BUILDING BONES FOR A LIFETIME - Osteoporosis and You
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BUILDING BONES FOR A LIFETIME
Osteoporosis and You
Osteoporosis: ARE YOU AT RISK?
You may feel and look fine on the outside, but your
bones may tell a different story. The risk factors for
osteoporosis can start as early as infancy.
Check any of the following that describe you:
☐ female
☐ white or Asian
☐ family member has osteoporosis
☐ thin-boned, slight, or small build
☐ 45 years or older
☐ no menses (no “monthly periods”)
☐ lack of regular exercise
☐ underweight or thin for height
☐ smoke cigarettes
☐ drink more than one alcoholic drink a day
☐ on long-term steroidal, anticonvulsant, or
thyroid medications or cortisone-like drugs for
asthma, arthritis, or cancer
☐ frequently take magnesium-containing antacids
and pain relievers
☐ don’t consume milk, milk products, or other
calcium-rich products
The more of these you checked, the more at risk
you are. Reducing your chances of developing
osteoporosis depends on your understanding of the
risks and on developing a lifestyle that will reduce
your risk.
Department of Youth, Family
and Community Sciences
Osteoporosis Risk Factors
Factors We Can’t Change... and size. This can happen fairly rapidly even to
those who had previously been exercising because
Gender—In their formative years, males generally the effects of exercise on this process cannot be
build larger, thicker, denser bones than females. stored. For example, for every week a person
After middle age, both men and women lose bone spends in bed, about one percent of bone mass will
mass and do so at the same rate. However, since be lost. Therefore, daily exercise and lifelong ac-
their bones are thicker at peak density, men have tivity are the keys to building and retaining strong
many more years of losing calcium before their bones.
bones become frail and thin. For women, bone loss
accelerates after menopause, when estrogen levels Body Weight—Bones of heavy people are usu-
fall. ally stronger and thicker than bones of lightweight
people because weight puts more physical strain
Race—In general African-Americans develop on bones, causing greater formation of bone. More
stronger and thicker bones than Caucasians and weight-bearing exercise occurs when a heavy
Asians. African-Americans generally average a 10 person walks than when a lightweight one does.
percent higher bone mass than Caucasians, but this However, the location of the body fat is a mediat-
does not always hold true because some African- ing factor and heavy people can have thin bones.
Americans are small and thin-boned. Being more than 10 percent under “ideal” body
weight increases the chance of having thin bones.
Genetics—Genetics is involved in the develop-
ment of bones and in the tendency to lose or retain Diet—Proper diet plays a major role in bone
bone over a lifetime. If one family member has development and retention. Since bone is made
had problems with thin, frail bones, other mem- up mostly of proteins, minerals, and water, lack-
bers may be at greater risk of developing weak
ing any of these will keep bones from forming
bones.
properly. People typically get enough of these to
take care of bone needs, but they don’t always
Factors We Can Change... consume enough calcium or vitamin D. The body
Weight-bearing exercise—Bone development is needs calcium for other functions and the stored
stimulated when bones are under pressure. As a calcium in bone is removable. Therefore, when
result, the bones of physically active individuals our bodies are low in calcium, it is withdrawn
are usually stronger and thicker than the bones of and used where needed. As a consequence, bones
inactive people. Normal activities, such as walk- will be weakened or, if this occurs during a
ing, running, or dancing, help everyone build growth period, bones may not develop adequate-
and keep strong bones. Bones of people who are ly. So adequate calcium is crucial to bone health.
totally inactive (such as those of an astronaut in Equally important, vitamin D from the diet or
space, those in a cast, or those in people who are sunlight is critical to the absorption and utiliza-
bedridden) lose calcium and decrease in strength tion of dietary calcium.
2 Building Bones for a Lifetime
Osteoporosis DO N’ T L E T Y O URS E L F BE AT R ISK Most of us take our bones for granted but we shouldn’t. Everyone’s bones will not be strong and dependable all through life. For some, who don’t take precautions, bones will become thin and brittle later in life, a con- dition known as osteoporosis. To find out how to promote dense, strong bones, let’s look a little more closely at our bones, “the framework of our bodies.” Bone is that dense, hard material is a “hidden” disease, in that it HOW CAN YOU GET MORE that makes up the skeleton. Most produces no symptoms (no pain) or CALCIUM? of us “know bone when we see it,” warning signs until fractures occur. but what we usually see is pre- First, look to your food to supply served bone that appears “hard as Fortunately, we know a lot about your calcium. Choose more foods a rock.” That’s why we don’t think factors that promote strong bones rich in calcium. For help see: the of our bones as living tissue. Our and protect against net loss of bone Calcium Food Wheel, the My- bones contain many nerves, blood tissue. The rest of this publication Plate, and the Calcium Checklist. vessels, and other cells. About half will help you become an active Using food to increase calcium of the bone content is solid mate- participant in building and main- intake also gives you other essen- rial and the rest is water. The solid taining the best bones possible for tial nutrients, such as magnesium, part is composed of mineral depos- the rest of your life. Start with get- phosphorus, potassium, thiamine, its held together by a network of ting enough calcium. riboflavin, and vitamins C and D. proteins. The most abundant and important minerals are calcium and phosphorus. (For more discussion of bone development, see page 10.) Osteoporosis (brittle bones) is a disease in which more bone tissue is removed than is added so that over time the skeleton becomes thin and frail. It may become so weakened that normal workloads, the slightest injury, or certain movements can cause bones to break. Osteoporosis affects all bones, but most of the breaks occur in the hip, wrist, and spine. These fractures can cause pain, disfigure- ment, and disability. Osteoporosis Osteoporosis and You 3
Calcium from MyPlate
Milk, yogurt, and cheese are the rich- ars contain no calcium. Cream cream, are high in fat. Read
est sources of calcium. Contrary to what cheese, sour cream, whipping labels and choose the lowfat
many think, you don’t have to get all cream, coffee cream, artificial or nonfat foods if you are
your dietary calcium from milk; it’s just creamer, and whipped topping trying to keep the fat con-
easier that way (if you can drink milk) contain little or no calcium. tent of your diet low.
as shown by the Calcium Food Wheel. If
you do not consume milk products, you Neither the Fruit group nor the To increase calcium in
are likely to get less than 25 percent of Grains group is a good, natural the diet, add nonfat dry
your daily calcium recommendation. source of calcium. However, milk powder to recipes for
some products in these groups sauces, soups, biscuits,
Dark green vegetables contain high may have calcium added dur- cornbread, puddings, casse-
levels of calcium, but all of that calcium ing processing. The amounts are roles, meatloaf, and cus-
is not necessarily available to the body. listed on the labels. tards. One-third cup nonfat
Some contain certain plant substances, dry milk provides the same
such as oxalates and phytates, that bind Note: Many dairy products, such amount of calcium as 1 cup
calcium and interfere with calcium ab- as whole milk, cheese, and ice of milk.
sorption. Foods with high levels of these
substances make poor sources of avail-
able calcium. For example, only about
5 percent of the calcium from spinach
(which is high in oxalate) is absorbed
while about 30 percent of the calcium
from milk is absorbed.
The Meat and Beans group provides
some good calcium sources. Soy prod-
ucts like tofu and soy milk can provide
calcium if calcium has been used in the
processing. Read the label for amounts
of calcium. Fish with bones, such as
sardines and salmon, is a good source
of calcium if you eat the bones. For ex-
ample, 4 1/2 ounces of canned salmon
with bones or 3 ounces of sardines sup-
ply about the same amount of calcium
as does 1 cup of milk.
Fats, oils, and sweets supply little
or no calcium. Pure fats, oils, and sug-
MyPlate.gov
4 Building Bones for a LifetimeCalcium Checklist
To see how much calcium you get in a typical day: 1) record the number of servings you ate on a typi-
cal food-intake day last week and use the drawings to determine serving sizes; 2) multiply the number
of servings times the calcium value; 3) total your calcium intake for each group.
Number Calcium Amount
Servings x Calcium Value = Food (1 serving) servings Value Consumed
Amount of Calcium MILK, YOGURT, CHEESE
Consumed (mg) Cheddar cheese (1 ounce or 6 tablespoons) __ x 204 =
Cottage cheese, 1% fat (1/2 cup) __ x 70 =
Custard, pudding, tapioca (1/2 cup) __ x 150 =
Ice cream, frozen yogurt (1 cup) __ x 188 =
Milk, milk shake, or cocoa made with milk (1 cup) __ x 300 =
Soy milk (1 cup) __ x 10 =
Yogurt whole (8 fl.oz.) __ x 274 =
Cream soup or sauce prepared with
milk (1 cup) __ x 200 =
Macaroni and cheese, homemade (1 cup) __ x 300 =
Cheese pizza (1/8 of 15-inch pie) __ x 200 =
Quiche (1/8 of 8-inch pie) __ x 250 =
TOTAL
FRUITS, VEGETABLES
1 cup Coleslaw (1/2 cup) __ x 40 =
(8 fluid ounces) Cooked collards (1/2 cup) __ x 74 =
Fruits (1/2 cup or 1 small) __ x 30 =
Spinach (1/2 cup, cooked) __ x 122 =
Broccoli and turnip greens (1/2 cup, cooked) __ x 90 =
½ cup TOTAL
(4 fluid ounces)
BREADS, CEREALS, RICE, PASTA
Bagel (1) __ x 20 =
Bread (1 slice) or cereal (1 ounce) __ x 20 =
2-inch biscuit or roll, or 6-inch corn tortilla,
or 3-inch muffin, cornbread, or doughnut __ x 40 =
Rice, noodles, or pasta (1 cup) __ x 20 =
Pancake, waffle, or french toast (1) __ x 100 =
TOTAL
Osteoporosis and You 5Number Calcium Amount
Food (1 serving) servings Value Consumed
Meat, Fish, Poultry, Dry Beans, Nuts
Dried beans, cooked (navy, ½ cup vegetable or fruit
kidney, pinto) (1 cup) __ x 50 =
Meat, fish, poultry (3 ounces) __ x 10 =
Peanuts (1/2 cup) or large egg (1) __ x 30 =
Canned salmon with bones (3 ounces) __ x 199 = this high in center
Sardines with bones (3 ounces) __ x 321 =
3 ounces shrimp or 7-9 oysters __ x 100 =
Tofu (2 1/2 x 2 1/2 x 1-inch square) __ x 100 =
TOTAL
Fat, Sugar, Alcohol*
Cake (1/16 of 9-inch cake) __ x 40 =
Beer (12 ounces) __ x 10 =
Colas (12 ounces) __ x 10 =
Chocolate (1 ounce) __ x 50 =
TOTAL
½ oz. = 1” Cube
*It is recommended that you limit your intake of fat, sugar, and alcohol.
The actual amount that you can eat depends upon a variety of factors and
your overall dietary goals.
How much calcium did you consume?
Group Calcium mg
Milk _______
Fruits, Vegetables _______ cheese or luncheon
Bread _______ meat this thick
Meat _______ ½ oz.
Fat, Sugar, Alcohol _______
Total Calcium Consumed _______ 1 oz.
Presently, adults average 75% of the recommended amount of calcium each day. There are differences of
opinion as to how much we need. Several experts suggest that adequate intakes for all adults would be 1,000
milligrams for ages 19 to 50 and 1,200 for age 51 and over. After menopause, calcium intake is even more
important to help prevent bone loss due to normal age-related decreases in bone tissue, calcium absorption,
and estrogen levels. Since most of the dietary calcium comes from the milk, yogurt, and cheese group, it is
generally difficult to get enough calcium without dairy products.
6 Building Bones for a LifetimeHOW WELL DID cium shown for your age and Try to get that amount each
YOU DO? condition. For example, if day. The chart shows that
you are a 30-year-old woman you get almost that amount
Check your calcium con- who is not pregnant, nurs- of calcium by drinking 3 cups
sumption number against ing, or postmenopausal, you of milk (One cup of milk con-
the recommended amounts. would find the recommenda- tains 297 mg calcium.) Make
Your best bet is to consume tion for you to be 1,000 milli- sure you also get enough
at least the amount of cal- grams (mg) calcium per day. vitamin D.
Institute of Medicine 2010
Milligrams Calcium Equivalent 1-cup IU Vitamin D
Age/Condition Each Day Servings of Milk Each Day
1 - 3 . . . . . . . . . . . . . . . . . . . . . . 700 . . . . . . . 2 - 2 ¹/3
4 -8 . . . . . . . . . . . . . . . . . . . . . . 1,000 . . . . . . 3 - 2 ¹/3 . . . . . . . 600
9 - 18 . . . . . . . . . . . . . . . . . . . . . 1,300. . . . . . 4 - 4 ¹/3 . . . . . . . 600
19 -50 . . . . . . . . . . . . . . . . . . . . . 1,000 . . . . . . 3 - 3 ¹/3 . . . . . . . 600
51+ . . . . . . . . . . . . . . . . . . . . . . 1,200 . . . . . . 4. . . . . . . . . . . 800
Pregnant & nursing women (19-50 yrs.). . . 1,000 . . . . . . 3 - 3 ¹/3 . . . . . . . 600
Pregnant & nursing teenagers (14-18 yrs.) . . 1,300 . . . . . . 4 - 4 ¹/3 . . . . . . . 600
OVERCOMING PROB- If you have this problem, sugges- ☐ Drinking milk in small
LEMS WITH LACTOSE tions include trying: amounts, preferably with other
foods.
INTOLERANCE ☐ 100% lactose free milk (which
has been treated to break down ☐ Yogurt, particularly with live,
If you are lactose intolerant (can’t the lactose). active cultures. Yogurts vary,
digest the natural milk sugar, ☐ Calcium-fortified soy milk so if one brand doesn’t work,
lactose), you may avoid milk (contains no lactose). try another.
and milk products because of the ☐ Buttermilk (contains less lac-
discomfort it causes you. People tose)
Discuss any of your choices with
vary widely in the amount of ☐ Lactose-reducing enzyme tab-
your physician before trying
lactose they can tolerate. Many lets whenever you drink milk.
☐ Lactose-reducing enzyme them. If these don’t help, ask
times only milk, milk beverages,
preparation added to milk be- your physician to recommend a
creamed foods, and ice cream
fore you drink it. calcium supplement.
need to be avoided.
Osteoporosis and You 7Other Dietary Factors
Vitamin D—Vitamin D is needed Fatty fish (like salmon, sardines, up to 400 mg caffeine/day.
for the body to absorb calcium, so herring, mackerel, and swordfish),
low vitamin D levels may increase eggs, and chicken livers contain Alcohol—Excessive consumption
your risk of thin bones. The rec- vitamin D. of alcohol increases a woman’s
ommended amount of vitamin D chance of developing osteoporosis
is under discussion. The National Phosphorus—Phosphorus is found since alcohol reduces the body’s
Osteoporosis Foundation recom- in so many foods that a dietary ability to absorb calcium and also
mends that adults aged 50 and lack almost never happens. In fact, has been shown to interfere with
older get 800 to 1,000 International some people get too much phos- estrogen’s bone-sparing effects.
Units of vitamin D3 daily. The phorus because it is used as a pre- The Dietary Guidelines for Ameri-
Institute of Medicine recommends servative in the form of phosphoric cans recommend that women con-
600 IU/day for adults until age 70 acid. High levels of phosphorus sume no more than one drink a day
and thereafter 800 IU/day. Vitamin in foods can keep calcium from (equivalent to 5 ounces of wine,
D3 is the form of vitamin D that being used by your body. Because 1 1/2 ounces of hard liquor, or 12
best promotes bone health. of this, the FDA won’t allow ounces of beer).
high-calcium foods that are also
Very high amounts of vitamin D high-phosphorus foods to make Protein—Excess consumption of
can be harmful. Experts disagree health claims about calcium and protein has also been linked to ex-
on the safe upper limit for vitamin osteoporosis. That’s why you don’t tra calcium loss through excretion
D. In the past, the National Acad- see claims on low-fat processed in urine. However, it also has been
emy of Sciences (2010) recom- cheeses that are made with sodium shown that the lost calcium comes
mended an upper tolerable limit of phosphate. Phosphoric acid is also from the diet and not the bone if
vitamin D at 4,000 IU a day. It is used in diet and regular soft drinks, getting adequate dietary calcium.
not easy to get too much vitamin D bakery products, breakfast cereals, To prevent issues, follow the 2015
unless you are taking a prescription and other processed foods. Drink- Dietary Guidelines for your situ-
dose of it. In that case, your vita- ing three or four 12-ounce cans of ation. Most Americans should get
min D level can be monitored with soft drinks a day may be enough about 10-30% of their calories
a blood test. to compromise your bone health. from protein daily.
More research needs to be done.
Your body can make the vitamin Supplement Usage—If you can’t
D you need if you get 10 to 15 Caffeine—Beverages contain- get enough calcium through your
minutes of exposure to sunshine on food, ask your physician about
ing caffeine, like coffee, tea, or
your hands, face, and arms.* alternatives, such as calcium with
cola, have been associated with
vitamin D supplements. People
osteoporosis, but no proof exists
Vitamin D-rich foods include with a low calcium intake tend to
that caffeine leads to osteoporo- have low intakes of other nutrients,
vitamin D fortified milk (1 cup
sis. Moderation in consumption too. Calcium supplements may
contains 100 IUs) and other forti-
has been suggested. The defini- correct a calcium deficiency, but
fied milk products. Yogurt and
tion of “moderate” is not clear at supplements cannot “fix” multiple
cheeses generally do not contain
this time...perhaps 4 or fewer cups nutrient inadequacies that are the
vitamin D. Be sure to read labels.
brewed regular coffee per day or result of poor dietary choices.
8 Building Bones for a LifetimeTake Care of Other Important Factors
Weight-Bearing Exercise— As mass (2 1/2 to 5 percent per year) could place you at risk of losing
mentioned previously, exercise for several years. The result is that bone calcium. Examples of medi-
helps maintain bone mass. Ex- by 65 years of age, 50 percent of cations that can lower bone mass
amples include walking, jogging, all women have a bone-mineral include: diuretics, aluminum-con-
and running. However, too much density below the fracture thresh- taining antacids, antiseizure medi-
exercise, such as may be done by old of a typical 20-year-old wom- cations, glucocorticoids (steroids),
long-distance runners, can be coun- an. Hormone replacement therapy thyroid medications, or high doses
terproductive for women, because (estrogen and progesterone) helps of cortisone-like drugs for asthma
it may lower hormonal (estrogen) slow this process. Hormone re- or arthritis. Your physician may
levels. Lowered estrogen levels placement therapy (HRT) is not make changes in your medications
will cause bone loss. Before begin- without other risks. The decision or suggest changes in your diet to
ning an exercise program, be sure should be made with your physi- compensate for this problem.
to consult with your physician. cian.
Smoking—Smoking cigarettes
Hormone Replacement Thera- Drugs—If you are taking any significantly increases your risk of
py—At menopause, due to changes over-the-counter or prescription osteoporosis. The negative impact
in hormonal levels, women have drugs, talk with your health-care of smoking is being studied.
an accelerated loss of bone mineral provider to see if any of them
Detection: Can you know if you have osteoporosis . . .
before fractures?
If you think you are at high risk with your physician or
risk, you do not have to wait health-care provider. If, after If you have a family
until you get fractures to learn careful consideration of your
that you have the disease. situation, you are thought to member or loved one
Osteoporosis is chronic, incur- have osteoporosis, there are who is at risk for
able, and degenerative. It is ways to measure your bone
best to prevent it or to detect mass (bone densitometry osteoporosis,
and treat it as soon as possible. testing) and to track changes
The risk factors only offer a over time. If you do already support his or her
guideline, and they miss at have osteoporosis, there are efforts to build
least one-third of the women steps you can take to slow
who actually have low bone its progress. strong bones.
mass. Discuss your level of
Osteoporosis and You 9Primer on Bones
BONES CHANGE more dense. New bone is added During pregnancy, hormonal (es-
CONTINUALLY to the skeleton faster than old trogen) levels rise, promoting the
bone is removed. This remodeling deposition of calcium in the bones
Our bones change every day. Old becomes evident as children grow. of both mother and fetus. Dietary
bone tissue is broken down and Bones continue to grow stronger calcium needs are especially high
during this time.
removed, and new bone tissue well into adulthood.
replaces it. We are constantly
Peak bone mineral density is
undergoing “remodeling” and, Stocking up on bone— The most
achieved at about 35 years. Bone
over time, bone is renewed. This crucial years for building bones density and size normally remain
process varies with age. Infants do are from youth, and especially fairly stable until the mid-forties.
this so rapidly that they entirely at the onset of adolescence, to After that, people begin to lose
replace the bones they were born about age 30. Approximately 45 more bone than they form.
with by age 1. Even after we are percent of bone is formed during
grown, some remodeling takes this growth period, so our need Advanced age increases bone
place each day. About one-fifth of for calcium is particularly great. loss—As aging and remodeling
an adult’s bone is replaced each After reaching adult length, bones continue, bone becomes less dense
year. A continual supply of cal- continue to increase in thickness and weaker because calcium is
cium and other nutrients is needed (width) and in mineralization removed and not fully replaced.
for these activities. Bones will be (density). Over a lifetime, an inch or two
dense and strong as long as com-
plete mineral replacement takes
place.
STAGES OF LIFE AND BONE crush
DEVELOPMENT fractures
The beginnings—Bone formation
begins even before birth as the
fetus’ nutrient needs are supplied
by the mother.
In infancy and childhood, bones
grow in length and width by regu- Anatomical Illustration of Vertebrae With Crush
larly depositing calcium and phos- Normal Vertebrae Fractures Resulting from Osteoporosis
phorus from the diet. This process
makes them harder, stronger, and Figure 1: Compacting of weakened spinal bones
10 Building Bones for a Lifetimeof height is generally lost due very strong and dense when fracture easily. When your
to the compacting of weakened you start this process, then your bones have reached this weak-
spinal bones (Figure 1). Some bones will become frail more ened state, you are said to have
bone mineral loss and weaken- quickly. Eventually, your bones osteoporosis (Figure 2).
ing with increasing age are to may become weak enough to
be expected. But the extent to
which this occurs varies and can
be affected by lifestyle.
WHAT CAN HAPPEN
IF YOU DON’T BUILD cortical
STRONG BONES? trabecular
cortical
If you haven’t built strong,
dense bones by the time you
trabecular
are middle-aged, you risk hav-
ing weak, frail bones in the
later years. As a result of the
natural process of aging and
Anatomical Illustration of Femur With Crush
bone remodeling, the longer
Normal Femur Fractures Resulting from Osteoporosis
you live, the more bone you
will lose. If your bones aren’t Figure 2: Crush fractures resulting from osteoporosis
Notes:
* When speaking about the amount of time it takes to get sufficient vitamin D from being in the sunshine,
there is no one recommendation that works for everyone everywhere. There are a number of factors in-
volved such as the season of the year, the time of day, the latitude of your location, your age, the color of
your skin, and the amount of skin exposed to the sunlight. For example, it takes longer to get enough sun
exposure in the winter than in the summer. It is also important to note that too much exposure to sunlight
increases the risk of skin cancers so each person has to balance that risk with the need for short daily
periods of sun exposure.
Osteoporosis and You 11To Avoid Osteoporosis
Take these steps to build strong bones or to prevent further bone loss:
Eat a calcium-rich, balanced diet based on the MyPlate.
Get plenty of weight-bearing exercise, such as walking, aerobics, tennis,
dancing, and team sports. Exercise three or more days a week, 30 minutes
each time, or in three 10-minute segments over the course of the day.
Get 10 to 15 minutes of daily exposure to sunshine on hands, arms, and face.
Start eating right, getting weight-bearing exercise, and getting daily expo-
sure to sunlight in your youth and continue throughout your life.
Gain weight if you are underweight and your physician thinks you should.
Ask your doctor about hormone replacement therapy if you are female and
have no menses.
Don’t smoke.
Limit alcohol and phosphorus-and caffeine-rich foods and drinks.
Consider taking a vitamin-mineral supplement that includes calcium and
vitamin D.
Prepared by
Jacquelyn McClelland, Ph.D.
Professor and Nutrition Specialist
Calcium Checklist adapted from Ann A. Hertzler Ph.D., R.D., C.H.E., retired Professor and
Extension Specialist, Dept. of Human Nutrition and Foods, Blacksburg, Va. 24061-0430.
The use of brand names in this publication does not imply endorsement of products or services
named or criticism of similar ones not mentioned.
Published by NC Cooperative Extension Service
Distributed in furtherance of the acts of Congress of May 8 and June 30, 1914. North Carolina State University and North Carolina A&T State
University commit themselves to positive action to secure equal opportunity regardless of race, color, creed, national origin, religion, sex, age,
veteran status, or disability. In addition, the two Universities welcome all persons without regard to sexual orientation. North Carolina State
University, North Carolina A&T State University, U.S. Department of Agriculture, and local governments cooperating.
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