Bone Health and Osteoporosis

Page 5

Prevention
The good news is that for most women, osteoporosis can be prevented. The best things you can do to prevent osteoporosis is do regular weight-bearing and resistive exercise; eat a healthy diet with at least 1,200 mg calcium daily; limit carbonated drinks, salt, and excess protein; and don't smoke. Additional preventive measures are limiting alcohol to no more than 10 drinks a week and having a bone density test if you have had more than three fractures in your life or have gone through menopause. If you are of reproductive age, make sure you are having regular periods.

Calcium Intake
Research suggests that 90 percent of American women do not get enough calcium.

Calcium is a mineral your body needs in daily supply, because it cannot be made by the body and is cycled out of the body through nails, hair, skin, sweat, urine, and stool. Unless you are a person who loves dairy products and regularly eats four servings a day of milk, cheese, or yogurt, or regularly eats calcium-fortified foods , you must take supplements. Most women must make a conscious effort to eat 1,200 to 1,500 mg calcium a day, because the majority of American women's diets do not even contain half the recommended amount! The bonus: Calcium eases symptoms of PMS, prevents muscle cramping, and has also been found to help with weight management.

Daily Recommended Calcium Intakes*

Age	Amount mg/day
Birth to 6 months	210
6 months to 1 year	270
1 to 3	500
4 to 8	800
9 to 13	1,300
14 to 18	1,300
19 and over	1,200
Pregnant and lactating	1,300
Athletic girls and women	1,500

*Adapted from the National Osteoporosis Foundation

Calcium Supplements
Calcium, a mineral element, is only available to our body in combination with other substances called calcium compounds. The best compounds are those found naturally in dairy products and certain foods, such as broccoli, almonds, and canned salmon. Supplements are usually one of three compounds: calcium carbonate, calcium phosphate, or calcium citrate. The RDI, or daily recommended milligrams of calcium, refers to the amount of calcium in the supplement compound (not total milligrams of compound), also called "elemental calcium." When reading labels, be sure to look for the amount of "elemental calcium" in the supplement compound. Another way to determine the actual calcium of a food source is to take the "percent daily value" (%DV) listed on the food label and add a zero (the FDA's recommended daily intake of calcium is 1,000 mg). For example, one cup of milk has 30%DV of calcium; this equals 300 mg elemental calcium.

The type of calcium compound and the ease of its breakdown by the digestive system affects how well it reaches the bones. In order for calcium to become available to the bones, it must be absorbed; this occurs best in a chewable or liquid form. Calcium is also absorbed best when taken in smaller doses of 500 mg or less at a time. The two most common compounds are calcium citrate and calcium carbonate. Calcium carbonate is found in stomach-soothing tablets such as Tums and offers a cheap and tasty way to get your calcium supplement. Calcium carbonate is best absorbed with food. Calcium citrate can be taken at any time and is recommended for women who also take iron supplements, as carbonate can interfere with iron absorption. (Otherwise, the calcium and iron supplements should be taken separately.) Try to take "purified" forms of calcium, rather than "natural" ones. Oyster shell, bonemeal, or dolomite preparations or many "natural" preparations are not recommended, as they can contain high levels of lead, magnesium, or aluminum, which can be dangerous.

Because of the inconsistencies of the amount of calcium that actually gets absorbed by the bones, it is recommended to slightly exceed the recommended dose and aim for 1,500 mg daily. This is especially true for active athletic girls and women, as calcium is lost through sweat. If your diet is rich in calcium, taking one 300 to 600 mg supplement or taking a multivitamin that contains calcium daily is still recommended. Vegetarians and women who do not eat dairy must take supplements or eat calcium-fortified foods to total at least 1,200 mg a day.

To test absorption of your calcium supplement, place one tablet in a glass of half vinegar, half water. If it dissolves within 30 minutes, it is recommended as an easily absorbed supplement.

Tips to Help Your Body Absorb Calcium Most Effectively

• Divide your total dose if you need to supplement more than 600 mg; take half with dinner and half before bedtime.
• Make sure it is an absorbable form (see above).
• Do not take it with iron unless you are also taking vitamin C or calcium citrate.
• Calcium carbonate should be taken with food.
• Take calcium with or after a snack or meal.

Tips in Selecting a Calcium Supplement

• Avoid "natural," aluminum, oyster shell, or bonemeal supplement types.
• Look for "purified" on the label.
• Select a chewable or liquid form.
• Experiment with different flavors to find one you like.

The importance of maintaining and developing maximum bone strength is clear. Living a healthy, physically active life with a diet rich in calcium is the best thing you can do to take care of your bones. Continue your activities, making sure you are doing weight-bearing exercises and strength training if your sports activity is not impact. Take an extra calcium supplement or two if you are not sure you ate enough foods, and make sure you are having regular periods or have had a bone density test if you are in menopause. Do not smoke and avoid excessive alcohol, carbonated drinks, and high-protein diets. As with anything, if you have concerns, and especially if you have had multiple fractures, see your doctor.