What’s good for bones

It’s a well-known fact that diets rich in calcium and vitamin D can help prevent or slow the progression of the brittle bone disease osteoporosis. So any foods filled with these two nutrients are a smart move for fiftysomething eaters, particularly when you consider that 10 million people over the age of 50 already have osteoporosis of the hip. About 4 in 10 women over the age of 50, and 1 in 10 men, will break a hip, spine or wrist.
Just how much calcium and vitamin D does a fiftysomething body need? Government guidelines suggest at least 1,200 milligrams per day and 400 to 600 IUs (International Units) of vitamin D. But the truth is there are dozens of nutrients involved in bone health. So a healthy overall diet, one rich in fruits, vegetables, lean proteins and whole grains, is a good start for nabbing all the nutrients bones require. Still, you might want to add the following four key foods to the plan. Promising studies suggest they might give you that extra edge when it comes to building and maintaining bones.
(For the latest information on calcium and vitamin D in dairy foods, see “What About Milk?” at the end of this article.)

(MORE: Cut Down Risks of Osteoporosis Diagnosis)

1. Grapefruit Instead of an apple a day, researchers at Texas A & M University are finding that grapefruit — both the juice and pulp — might be just the daily medicine needed to boost bone health. In 2006 these scientists reported that animals given a daily dose of grapefruit juice or orange juice (with the pulp left in) in the morning had stronger bones than counterparts who drank no citrus juice.
Later studies (done by the same researchers in 2008) specifically pinpointed grapefruit juice for its ability to enhance bone mineral deposits and improved bone density. They also discovered the pulp of red grapefruit had the ability to slow down the rate of bone loss and spark higher bone mineral deposition, factors that improve bone quality. Researchers suspect high antioxidant levels in grapefruit could be responsible. One precaution: grapefruit doesn’t mix well with some medications, like statins (for lowering blood cholesterol), calcium channel blockers (for heart disease/blood pressure) and antihistamines. Compounds in the fruit negatively interact with these drugs and can cause serious problems.

2. Olive Oil It’s a well-established heart-healthy benefit of the Mediterranean diet. But Spanish researchers wondered if olive oil could also be one of the reasons why the incidence of osteoporosis is lower in the Mediterranean basin. They answered that question in a 2012 study of 127 middle-aged and older men (55 to 80 years old) who followed one of three diets for two years. The findings: Men eating a Mediterranean diet enriched with virgin olive oil had higher levels of circulating osteocalcin, a marker of bone health, than men in the group assigned to a nut-rich Mediterranean diet or a low-fat diet.

“The intake of olive oil has been related to the prevention of osteoporosis in experimental and in vitro models,” said the study’s lead author, Dr. José Manuel Fernández-Real of Hospital Dr. Josep Trueta in Girona, Spain. “This is the first randomized study which demonstrates that olive oil preserves bone, at least as inferred by circulating bone markers, in humans.”

There’s a Catch 22 with the findings: High levels of osteocalcin don’t necessarily equate to increased bone density or a lower risk of fracture. They’re simply a marker of good bone health. Bottom line: It’s a bit early to crown olive oil as a magic bone elixir, says the National Osteoporosis Foundation. Yet, its overall health benefits make olive oil “an excellent choice to add to your diet.”
3. Sardines According to the National Institutes of Health, “lack of calcium has been singled out as a major public health concern because it is critically important to bone health.” These tiny fish are often overlooked as not only being great sources of calcium, but superstars when it comes to the other bone-strengthening mineral, vitamin D.
One can (3.75 ounces) of sardines naturally provides 351 milligrams of calcium (from the small fish bones) and 178 IUs of Vitamin D — about half the requirements — from fish oils. Compare that to an 8-ounce cup of 1% milk, which has about the same amount of calcium (349 milligrams) but is fortified with less than half the amount of vitamin D, about 98 IUs. Of course, there are no medical studies to support sardines as a good food for bone health, just the obvious facts of their natural nutrient density. Wondering how to enjoy canned sardines? Add them to salads, casseroles, pizzas or bruschetta. Or try these healthy Eating Well recipes.
4. Walnuts and Flaxseed Oil While much is made of the omega 3 fatty acids in fish, a 2007 Nutrition Journal study finds that plant-based omega 3 fats, also known as alpha-linolenic acids, could help keep bones strong. In this study, researchers at Penn State fed high amounts of walnuts (as well as walnut granola, honey walnut butter and walnut pesto) and flax oil to a small group of overweight, mostly middle-aged adults. They reported a decrease in the rate of bone breakdown and noticed that bone formation stayed constant.
How so? The scientists measured biological markers of bone health, ones that show up in the blood when bones are being built and ones that show up in the blood when bones break down. “If less bone is being resorbed and the same amount of bone is being created, then there is a positive balance for bone health,” said Dr. Rebecca Corwin, associate professor of nutrition. She and fellow researchers also point out that “recent epidemiologic data suggest that the effects of dietary fats on bone health may be particularly strong in men.”

Another plus: In 2010 Penn State researchers found that a diet rich in walnuts helps lower blood pressure and stress.

(MORE: Milk Alternatives: Are They Really Better for You, or Is It Hype?)
What About Milk?

Everyone knows that dairy foods are a good source of both calcium and vitamin D. But what do you do when you’re either lactose intolerant or don’t like dairy? Do you really need milk to keep bones strong? Experts at Harvard School of Public Health offer a review on both sides of the issue and suggest that it’s easily possible to increase and maintain bone health without dairy.
Think about many Asian countries, like Japan, where people eat very few, if any, dairy foods. Yet osteoporosis is rare. Consider too that in Western countries where dairy is eaten at high levels, the number of osteoporotic fractures is one of the highest levels in the world.

On the surface these two facts appear to be major diet contradictions. But one new theory may hold an explanation: Some experts suggest that many of the protein-rich foods in Western diets produce acid, and that high levels of acidity might weaken bones. Speculation is that diets low in acid — ones rich in fruits and vegetables and with moderate amounts of cereal grains and low-acid producing proteins — might, on the other hand, help strengthen bones. An excellent article by New York Times health writer Jane Brody gives all the details of this low-acid diet theory.

By Maureen CallahanMaureen Callahan is a registered dietitian, recipe developer and lead author of the Health.com diet book review series. She is a two-time James Beard Award winner.

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Calcium and Bone Health

Calcium is the key to lifelong bone health. Learn how to eat to strengthen your bones and prevent osteoporosis.

Calcium is a key nutrient that many of us overlook in our diets. Almost every cell in the body uses calcium in some way, including the nervous system, muscles, and heart. Your body uses calcium to build healthy bones and teeth, keep them strong as you age, send messages through the nervous system, help your blood clot, your muscles contract, and regulate the heart’s rhythm.

If you don’t get enough calcium in your diet, your body will take it from your bones to ensure normal cell function, which can lead to weakened bones or osteoporosis. Calcium deficiency can contribute to mood problems such as irritability, anxiety, depression, and difficulty sleeping.

Despite these vital functions, many of us are confused about calcium and how to best protect our bones and overall health. How much calcium should you get? Where should you get it? And what’s the deal with vitamin D, magnesium, and other nutrients that help calcium do its job? This confusion means that many of us are not getting the recommended daily amount of calcium and approximately one in two women (and about one in four men) over the age of 50 will break a bone due to osteoporosis.

Getting enough calcium in your diet is not just important for older people. It’s also vital for children, teens, and young adults since we continue building bone mass into our mid-20s. From then on, we can lose bone mass without sufficient calcium in our diets. Whatever your age or gender, it’s vital to include calcium-rich foods in your diet, limit those that deplete calcium, and get enough magnesium and vitamins D and K to help calcium do its job.

The calcium and osteoporosis connection

Osteoporosis is a “silent” disease characterized by loss of bone mass. Due to weakened bones, fractures become commonplace, which leads to serious health risks. People with osteoporosis often don’t recover after a fall and it is the second most common cause of death in women, mostly those aged 60 and older. Men are also at risk of developing osteoporosis, but typically 5 to 10 years later than women. For most people, osteoporosis is preventable, and getting enough calcium in your diet is the first place to start.

Food is the best source of calcium

Doctors recommend that you get as much of your daily calcium needs as possible from food and use only low-dose supplements to make up any shortfall. Your body is better able to absorb calcium from food than it can from supplements. In fact, studies show that even though people who take calcium supplements have a higher average intake, those who get their calcium from food have stronger bones. Furthermore, using high-dose calcium supplements may increase your risk of kidney stones and heart disease.

Good food sources of calcium

Good sources of calcium include dairy products, leafy green vegetables, certain fish, oatmeal and other grains, tofu, cabbage, summer squash, green beans, garlic, sea vegetables and calcium-fortified foods such as cereals and orange juice.

Calcium and whole milk dairy: The pros and cons

While milk and other dairy products contain a lot of calcium in a highly absorbable form, there may be some potential downsides.

Whole milk dairy products are often high in saturated fat. Many prominent health organizations recommend that you limit your saturated fat intake and choose low- or non-fat dairy foods, though an increasing body of research shows that eating whole-milk dairy products is linked to less body fat and lower levels of obesity. Low-fat and non-fat dairy products also tend to contain lots of hidden sugar to make up for the loss of taste, which can be far more detrimental to your health and weight than the saturated fat it’s replaced.

Milk can contain high levels of estrogen. Some studies show a possible link between the natural estrogens found in milk and breast, prostate, and testicular cancer. Part of the problem is modern dairy practices, where the cows are fed synthetic hormones and antibiotics, kept continuously pregnant, and milked over 300 days per year. The more pregnant the cow, the higher the hormones in the milk. Organic milk comes from cows that are grass-fed and not given synthetic hormones or other additives, although organic milk can still be high in natural hormones. Because both natural and synthetic hormones are found in the milk fat, skim milk has a much lower level.

Some people are lactose intolerant, meaning they are unable to digest lactose, a sugar found in milk and milk products. Symptoms range from mild to severe, and include cramping, bloating, gas, and diarrhea. Beyond the discomfort it causes, lactose intolerance can also interfere with calcium absorption from dairy.

Tips for upping your calcium intake

To boost your daily intake, try to include calcium-rich foods in multiple meals or snacks.

Tips for adding more calcium from dairy to your diet

  • Use milk instead of water when making oatmeal or other hot breakfast cereals.
  • Substitute milk for some of the liquid in soups such as tomato, squash, pumpkin, curries, etc.
  • Milk can be added to many sauces or used as the base in sauces such as Alfredo and Béchamel sauce.
  • Make whole-wheat pancakes and waffles using milk or yogurt.
  • Get creative with plain yogurt. Use it to make a dressing or a dip, or try it on potatoes in place of sour cream.
  • Add milk or yogurt to a fruit smoothie. You can even freeze blended smoothies for popsicles.
  • Enjoy cheese for dessert or as a snack. Try cheddar, mozzarella, Gouda, jack, Parmesan, or a type of cheese you’ve never had before.

Tips for getting your calcium from non-dairy sources

Greens can easily be added to soups, casseroles, or stir-fries. Opt for kale, collard greens, turnip greens, dandelion greens, mustard greens, beet greens, broccoli, and cabbage. Spice up these and other dishes with garlic, basil, thyme, oregano, and rosemary to add more nutrients.

Eat dark green leafy salads with your meals. Try romaine hearts, arugula, butter lettuce, mesclun, watercress, or red leaf lettuce (avoid iceberg lettuce as it has very little nutrient value).

Add extra servings of veggies to your meals, i.e. asparagus, fresh green peas, broccoli, cabbage, okra, bok choy.

Top salads or make a sandwich with canned fish with bones, such as sardines and pink salmon.

Use beans/legumes as part of your meals. They are wonderful in stews, chili, soup, or as the protein part of a meal. Try tofu, tempeh, black-eyed peas, black beans, and other dried beans. You can also snack on edamame.

Start your day with oats. Steel cut oats or rolled oats make a filling breakfast. For an added punch include cinnamon

Snack on nuts and seeds such as almonds and sesame seeds. You can also add these to your morning oatmeal.

Order or prepare sandwiches on whole grain wheat bread.

Beyond calcium: Other nutrients for healthy bones

When it comes to healthy bones and preventing osteoporosis, calcium alone is not enough. There are a number of other vital nutrients that help your body absorb and make use of the calcium you consume.

Magnesium

Why it’s important: Magnesium helps your body absorb and retain calcium to help build and strengthen bones and prevent osteoporosis. Since your body is not good at storing magnesium, it is vital to make sure you get enough of it in your diet.

How much do you need? For adult men, 400-420 mg daily. For adult women, 310-320 mg daily (more during pregnancy).

How to include more in your diet: Magnesium is found in nuts (especially almonds and cashews), seeds (pumpkin, sesame, flax, sunflower), whole grains, seafood, legumes, tofu, and many vegetables, including spinach, Swiss chard, summer squash, turnip and mustard greens, broccoli, sea vegetables, cucumbers, and celery. Reduce sugar and alcohol, which increase the excretion of magnesium.

Vitamin D

Why it’s important: Vitamin D helps the body absorb calcium and regulates calcium in the blood.

How much do you need? Up to age 70, 600 IU (international units) per day. Over 70, 800 IU per day.

How to include more in your diet: Your body synthesizes vitamin D when exposed to the sun. Spend at least 15 minutes outside in the sun each day and include good food sources of vitamin D in your diet, such as fortified milk, eggs, cheese, fortified cereal, butter, cream, fish, shrimp, and oysters.

Phosphorous

Why it’s important: Phosphorous works with calcium to build bones. But again, it’s important to get the balance right: too much phosphorous will cause your body to absorb less calcium and can even be toxic.

How much do you need? For adults, 700 mg a day.

Vitamin K

Why it’s important: Vitamin K helps the body regulate calcium and form strong bones.

How much do you need? Adult men, 120 micrograms daily. Adult women, 90 micrograms daily.

How to include more in your diet: You should be able to meet the daily recommendation for vitamin K by simply eating one or more servings per day of broccoli, Brussels sprouts, dark green lettuce, collard greens, or kale.

Vitamin C and vitamin B12

New research suggests that vitamin C and vitamin B12 may also play important roles in bone health and the prevention of osteoporosis.

Consuming foods rich in vitamin C may help to prevent bone loss. Good sources include citrus fruit, such as oranges and grapefruit, strawberries, kiwi, mango, Brussels sprouts, and green bell peppers.

Studies have also found a link between vitamin B12 levels and bone density and osteoporosis. Good sources of B12 include seafood such as salmon, haddock, and canned tuna, as well as milk, yogurt, eggs, and cottage cheese.

Other tips for building strong bones and preventing osteoporosis

In addition to adding calcium-rich foods to your diet, you can also minimize the amount of calcium you lose by reducing your intake of foods and other substances that deplete your body’s calcium stores.

Salt – Eating too much salt can contribute to calcium loss and bone breakdown. Reduce packaged and convenience foods, fast foods, and processed meats which are often high in sodium. Instead of salt, try using herbs and spices to enhance the taste of food.

Caffeine – Drinking more than 2 cups of coffee a day can lead to calcium loss. The amount lost can have a significant impact on older people with already low calcium levels. You can buffer the effects to an extent by drinking coffee with milk.

Alcohol – Alcohol inhibits calcium absorption and disrupts your body’s calcium balance in a number of ways. Try to keep your alcohol consumption to no more than 7 drinks per week.

Soft drinks – In order to balance the phosphates in soft drinks, your body draws calcium from your bones, which is then excreted. Opt for water or calcium-fortified orange juice instead.

For lifelong bone health, exercise is key

When it comes to building and maintaining strong bones, exercise is essential, especially weight-bearing activities such as walking, dancing, jogging, weightlifting, stair climbing, racquet sports, and hiking. Find something that you enjoy doing and make it a regular activity.

Calcium supplements: What you need to know

While food is the best source of calcium, making up any shortfall in your diet with supplements is another option. But it’s important not to take too much.

Calcium citrate is a highly absorbable calcium compound.

Calcium ascorbate and
calcium carbonate are not as easily absorbed as calcium citrate.

Be smart about calcium supplements

Don’t take more than 500 mg at a time. Your body can only absorb a limited amount of calcium at one time, so it is best to consume calcium in small doses throughout the day.

Don’t take more than the recommended amount for your age group. Take into account the amount of calcium you get from food. And remember: more isn’t better; it may damage the heart and have other negative health effects.

Take your calcium supplement with food. All supplemental forms of calcium are best absorbed when taken with food. If it’s not possible to take your supplement with food, choose calcium citrate.

Purity is important. It’s best to choose calcium supplements with labels that state “purified” or, if you’re in the U.S., have the USP (United States Pharmacopeia) symbol. Avoid supplements made from unrefined oyster shell, bone meal, or dolomite that don’t have the USP symbol because they may contain high levels of lead or other toxic metals.

Be aware of side effects. Some people do not tolerate calcium supplements as well as others and experience side effects such as acid rebound, gas, and constipation. For acid rebound, switch from calcium carbonate to calcium citrate. For gas or constipation, try increasing your intake of fluids and high-fiber foods.

Check for possible drug interactions. Calcium, magnesium, and vitamin K supplements can interfere with other medications and vitamins you’re taking, including heart medicine, certain diuretics, antacids, blood thinners, and some cancer drugs. Talk with your doctor or pharmacist about possible interactions. Any medications that you take on an empty stomach should NOT be taken with calcium.

Your body needs vitamin D to help it absorb calcium needed for strong bones.

Osteoporosis is a condition that affects the bones, causing them to become weak and fragile and more likely to break (fracture). It has no symptoms so the first clue may be that you fracture a bone.

Whether you have osteoporosis or just want to build strong bones for the future, there are several things you can do to maintain your bones.

Eat calcium-rich foods

Calcium is important for maintaining strong bones. Most people need at least 2-3 serves of milk, yoghurt and cheese and/or alternatives a day while women aged over 50 should have 4 and men over 70 should have 3 ½ a day. Calcium is found in a number of different foods including dairy foods, green leafy vegetables, and tofu.

If you can’t get the recommended amount of calcium from your diet you may need to take a calcium supplement, particularly if you have low bone density. Osteoporosis Australia recommends taking a maximum of 500-600 mg of calcium per day. Talk to your doctor about whether you need a calcium supplement and what the right dose is for you.

Get your sunshine quota

Your body needs vitamin D to help it absorb calcium. Vitamin D is found in oily fish, liver, fortified spreads and cereals, and egg yolks. Your body also makes its own vitamin D when you’re exposed to sunshine.

To produce enough vitamin D most Australians only need a few minutes a day of sunlight during summer and a couple of hours of sun exposure spread over the week while during winter. The amount of exposure to sunlight needed depends on your skin type (darker skin requires longer exposure), the time of year, where you live and your lifestyle. Overexposure to sunlight can damage your skin and increase your risk of skin cancer. Visit the Cancer Council website for more information on vitamin D and safe sun exposure requirements.

Eat a balanced diet

Quit smoking

The more you smoke, the more likely you’ll get osteoporosis. Aim to cut down or, better still, quit smoking altogether. A great place to start is to check out the Quit Now website and its variety of information and tools to support you in quitting smoking.

The Quit Now: My QuitBuddy is a personalised interactive app with quit tips, daily motivational messages and countdown to quitting reminders. The user records their goals in pictures, words or audio messages and the panic button when craving provides a range of distractions. Call the Quitline on 13 7848 or a buddy from the app, or post a note on the community board. The Quit Now: My QuitBuddy is free to download on iPhone, iPad and Android phones. To install visit iTunes online store or Google Play store.

Cut out the salt

Salt is thought to speed up the body’s loss of calcium. So try to limit your daily salt intake to the recommended amount. Australian adults are recommended to consume is less 2000 mg of sodium a day — that’s less than a teaspoon of salt.

Try not to add salt to your food, flavouring with herbs or a squeeze of lemon juice can be a good substitute.

Looking at nutrition labels can also help you reduce your salt intake. Look for foods with 120mg sodium or less per 100g. Crisps, ham, cheese, cooking sauces and processed foods such as pies, pizza and soups are all high in salt.

Be active

Bones get stronger when you use them. A great way to strengthen them is with weight-bearing exercise. This includes walking, running, dancing, golf or tennis. It doesn’t include cycling or swimming (although swimming is good for staying flexible).

Bones also benefit if you lift and carry things. Weight training is ideal, but carrying shopping, gardening and housework all count. If you are new to exercise it’s a good idea to talk to your doctor before you take up any new exercise activity, to make sure it’s right for you.

Drink sensibly

Alcohol, tea, coffee, cola and other soft drinks reduce the amount of calcium you absorb, and weaken bones. Stick to the recommended amounts of alcohol, and swap your caffeine-fueled drinks for water.

Maintain a healthy weight

Being underweight is a risk factor for osteoporosis.

Losing too much weight too fast under a crash diet can increase your risk of osteoporosis. The same is true if you’re anorexic (or, for women, if you’re so thin that your periods have stopped).

Being underweight can affect the amount of oestrogen (a hormone that helps to protect your bones) in your body. If you need to lose weight, do it sensibly.

Bone Health for Life: Health Information Basics for You and Your Family

Why does bone health matter?

Our bones support us and allow us to move. They protect our brain, heart, and other organs from injury. Our bones also store minerals such as calcium and phosphorous, which help keep our bones strong, and release them into the body when we need them for other uses.

There are many things we can do to keep our bones healthy and strong. Eating foods rich in calcium and vitamin D, getting plenty of exercise, and having good health habits help keep our bones healthy.

But if we don’t eat right and don’t get enough of the right kinds of exercise, our bones can become weak and even break. Broken bones (called fractures) can be painful and sometimes need surgery to heal. They can also cause long-lasting health problems.

But the good news is that it is never too late to take care of your bones.

  • What is osteoporosis?
  • Who gets osteoporosis?
  • Am I really at risk?
  • How do I know if I have osteoporosis?
  • What can I do to make my bones healthier?
  • Will I need to take medicine for my bones?
  • How can I join a research study?
  • Where can I find more information about bone health?

Tables

  • Sources of calcium
  • Recommended calcium and vitamin D intakes

What is osteoporosis?

There are many kinds of bone diseases. The most common one is osteoporosis (AH-stee-oh-por-OH-sis). With osteoporosis, our bones become weak and are more likely to break. People with osteoporosis most often break bones in the wrist, spine, and hip.

Our bones are alive. Every day, our body breaks down old bone and puts new bone in its place. As we get older, our bones break down more bone than they put back. It is normal to lose some bone as we age. But, if we do not take steps to keep our bones healthy, we can lose too much bone and get osteoporosis.

Many people have weak bones and don’t even know it. That’s because bone loss often happens over a long period of time and doesn’t hurt. For many people, a broken bone is the first sign that they have osteoporosis.

Who gets osteoporosis?

There are many things that can increase your chances of getting osteoporosis. These things are called “risk factors.” Some risk factors are things you can control, and some things are outside of your control.

Risk factors you can control:

  • Diet. Getting too little calcium can increase your chances of getting osteoporosis. Not getting enough vitamin D can also increase your risk for the disease. Vitamin D is important because it helps the body use the calcium in your diet.
  • Physical activity. Not exercising and not being active for long periods of time can increase your chances of getting osteoporosis. Like muscles, bones become stronger – and stay stronger – with regular exercise.
  • Body weight. Being too thin makes you more likely to get osteoporosis.
  • Smoking. Smoking cigarettes can keep your body from using the calcium in your diet. Also, women who smoke go through menopause earlier than those who don’t smoke. These things can increase your risk for osteoporosis.
  • Alcohol. People who drink a lot are more likely to get osteoporosis.
  • Medicines. Certain medicines can cause bone loss. These include a type of medicine called glucocorticoids (gloo-ko-KOR-ti-koids). Glucocortiocoids are given to people who have arthritis, asthma, and many other diseases. Some other medicines that prevent seizures and that treat endometriosis (en-do-me-tree-O-sis), a disease of the uterus, and cancer can cause bone loss, too.

Risk factors you cannot control:

  • Age. Your chances of getting osteoporosis increase as you get older.
  • Gender. You have a greater chance of getting osteoporosis if you are a woman. Women have smaller bones than men and lose bone faster than men do because of hormone changes that happen after menopause.
  • Ethnicity. White women and Asian women are most likely to get osteoporosis. Hispanic women and African American women are also at risk, but less so.
  • Family history. Having a close family member who has osteoporosis or has broken a bone may also increase your risk.

Am I really at risk?

Because more women get osteoporosis than men, many men think they are not at risk for the disease. Many Hispanic and African American women are not concerned about their bones either. They believe that osteoporosis is only a problem for white women. However, it is a real risk for older men and women from all backgrounds.

Also, people from certain ethnic backgrounds may be more likely to have other health problems that increase their risk for bone loss. If you have one of the following health problems, talk to your doctor about your bone health:

  • Alcoholism.
  • Anorexia nervosa.
  • Asthma/allergies.
  • Cancer.
  • Cushing’s disease.
  • Diabetes.
  • Hyperparathyroidism.
  • Hyperthyroidism.
  • Inflammatory bowel disease.
  • Lactose intolerance.
  • Lupus.
  • Liver or kidney disease.
  • Lung disease.
  • Multiple sclerosis.
  • Rheumatoid arthritis.

How do I know if I have osteoporosis?

Since osteoporosis does not have any symptoms until a bone breaks, it is important to talk to your doctor about your bone health. If your doctor feels that you are at risk for osteoporosis, he or she may order a bone density test. A bone density test measures how strong – or dense – your bones are and whether you have osteoporosis. It can also tell you what your chances are of breaking a bone. Bone density tests are quick, safe, and painless.

What can I do to make my bones healthier?

It is never too early or too late to take care of your bones. The following steps can help you improve your bone health:

  • Eat a well-balanced diet rich in calcium and vitamin D. Good sources of calcium include low-fat dairy products, and foods and drinks with added calcium. Good sources of vitamin D include egg yolks, saltwater fish, liver, and milk with vitamin D. Some people may need to take nutritional supplements in order to get enough calcium and vitamin D. The charts below show how much calcium and vitamin D you need each day. Fruits and vegetables also contribute other nutrients that are important for bone health.

Sources of calcium

Recommended calcium and vitamin D intakes

Life-stage group Calcium mg/day Vitamin D (IU/day)
Infants 0 to 6 months 200 400
Infants 6 to 12 months 260 400
1 to 3 years old 700 600
4 to 8 years old 1,000 600
9 to 13 years old 1,300 600
14 to 18 years old 1,300 600
19 to 30 years old 1,000 600
31 to 50 years old 1,000 600
51- to 70-year-old males 1,000 600
51- to 70-year-old females 1,200 600
>70 years old 1,200 800
14 to 18 years old, pregnant/lactating 1,300 600
19 to 50 years old, pregnant/lactating 1,000 600

Definitions: mg = milligrams; IU = International Units

Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2010.

  • Get plenty of physical activity. Like muscles, bones become stronger with exercise. The best exercises for healthy bones are strength-building and weight-bearing, like walking, climbing stairs, lifting weights, and dancing. Try to get 30 minutes of exercise each day.
  • Live a healthy lifestyle. Don’t smoke, and, if you choose to drink alcohol, don’t drink too much.
  • Talk to your doctor about your bone health. Go over your risk factors with your doctor and ask if you should get a bone density test. If you need it, your doctor can order medicine to help prevent bone loss and reduce your chances of breaking a bone.
  • Prevent falls. Falling down can cause a bone to break, especially in someone with osteoporosis. But most falls can be prevented. Check your home for dangers like loose rugs and poor lighting. Have your vision checked regularly. Increase your balance and strength by walking every day and taking classes like Tai Chi, yoga, or dancing.

Will I need to take medicine for my bones?

There are medicines to help prevent and treat osteoporosis. These include bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMs); calcitonin; parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor. Your doctor may want you to take medicine if your bone density test shows that your bones are weak and that you have a good chance of breaking a bone in the future. Your doctor is more likely to order medicine if you have other health concerns that increase your risk for breaking a bone, such as a tendency to fall or a low body weight.

How can I join a research study?

The National Institutes of Health (NIH) conducts research studies all over the country in which people take part as volunteers. These studies help uncover new risk factors and treatments for osteoporosis and other diseases.

There are many benefits to being part of a research study, such as getting related medical care at no charge and, in some cases, help with travel and other costs. Also, study volunteers are seen by a team of experts and are often among the first to receive new treatments ahead of the general public. Many volunteers take part in the research simply because they want to help others with the same disease, both today and in the future.

More information on research is available from the following websites:

  • NIH Clinical Research Trials and You was designed to help people learn more about clinical trials, why they matter, and how to participate. Visitors to the website will find information about the basics of participating in a clinical trial, first-hand stories from clinical trial volunteers, explanations from researchers, and links on how to search for a trial or enroll in a research-matching program.
  • ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.
  • NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding.
  • PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences.

Where can I find more information about bone health?

For more information on osteoporosis and bone health, contact any of the following organizations:

NIH Osteoporosis and Related Bone Diseases ~ National Resource Center
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information Clearinghouse
National Institutes of Health

If you need more information about available resources in your language or another language, please visit our website or contact the NIAMS Information Clearinghouse at [email protected]

Other resource

National Osteoporosis Foundation

Website: https://www.nof.org

Do you have osteoporosis or a related condition?

You may be able to help scientists learn more about these conditions.

For information about research projects across the country, call:

NIAMS
Toll free: 877-22-NIAMS (226-4267)
Email: [email protected]

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For your information

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For updates and for any questions about any medications you are taking, please contact

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NIH Pub. No. 18-7847-E

Table of Contents

  • Introduction
  • What Is Calcium, and Where Do We Get It?
  • Growing Healthy Bones
  • What Is Osteoporosis
  • How Can Osteoporosis Be Slowed Down?
  • Preventing Bone Loss in Adulthood
  • Do We Need Calcium from Dairy Foods?
  • The Bottom Line: Recommendations for Calcium Intake and Bone Health

Introduction

Advertisements pushing milk as the answer to strong bones are almost inescapable. But does “got milk?” really translate into “got strong bones?”

The pro-milk faction believes that increased calcium intake—particularly in the form of the currently recommended three glasses of milk per day—will help prevent osteoporosis, the weakening of bones. Each year, osteoporosis leads to more than 2 million fractures, including more than 250,000 broken hips.

On the other side are those who believe that consuming a lot of milk and other dairy products will have little effect on the rate of fractures but may contribute to problems such as heart disease or prostate cancer.

Which view is right? The final answers aren’t in. But here is a summary of what’s currently known about calcium and its effects on the body.

What Is Calcium, and Where Do We Get It?

Calcium is a mineral that the body needs for numerous functions, including building and maintaining bones and teeth, blood clotting, the transmission of nerve impulses, and the regulation of the heart’s rhythm. About 99% of the body’s calcium is stored in the bones and teeth. The remaining 1% is found in the blood, muscle, and other tissues.

The body gets the calcium it needs in two ways. One is by eating foods or supplements that contain calcium, and the other is by drawing from calcium stores in the body, primarily the bones. Good food sources include dairy products, which have the highest concentration per serving of highly absorbable calcium, and salmon, dark leafy greens, beans, and soy foods, which have varying amounts of absorbable calcium. Calcium supplements often contain vitamin D; taking calcium paired with vitamin D seems to be more beneficial for bone health than taking calcium alone. (Read more about calcium and osteoporosis.)

If one does not eat enough calcium-containing foods, the body will remove calcium from bones. Ideally, the calcium that is “borrowed” from the bones will be replaced at a later point. But this doesn’t always happen. Most importantly, this payback can’t be accomplished simply by eating more calcium.

Food Sources of Calcium

Milk and other dairy products are not the only sources of calcium. Here is a list of some popular foods that are high in calcium:

Food Amount Calcium (milligrams)
Tofu, firm, prepared with calcium sulfate* ½ cup 861
Almond milk * 1 cup 516
Nonfat milk 1 cup 504
Tofu, regular, prepared with calcium sulfate* ½ cup 434
Orange juice, with added calcium and vitamin D* 1 cup 349
Ricotta cheese, part skim milk ½ cup 337
Yogurt, plain, low fat 6 oz. 311
Mozzarella cheese, low moisture, part-skim, shredded ½ cup 308
Milk, 1% milkfat, with added vitamins A and D 1 cup 305
Soymilk, with added calcium, vitamins A and D* 1 cup 299
Sardines, Atlantic, canned in oil, drained, solids with bone* ½ cup 285
Sesame seeds, whole, roasted* ¼ cup 280
Swiss cheese 1 slice 269
Collard greens, fresh, boiled, drained, no salt* 1 cup 268
Spinach, cooked, boiled, drained, no salt* 1 cup 245
Salmon, pink, canned, drained, solids* 3 oz. 241
Cheddar cheese ¼ cup 234
Parmesan cheese, grated ¼ cup 213
Chia seeds, dried* 1 oz. or 2 tbsp 179
Beans, canned, drained (pinto, kidney, great northern)* 1 cup 140-150
Cottage cheese, 2% milkfat ½ cup 125
Almonds, dry roasted, no salt added* ¼ cup 93

*Indicates lactose-free
An extensive list of the calcium content of foods is available online from the U.S. Department of Agriculture.

Growing Healthy Bones

Bone is living tissue that is always in flux. Throughout the lifespan, bones are constantly being broken down and built up in a process known as remodeling. Bone cells called osteoblasts build bone, while other bone cells called osteoclasts break down bone if calcium is needed.

In healthy individuals who get enough calcium and physical activity, bone production exceeds bone destruction up to about age 30. After that, destruction typically exceeds production.

What Is Osteoporosis?

Osteoporosis, or “porous bones,” is the weakening of bones caused by an imbalance between bone building and bone destruction. People typically lose bone as they age, despite consuming the recommended intake of calcium necessary to maintain optimal bone health. An estimated 10 million Americans—8 million women and 2 million men—have osteoporosis. Another 34 million have low bone mass, placing them at increased risk for osteoporosis. (1, 28)

Achieving adequate calcium intake and maximizing bone stores during the time when bone is rapidly deposited (up to age 30) provides an important foundation for the future. But it will not prevent bone loss later in life. The loss of bone with aging is the result of several factors, including genetic factors, physical inactivity, and lower levels of circulating hormones (estrogen in women and testosterone in men).

Postmenopausal women account for 80% of all cases of osteoporosis because estrogen production declines rapidly at menopause. Of course, men are also at risk of developing osteoporosis, but they tend to do so 5 to 10 years later than women, since testosterone levels do not fall abruptly the way estrogen does in women. It is estimated that osteoporosis will cause half of all women over age 50 to suffer a fracture of the hip, wrist, or vertebra.

How Can Osteoporosis Be Slowed Down?

Preventing osteoporosis depends on two things: making the strongest, densest bones possible during the first 30 years of life and limiting the amount of bone loss in adulthood.

There are a number of lifestyle factors that can help prevent or minimize bone loss during adulthood and old age:

  • Getting regular exercise, especially weight-bearing and muscle strengthening exercise.
  • Getting adequate vitamin D, whether through diet, exposure to sunshine, or supplements.
  • Consuming enough calcium to reduce the amount the body has to borrow from bone.
  • Consuming adequate vitamin K, found in green, leafy vegetables.
  • Not getting too much preformed vitamin A.

Preventing Bone Loss in Adulthood

Getting Regular Exercise

Physical activity that puts some strain or stress on bones causes the bones to retain and possibly even gain density throughout life. Cells within the bone sense this stress and respond by making the bone stronger and denser. Such “weight-bearing” exercises include walking, dancing, jogging, weightlifting, stair-climbing, racquet sports, and hiking.

Swimming is a useful form of exercise for the heart and cardiovascular system. But because water supports the bones, rather than putting stress on them, it’s not considered a good “weight-bearing” exercise for bone strength. In addition, physical activity doesn’t strengthen all bones, just those that are stressed, so you need a variety of exercises or activities to keep all your bones healthy.

Another function of physical activity, probably at least as important as its direct effect on bone mass, is its role in increasing muscle strength and coordination. With greater muscle strength, one can often avoid falls and situations that cause fractures. Making physical activity a habit can help maintain balance and avoid falls.

Getting Enough Calcium

Despite the debates surrounding milk and calcium, one thing is clear: adequate calcium—both for bone development and for non-bone functions—is key to reducing the risk of osteoporosis. However, the healthiest or safest amount of dietary calcium hasn’t yet been established. Different scientific approaches have yielded different estimates, so it’s important to consider all the evidence.

Maximum-calcium-retention studies, which examine the maximum amount of calcium that can be forced into bones, suggest a fairly high requirement. To ensure that 95% of the population gets this much calcium, the National Academy of Sciences established the following recommended intake levels:

  • 1,000 milligrams/day for those ages 19 to 50
  • 1,200 milligrams/day for those ages 50 or over
  • 1,000 milligrams/day for pregnant or lactating adult women

But the maximum-calcium-retention studies are short-term and therefore have important limitations. To detect how the body adapts to different calcium intakes over a long period of time—and to get the big picture of overall bone strength—requires studies of longer duration.

The results from such long-term studies may be surprising to some. While they do not question the importance of calcium in maximizing bone strength, they cast doubt on the value of consuming the large amounts currently recommended for adults.

In particular, these studies suggest that high calcium intake doesn’t actually appear to lower a person’s risk for osteoporosis. For example, in the large Harvard studies of male health professionals and female nurses, individuals who drank one glass of milk (or less) per week were at no greater risk of breaking a hip or forearm than were those who drank two or more glasses per week. (2, 3) When researchers combined the data from the Harvard studies with other large prospective studies, they still found no association between calcium intake and fracture risk. (4) Also, the combined results of randomized trials that compared calcium supplements with a placebo showed that calcium supplements did not protect against fractures of the hip or other bones. Moreover, there was some suggestion that calcium supplements taken without vitamin D might even increase the risk of hip fractures. A 2014 study also showed that higher milk consumption during teenage years was not associated with a lower risk of hip fracture in older adults. (27)

Additional evidence further supports the idea that American adults may not need as much calcium as is currently recommended. For example, in countries such as India, Japan, and Peru where average daily calcium intake is as low as 300 milligrams per day (less than a third of the U.S. recommendation for adults, ages 19 to 50), the incidence of bone fractures is quite low. Of course, these countries differ in other important bone-health factors as well—such as level of physical activity and amount of sunlight—which could account for their low fracture rates.

Ideally, these issues might be resolved by randomizing a large group of adults to get different amounts of calcium and following them to see how many would eventually break a bone. In fact, a few such studies have been conducted, and they have not provided evidence of benefit, as noted above. However, most of these studies were small or of short duration, so they could not rule out the possibility of a small benefit from supplementation. Other randomized trials have combined calcium in combination with vitamin D, which could obscure the true effects of calcium.

To illustrate the different conclusions drawn from examining the same body of data, a British committee that is comparable to the U.S. group that established calcium requirements here concluded that 700 milligrams per day was enough for individuals age 19 and older.

Getting Enough Vitamin D

Vitamin D plays a critical role in maintaining bone health. When blood levels of calcium begin to drop, the body responds in several ways. It promotes the conversion of vitamin D into its active form, which then travels to the intestines (to encourage greater calcium absorption into the blood) and to the kidneys (to minimize calcium loss in the urine).

For bone health, an adequate intake of vitamin D is no less important than calcium. Few foods naturally contain vitamin D. It is found in milk, fortified foods, and vitamin supplements, and can be made by the skin when it is exposed to sunlight in the summertime.

An examination of clinical trials of vitamin D for the prevention of osteoporosis found that getting 700 to 800 IUs of vitamin D per day decreases the risk of hip and non-vertebral fractures; (5) vitamin D may be even more effective when taken in conjunction with calcium. (6) A similar analysis of the effect of vitamin D on falls indicated that supplementation with vitamin D reduces the risk of falls among older individuals by more than 20 percent. (7)

Look for a multivitamin that supplies 800 to 1,000 IU of vitamin D per day. If your multi only has 400 IU of vitamin D, consider taking an extra supplement. Many people may need 2,000 IU per day (or more) of vitamin D for adequate blood levels, particularly if they have darker skin, spend winters at higher latitudes (such as the northern U.S.), or spend little time in the sun. If you fall into one of these groups, which would include most of the U.S. population, taking 2,000 IU is reasonable and well within the safe range. As always, it’s a good idea to discuss use of supplements with your doctor, and he or she may want to order a vitamin D blood test.

Getting Enough Vitamin K

Vitamin K, which is found mainly in green, leafy vegetables, likely plays one or more important roles in calcium regulation and bone formation. Low levels of circulating vitamin K have been linked with low bone density, and supplementation with vitamin K shows improvements in biochemical measures of bone health. (8) A report from the Nurses’ Health Study suggests that women who get at least 110 micrograms of vitamin K a day are 30 percent less likely to break a hip than women who get less than that. (9) Among the nurses, eating a serving of lettuce or other green, leafy vegetable a day cut the risk of hip fracture in half when compared with eating one serving a week. Data from the Framingham Heart Study also shows an association between high vitamin K intake and reduced risk of hip fracture in men and women, and increased bone mineral density in women. (10, 11) Getting one or more servings per day of broccoli, Brussels sprouts, dark green lettuce, collard greens, or kale should be enough to meet the daily recommended target of 120 micrograms per day for men and 90 micrograms per day for women.

Some other factors may also help lower the risk of osteoporosis:

  • Take care with caffeine and cola. Although the votes aren’t all in, there is some evidence that drinking a lot of coffee—about four or more cups per day—can increase the risk of fracture. Caffeine tends to promote calcium excretion in urine. Meanwhile, the Framingham Osteoporosis Study has found that older women who drink cola every day have lower bone mineral density than those who drink it less than once a month. (12) This may be due to cola’s high levels of phosphorous, which may alter the dietary balance between calcium and phosphorous and thereby weaken bones.
  • Get enough protein, but not too much. The body needs protein to build healthy bones. But as your body digests protein, it releases acids into the bloodstream, which the body neutralizes by drawing calcium from the bones. Following a high-protein diet for a few weeks probably won’t have much effect on bone strength. Doing it for a long time, though, could weaken bone. In the Nurses’ Health Study, for example, women who ate more than 95 grams of protein a day were 20 percent more likely to have broken a wrist over a 12-year period when compared to those who ate an average amount of protein (less than 68 grams a day). (13) But this area of research is still controversial, and findings have not been consistent. Some studies suggest increasing protein increases risk of fractures; others associate high-protein diets with increased bone mineral density. It is still unclear what level of protein intake provides the best protection against osteoporosis, and more research is needed.
  • Get enough vitamin A, but not too much. Long associated with good vision, vitamin A has also been found to direct the process of borrowing and redepositing calcium in bone. However, too much preformed vitamin A (also known as retinol) can promote fractures. Choose a multivitamin supplement that has all or the majority of its vitamin A in the form of beta-carotene, a vitamin A precursor, since beta-carotene does not increase one’s fracture risk. Many multivitamin manufacturers have already reduced the amount of preformed vitamin A in their products. The Recommended Daily Intake is 3000 IU of vitamin A for men and 2300 IU for women from food or supplements. If using supplements, choose one with less than 2000 IU as many foods contain vitamin A. Excellent sources are winter squash, carrots, sweet potatoes, cantaloupe, kale, and spinach.

Postmenopausal women may also want to talk to a health care provider about taking a medication that can strengthen bones. The estrogen in postmenopausal hormones can compensate for the drop in estrogen levels after menopause, helping to prevent—and perhaps even partially reverse—bone loss. However, hormone replacement therapy has fallen from grace as the mainstay for preventing osteoporosis after results from several studies showed that it increased the risk of breast cancer, stroke, and blood clots. (14)

Do We Need Calcium from Dairy Foods?

When most people in the United States think of calcium, they immediately think of milk. But should this be so? Milk is actually only one of many sources of calcium—dark leafy green vegetables and some types of legumes are among the other sources—and there are some important reasons why milk may not be the best source for everyone:

Lactose Intolerance

Many people have some degree of lactose intolerance. For them, eating or drinking dairy products causes problems like cramping, bloating, gas, and diarrhea. These symptoms can range from mild to severe.

One alternative for those who are lactose intolerant but still enjoy consuming dairy products is to take a pill with meals (or when eating a dairy food) that contains enzymes that digest milk sugar, or to consume milk that has the lactase enzyme added to it. Another option is to choose lower lactose dairy foods that may be tolerated if one has a milder form of lactose intolerance. These include Greek yogurt (the straining process removes much of the lactose) or aged cheeses like mozzarella, cheddar, or Swiss. There are also many non-dairy alternatives

High Saturated Fat Content

Many dairy products are high in saturated fats, and a high saturated fat intake is a risk factor for heart disease. While it’s true that most dairy products are available in fat-reduced or nonfat options, the saturated fat that’s removed from dairy products is inevitably consumed by someone, often in the form of premium ice cream, butter, or baked goods.

Related:

Study sheds light on dairy fat and cardiovascular disease risk

Possible Increased Risk of Ovarian Cancer

High levels of galactose, a sugar released by the digestion of lactose in milk, have been studied as being possibly damaging to the ovaries and leading to ovarian cancer. Although such associations have not been reported in all studies, there may be potential harm in consuming high amounts of lactose. A recent pooled analysis of 12 prospective cohort studies, which included more than 500,000 women, found that women with high intakes of lactose—equivalent to that found in 3 cups of milk per day—had a modestly higher risk of ovarian cancer, compared to women with the lowest lactose intakes. (15) The study did not find any association between overall milk or dairy product intake and ovarian cancer. Some researchers have hypothesized, however, that modern industrial milk production practices have changed milk’s hormone composition in ways that could increase the risk of ovarian and other hormone-related cancers. (16) More research is needed.

Probable Increased Risk of Prostate Cancer

A diet high in calcium has been implicated as a probable risk factor for prostate cancer. (17) In a Harvard study of male health professionals, men with high intakes of calcium (whether from dairy or nondairy foods, or supplements) especially greater than 2000 mg daily, had a higher risk of prostate cancer. Men who drank more than two glasses of milk a day were almost twice as likely to develop advanced prostate cancer as those who didn’t drink milk at all. (18) Another Harvard study found that men with the highest calcium intake—more than 2,000 milligrams a day—had nearly double the risk of developing fatal prostate cancer as those who had the lowest intake at less than 500 milligrams per day. (19)

Clearly, although more research is needed, we cannot be confident that high milk or calcium intake is safe.

The Bottom Line: Recommendations for Calcium Intake and Bone Health

Adequate, lifelong dietary calcium intake is necessary to reduce the risk of osteoporosis. Consuming adequate calcium and vitamin D and performing regular, weight-bearing exercise are also important to build maximum bone density and strength. After age 30, these factors help slow bone loss, although they cannot completely prevent bone loss due to aging.

Milk and dairy products are a convenient source of calcium for many people. They are also a good source of protein and are fortified with vitamins D and A. At this time, however, the optimal intake of calcium is not clear, nor is the optimal food source or sources of calcium. As noted earlier, the National Academy of Sciences currently recommends that people ages 19 to 50 consume 1,000 milligrams of calcium per day, and that those age 50 or over get 1,200 milligrams per day. Reaching 1,200 milligrams per day would usually require drinking two to three glasses of milk per day—or taking calcium supplements—over and above an overall healthy diet.

However, these recommendations are based on very short-term studies, and are likely to be higher than what people really need. Currently, there’s no good evidence that consuming more than one serving of milk per day in addition to a reasonable diet (which typically provides about 300 milligrams of calcium per day from nondairy sources) will reduce fracture risk. Because of unresolved concerns about the risk of ovarian and prostate cancer, it may be prudent to avoid higher intakes of dairy products.

At moderate levels, though, consumption of calcium and dairy products has benefits beyond bone health, including possibly lowering the risk of high blood pressure and colon cancer. (20–25) While the blood pressure benefits appear fairly small, the protection against colon cancer seems somewhat larger, and most of the latter benefit comes from having just one or maybe two glasses of milk per day in addition to what we get from other foods in our diet. Getting more than this doesn’t seem to lower risk further.

For individuals who are unable to digest—or who dislike—dairy products and for those who simply prefer not to consume large amounts of such foods, other options are available. Calcium can be found in dark green leafy vegetables, such as kale and collard greens, as well as in dried beans and legumes. A variety of calcium-fortified foods, such as orange juice, cereals, and plant-based milk (soy, rice, almond), are also available in most markets.

Calcium is found in spinach and chard, but these vegetables contain oxalic acid, which combines with the calcium to form calcium oxalate, a chemical salt that makes the calcium less available to the body.

Calcium can also be ingested as a supplement, and if you do go the supplement route, it’s best to choose one that includes some vitamin D. Research suggests that calcium-only supplements do not protect against fractures, and may in fact increase risk of fractures. (4) There’s also some emerging evidence that taking calcium-only supplements may possibly increase the risk of heart attacks—another reason to avoid calcium-only supplements. (26) Men may want to avoid calcium supplements because of questions about possible risks of prostate cancer; if men do take a calcium supplement, limiting supplement intake to 500 milligrams of calcium per day seems prudent.

Antacids contain calcium, but do not contain vitamin D. So if you choose antacids as a calcium source, you may want to consider taking a separate vitamin D supplement. Discuss your options with a health care provider. (Read more about vitamin D and health.)

1. Osteoporosis: fast facts. National Osteoporosis Foundation. Accessed January 24, 2008.

2. Owusu W, Willett WC, Feskanich D, Ascherio A, Spiegelman D, Colditz GA. Calcium intake and the incidence of forearm and hip fractures among men. J Nutr. 1997; 127:1782–87.

4. Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, et al. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007; 86:1780–90.

5. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005; 293:2257–64.

6. Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2007; 92:1415–23.

7. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: a meta-analysis. JAMA. 2004; 291:1999–2006.

8. Weber P. Vitamin K and bone health. Nutrition. 2001; 17:880–87.

10. Booth SL, Tucker KL, Chen H, et al. Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women. Am J Clin Nutr. 2000; 71:1201–08.

11. Booth SL, Broe KE, Gagnon DR, et al. Vitamin K intake and bone mineral density in women and men. Am J Clin Nutr. 2003; 77(2):512-16.

12. Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA, Kiel DP. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: the Framingham Osteoporosis Study. Am J Clin Nutr. 2006; 84:936–42.

13. Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Protein consumption and bone fractures in women. Am J Epidemiol. 1996; 143:472–79.

14. Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003; 349:523–34.

15. Genkinger JM, Hunter DJ, Spiegelman D, et al. Dairy products and ovarian cancer: a pooled analysis of 12 cohort studies. Cancer Epidemiol Biomarkers Prev. 2006; 15:364–72.

16. Ganmaa D, Sato A. The possible role of female sex hormones in milk from pregnant cows in the development of breast, ovarian, and corpus uteri cancers. Med Hypotheses. 2005; 65:1028–37.

17. World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR, 2007.

18. Giovannucci E, Rimm EB, Wolk A, et al. Calcium and fructose intake in relation to risk of prostate cancer. Cancer Res. 1998; 58:442–447.

19. Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC. Risk factors for prostate cancer incidence and progression in the Health Professionals Follow-up Study. International Journal of Cancer. 2007; 121:1571–78.

20. Larsson SC, Bergkvist L, Rutegard J, Giovannucci E, Wolk A. Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men. Am J Clin Nutr. 2006; 83:667–73; quiz 728–29.

22. Martinez ME, Willett WC. Calcium, vitamin D, and colorectal cancer: a review of the epidemiologic evidence. Cancer Epidemiol Biomarkers. Prev 1998; 7:163–68.

23. Hyman J, Baron JA, Dain BJ, et al. Dietary and supplemental calcium and the recurrence of colorectal adenomas. Cancer Epidemiol Biomarkers Prev. 1998; 7:291–95.

24. Dickinson HO, Nicolson DJ, Cook JV, et al. Calcium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev. 2006:CD004639.

25. Cappuccio FP, Elliott P, Allender PS, Pryer J, Follman DA, Cutler JA. Epidemiologic association between dietary calcium intake and blood pressure: a meta-analysis of published data. Am J Epidemiol. 1995; 142:935–45.

27. Feskanich D, Bischoff-Ferrari HA, Frazier AL, Willett WC. Milk consumption during teenage years and risk of hip fractures in older adults. JAMA Pediatr. 2014 Jan;168(1):54-60.

28. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014 Nov;29(11):2520-6.

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7 foods that will keep your bones healthy

Did you know at least one in three women and one in five men will suffer an osteoporotic fracture at some point in their lives?

According to Osteoporosis Canada, at least two million Canadians are affected by osteoporosis, a condition that causes the bones to thin and become porous which impacts bone strength and increases the risk of breaking bones.

No single cause has been found, but health care professionals do know that a diet rich in certain nutrients can help lower one’s risk of bone loss, thus preventing bone fractures.

READ MORE: Canadian teens are developing ‘lazy bones.’ Here’s why

“Physical activity and genetics also play a role, but diet can make or break our bone health,” registered dietitian Tristica Curley of Fueling with Food says. “The impact of diet on our bone health begins at birth and continues until we die. While we are growing, up until about our early 20s, diet will impact how dense our bones grow. Adequate nutrient intake will ensure our bones reach peak bone mass or become as dense and as strong as possible. From our early 20s on, diet can prevent bone losses and maintain the bone mass we have.”

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In order to have good bone health, a diet rich in calcium and vitamin D is what you’ll need, along with protein, vitamin A, magnesium and vitamin K, Curley adds.

So what are some of the best foods for you to include in your diet to strengthen your bones? Curley, along with registered dietitian Andrea D’Ambrosio of Dietetic Directions and spokesperson for Dietitians of Canada, reveal their list in support of Osteoporosis Awareness this November.

Low-fat milk or calcium-fortified soy milk

“Interestingly, almost all of the calcium in our body is found in our bones,” D’Ambrosio says. “Therefore, if we don’t achieve adequate calcium intake through our diet (or supplements), our body will pull calcium out of our bones and use this to maintain constant calcium amounts in our blood and in our muscles. This makes our bones weaker and puts us at a higher risk for fracture.”

And because our bones are living tissue, they are constantly breaking down and releasing minerals and depositing calcium to make new bones, D’Ambrosio adds. This is why she encourages people to ensure they’re meeting their dietary calcium requirements, and one of the top sources of calcium is cow’s milk or calcium-fortified soy milk.

“Milk contains magnesium, vitamin D and phosphorus which support calcium absorption,” she says. “One cup of milk contains approximately 300 milligrams of calcium.”

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If you can’t tolerate dairy, Curley says non-dairy sources like almond or coconut milk will provide some calcium and vitamin D, but will lack the protein and vitamin A found in dairy milk.

Plain Yogurt

Choose plain yogurt over Greek yogurt, D’Ambrosio says, because of the higher calcium content.

“Straining out the extra whey in yogurt makes Greek yogurt thick, creamy and higher in protein but lower in calcium” she explains. “Regular yogurt delivers almost twice the bone-strengthening mineral calcium.”

Plain yogurt contains 263-275 milligrams of calcium, and Greek yogurt contains only 180-212 milligrams, she adds.

Salmon (preferably canned with the bones)

“Fatty fish such as salmon is a good source of vitamin D, which increases calcium absorption and the amount of calcium deposited into our bones,” Curley says. “Aim to get two servings per week of salmon. A supplement may be recommended for the winter. Salmon is also a rich source of protein, which is responsible for making collagen, which maintains bone strength and helps repair bone injury.”

READ MORE: Men with belly fat at risk for osteoporosis: study

According to D’Ambrosio, salmon is one of few foods that naturally contain vitamin D. And, she adds, by getting canned salmon with the bones, you’re increasing your calcium intake.”

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“Don’t be afraid of the bones,” she says. “Simply remove any large pieces and smash the thin salmon bones with a fork.”

Prunes

“A recent study came out in April of this year that showed regular consumption of prunes aids in bone health and decreasing risk of osteoporosis,” Curley says. “Prunes contain phenolic compounds that signal cells to increase formation of bone.”

Prunes are also a good source of vitamin K, she adds, as well as gut health.

Another study published last month found that eating five to six prunes a day for a six-month period helped postmenopausal women with low bone density in preventing bone loss.

Nuts

A good source of protein and magnesium, which both ensure strong bone mass, can be found in nuts, Curley says.

One 2010 study out of Barcelona, Spain also found that eating nuts, along with a high intake of calcium, is associated with protection against bone demineralization.

Tofu

This one may be surprising, D’Ambrosio says, because not many people realize tofu is often enriched with calcium.

“In a three-quarter cup serving, there is about 302-525 milligrams of calcium,” she says. “If you are uncertain if your tofu is fortified, check the nutrition label for the per cent daily value of calcium as well as the ingredient list to see if calcium sulfate is added.”

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Collard greens

“Cooking collard greens increases the amount of calcium available,” D’Ambrosio reveals. “One cup of cooked collard green contain approximately 330 milligrams of calcium.”

These greens also contain vitamin C and vitamin K, which are helpful for maintaining strong bones, she adds.

Other dark leafy vegetables also containing calcium, like kale, turnip greens and spinach, but to a lower level.

Despite the low level of calcium, spinach is a good source of vitamin K and magnesium, Curley says.

© 2017 Global News, a division of Corus Entertainment Inc.

3 Ways to Build Strong Bones

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It’s easy to take our bones for granted. After all, they do all their work behind the scenes. But when a bone breaks, it’s a big deal. Bones take time to heal, even for kids.

Having strong bones in childhood lays a foundation for bone health throughout life. We build almost all our bone density when we’re children and teens. The bone-building process is mostly finished around age 20. As adults, we still replace old bone with new bone, but more slowly. Over time, our bones get weaker.

Kids with strong bones have a better chance of avoiding bone weakness later in life. As a parent, you can help by making sure kids get the three key ingredients for healthy bones: calcium, vitamin D, and exercise.

1. Give Kids High-Calcium Foods

Calcium is a mineral that’s known for building healthy bones. It’s found in dairy products, beans, some nuts and seeds, and leafy green vegetables. It’s also often added to foods like orange juice or cereal.

What You Can Do

Encourage your kids to eat high-calcium foods:

  • If your child eats dairy, your doctor or dietitian can tell you how much to serve based on age. Younger kids may need 2–3 servings of low-fat dairy each day, while older kids may need 4 servings.
  • Look to replace common foods with high-calcium versions. Buy almond butter instead of peanut butter or calcium-fortified orange juice instead of regular juice.

2. Give Kids a Vitamin D Supplement

Vitamin D (sometimes labeled vitamin D3) helps the body absorb calcium. But most kids don’t eat many foods that contain vitamin D. Because vitamin D is so important, health care providers recommend all kids take a vitamin D supplement if they don’t get enough in their diet. Even babies need to take vitamin D unless they’re drinking at least 32 ounces of formula per day.

Ask your doctor, nurse practitioner, physician assistant, or a dietitian how much vitamin D your child needs and the best way to get it.

3. Encourage Kids to Exercise

Our muscles get stronger the more we use them. The same is true for bones.

Weight-bearing activities like walking, running, jumping, and climbing are especially good for building bone. They use the force of our muscles and gravity to put pressure on our bones. The pressure makes the body build up stronger bone.

Activities like riding a bike and swimming don’t create this weight-bearing pressure. They are great for overall body health, but kids also need to do some kind of weight-bearing exercise.

Make sure your child gets at least an hour of physical activity each day, including weight-bearing exercises.

Everyone needs to get enough calcium, vitamin D, and exercise. But these are really important for kids — especially when they’re growing during the preteen and teen years. Vitamin D and calcium also can be useful as part of a medical treatment. Health care providers often prescribe them when kids are recovering from fractures or orthopedic surgeries, such as spinal fusion for scoliosis.

Reviewed by: Richard W. Kruse, DO and Susan M. Dubowy, PA-C Date reviewed: August 2017

When it comes to wellness, the roughly 206 bones in our body tend to get short shrift—at least in terms of air time. We talk endlessly about our skin, microbiome, muscles, vaginas, etc., but the foundation of it all (i.e., your skeleton) gets little attention. Still, bone health is important, especially for women as bone density decreases after menopause. A loss in bone density can lead to osteoporosis which, in turn, can cause bones to fracture, thereby decreasing mobility. This isn’t a niche occurrence. According to the National Osteoporosis Foundation, 1 in 2 women over age 50 will experience bone breakage as a result of the disease.

As with all illnesses, the key is prevention. It’s important to pay attention to your bone health now, whether you’re anywhere near the mid-century mark or not. Stephen Honig, MD, rheumatologist and director of the osteoporosis center at NYU Langone Health, tells me this is accomplished with exercise (particularly of the strength-training variety) and by incorporating foods for strong bones into your diet, though this doesn’t account for the whole picture.

To begin with, your bone mass is 80 percent determined by genetics and the rest is influenced by environmental factors like diet and exercise. The relatively small percentage is then disproportionately affected by what happens in your teenage years, explains Dr. Honig, during which time it’s mission critical to get adequate amounts of bone-building calcium and vitamin D. This is because one does not work, for the purpose of strengthening bones, without the other (at any time in life). “When you take vitamin D, it undergoes a series of conversions in the body, but ultimately the active form of vitamin D binds to a vitamin D receptor in the intestine, and that is required for calcium to be absorbed from the intestine into the blood stream,” Dr. Honig explains.

So you need not only sources of calcium in your diet, but also vitamin D if the calcium is going to do its job. Meanwhile, you’ll want to avoid taking iron supplements, or even eating iron-rich foods, while trying to absorb calcium, as iron and calcium inhibit each others absorption, explains Monica Auslander Moreno, MS, RD, LD/N, a nutrition consultant for RSP Nutrition. Dr. Honig agrees, and cautions against taking iron pills with calcium; however, he admits that the average person is not likely to run into absorption problems if their calcium intake occurs via their diet.

With all of that science mumbo jumbo out of the way, let’s dive into the belly of the beast.

These are the most important foods for strong bones

1. DAIRY

In the era of alt-milk mania (almond, three-nut, soy, oat, banana, sesame, etc.), the belief that cow’s (or camel’s?) milk is critical for building strong bones seems quaint; however, there may be something to it, according to Dr. Honig and Moreno. The former says milk is a good source of absorbable calcium, as are other sources of dairy. These, according to Moreno, include Greek yogurt, cheese, cottage cheese, and kefir.

2. PROTEIN

Dr. Honig tells me that he and his colleagues recommend protein for osteoporosis patients, as there is some evidence that high-protein diets are important for bone health. Moreno recommends getting your protein dose from sardines and anchovies, as they’re rich in calcium and vitamin D as well. Less ideal would be a steak, as its iron content could impede calcium absorption.

3. FOODS ASSOCIATED WITH THE MEDITERRANEAN DIET

Okay, maybe it’s not quite accurate to say that ingesting any food classified as aligning with a Mediterranean diet will help protect your bones, but a study did find that women who adhered to the Blue Zones-approved eating plan had higher bone density than those who didn’t.

4. CRUCIFEROUS VEGETABLES

Although Dr. Honig points to some evidence that bone density in vegans is not as good as it might be in someone who follows “a more balanced diet,” he says more research is needed. There are plant foods that can go a distance to build up your bones, too. “Cruciferous vegetables like broccoli, kale, and cauliflower are high in calcium,” says Whitney English MS, RDN, for Plant-Based Juniors. That their intake has been shown to reduce fractures in post-menopausal women is yet another reason to get on board with the broccoli-everything trend, experiment with all the cauliflower gnocchi recipes, and/or really perfect the art of kale massage.

5. VITAMIN K-RICH FOODS

Bloat-inducing cruciferous veggies aren’t your only plant-based option for bone support, either. “Parsley, prunes, avocado, and kiwi are all sources of vitamin K, which also works with calcium to build strong bones,” says English.

6. UV-TREATED MUSHROOMS

Moreno further recommends adding Asian mushrooms into your diet, while English has an even more specific ‘shroom recommendation. “Mushrooms that have been exposed to sunlight or artificial light produce large amounts of the bone-health supporting nutrient vitamin D. Vitamin D regulates calcium use in the body and proper intake is essential for healthy bones. Not all mushrooms have been treated in a way to ensure vitamin D enrichment. Look for ‘uv-treated’ or ‘high in vitamin D’ on your ‘shrooms label if you’re buying from the grocery store,” says English. Also rich in vitamin D? Eggs, salmon, milk, yogurt, sardines and herring, and… the sun; however, Moreno notes that vitamin D metabolism is complex and as such, even adequate intake and sunlight can result in a deficiency.

But you should avoid alcohol

No surprises. Dr. Honig says booze is bad for your bones which, as someone who can no longer have more than two drinks without feeling like a an actual skeleton, seems like common sense.

Remember when we thought all fat was bad for you? LOL, except that you can still overdo it, even on the healthy kind. And here’s what a gastroenterologist wants you to eat for gut health.

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