcium intake/absorption with subsequent bone effects. The majority (60%) of total body stores of magnesium are stored in the bone thus the direct impact with bone health.

Vitamin K2 is the least known important supplemental vitamin source for bone health. Vitamin K is also responsible for clotting. The focus of this discussion is on the actions of vitamin K in regard to bone health. There are two main forms of vitamin K.

  • K1, which is produced by plants and makes up 90% of the vitamin K obtained in the diet.
  • Vitamin K2 (menaquinone) is the result of bacterial action in the GI tract converting K1 to K2 or obtained directly from food sources such as meat, egg yolks, fermented dairy and fermented soy.

Vitamin K promotes bone function, improves bone strength and reduces osteoporosis. Studies have shown that supplements with Vitamin K2 improves lumbar spine bone mineral density and reduced fractures. The current adequate intake of vitamin K in adult women is 90 mcg. The best sources of vitamin K are green leafy vegetables. Vitamin K is fat soluble and foods rich in vitamin K should be eaten with a healthy fat, such as olive oil or with meals. Patients taking warfarin (a medication to prevent clotting) should be counseled about dietary changes and supplements containing vitamin K.

Exercise:

Women with osteoporosis (and those who are seeking to prevent it), should exercise for at least 30 minutes three times per week. There is no conclusive evidence that high intensity exercise, such as running, is of greater benefit than lower intensity exercise, such as walking. The recommendation is to pick a regular weight-bearing exercise regimen that is joyful and stick to it.

Substances that may harm bone:

  • Sodium: high sodium diets can increase the body to rid itself of calcium through urine. Limit sodium to < 2,400 mg/day.
  • Caffeine: Daily coffee intake (exceeding > 300 mg/day) was associated with an increased risk of fractures among women.
  • Smoking: Cigarette smoking increases the risk of osteoporosis. Studies have shown a direct relationship between tobacco use and decreased bone density. Smoking has also been shown to have a negative impact on bone healing after fracture.
  • Alcohol: Excess alcohol interferes with the balance of calcium and vitamin D. Alcohol increases cortisol levels which decreases bone formation and increase bone breakdown.

It is important to determine early risk factors that are modifiable and make changes in your lifestyle now. Osteoporosis can have serious effects and early screening and detection is so important to improve one’s overall quality of life.

Haley Scellick, ARNP

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