Danger of Brittle Bones

Detecting Osteoporosis: Bone Density Screening

If you are at high risk for developing osteoporosis, or if you have already seen the early
warning signs, discuss an evaluation of your skeletal health with your doctor. Ordinary x-rays
do not detect osteoporosis until at least 30 percent of the bone is already lost and the disease
has progressed much farther than is healthy. But sophisticated technology is now available for
earlier detection of bone loss, when it can still be stopped or even reversed.
Several different methods of bone screening exist, all of which are painless, involve low-dose
x-ray procedures, and range in cost from $75 to $350. Make sure you use a facility that does
bone density testing on a regular basis. Most large hospitals have the necessary equipment,
and some even have special osteoporosis centers.
The current gold standard in bone density testing is dual x-ray absorptiometry (DXA), which
can measure the spine, hip, or total body. It uses a minimal amount of radiationabout 10
percent of what you'd receive in a chest x-ray. The p-DEXA, a cheaper alternative found at
many health fairs and malls, takes just 10 minutes. However, it measures bone density only at
the wrist, not at the spine and hip, where fractures are most serious, and isn't particularly
helpful in predicting such fractures. Be sure to discuss your test results with a qualified
medical professional.
Routine screening for changes in bone density is still considered controversial. However, most
experts agree that it's justified for women over 65 and others clearly at risk. It's also
recommended if you've already been diagnosed with osteoporosis, so the doctor can monitor
the effects of treatment. New biochemical tests, which measure bone breakdown products in
blood and urine, can also be helpful in gauging your response to therapy. Such tests are not,
however, reliable enough to provide a diagnosis.

Preventing Osteoporosis: Diet and Exercise

Calcium, the primary component of bone tissue, is the key factor in maintaining bone
strength. But if you diet, fast, or habitually eat little, your daily calcium requirements are
probably not being met. In addition, excess consumption of protein, sodium, sugar, alcohol,
and caffeine has been shown to decrease absorption of calcium from your diet. And a certain
amount of calcium is lost naturally each day through excretion. Since your body needs calcium
to function, it tries to compensate for all of these deficits by taking calcium from your bones.
Calcium needs vary according to unique requirements, but the bottom line is: To build bone
mass, you need calcium and most Americans do not get enough. One national survey found
that average daily intake ranges from only 530 milligrams among middle-aged women to a
high of 1,179 milligrams among teenaged boys. On average, no adult women met even
minimal requirements. Experts now agree that women need to get about 1,000 milligrams of
calcium a day prior to menopause, and 1,200 to 1,500 milligrams a day after menopause.
Because your body can absorb only about 600 milligrams of calcium at a time, it is advisable
to consume calcium-rich foods at separate sittings.
Ideally, calcium should come from a natural diet. Devising a plan to promote adequate calcium
levels includes making calcium-rich foodssuch as dairy products, nuts, leafy greens, broccoli,
rhubarb, salmon, and sardinesa regular part of your diet.
Skim milk is just as valuable to your bones as high fat whole milk. People who are lactose
intolerant should consider using Lactaid, which supplies the enzyme needed for proper
digestion of milk products. Calcium-rich yogurt is another alternative because it is easier to
digest than other dairy products.

Analyze your diet to learn how much calcium you are actually getting each day. Using the
nearby chart can help you become more aware of calcium content in food, and aid you in
shifting slowly to a new nutritional program.

Recommended Calcium Intakes (milligrams per day)

National Academy of
Sciences (1997)

National Institutes of
Health (1994)

Infants, Children, and Young Adults

Birth-6 months

210

Birth-6 months

400

6 months-12 months

270

6 months-12 months

600

1-3 years

500

1-10 years

4-8 years

800

9-18 years

800-1,200

1,300

11-24 years

1,200-1,500

19-50 years

1,000

25-50 years

1,000

51 and older

1,200

51-64 years, taking estrogen

1,000

51-64 years, not taking

estrogen

1,500

65 and older

1,500

Adult Women

Adult Men
19-50 years

1,000

25-64 years

1,000

51 and older

1,200

65 and older

1,500

Summary of recommendations for optimal calcium intake made by the consensus development
panel convened by the NIH, June 1994 and the Food and Nutrition Board of the National
Academy of Sciences, August 1997. Optimal calcium intake refers to the level of calcium
consumption from the diet plus supplements, if needed, that is necessary for a person to
maximize peak adult bone mass and minimize bone loss in later years.
Sources: National Institutes of Health, Bethesda, MD; National Osteoporosis Foundation,

Washington, DC.

Calcium supplements are recommended if you or your doctor feels your calcium needs are
not being met through your diet. The recommended amounts are the same for dietary
calcium. Don't overdo it. Excessive calcium can create other problems in the body, such as
promoting kidney stones and hardening of the arteries.
The most important point about supplements is absorption. To be properly absorbed, calcium
supplements must dissolve quickly in the stomach. Yet in recent studies, about half of the pills
on the market failed to dissolve fast enough. You can test your brand of choice at home. Drop
a tablet into a container with 2 to 4 ounces of vinegar, stirring twice. After 30 minutes the pill
should have completely dissolved or disintegrated into fine particles. If not, change brands.
Calcium citrate is the preferred formulation of many doctors because it is easily absorbed
(especially by older people who make less gastric hydrochloric acid), and does not need to be
taken with meals. To ensure best absorption, calcium should be taken in two daily doses,
preferably at breakfast and dinner. Also, for some people calcium needs to be accompanied by
daily doses of vitamin D (see below) or it is likely to go unabsorbed.
Antacids have become a newly touted source of calcium. However, with alternatives such as
calcium-rich food and pure calcium supplements, there's reason to wonder why anyone would
choose antacid tablets as a major source of calcium. Though antacids may be less expensive
than supplements, many contain aluminum, which can actually cause your body to lose
calcium. (Two popular brands, Tums and Titralac, are aluminum-free, however.)
If you need to take an antacid for its intended purpose, there's nothing wrong with taking one
that contains calcium. However, taking antacids solely for their calcium content is not
recommended. Taken 5 to 6 times a week, they may be harmless; but in excessive amounts
they can cause constipation and may lead to the formation of kidney stones and other urinary
problems. In addition, certain pre-existing medical conditions can be aggravated by antacids,
including colitis, stomach or intestinal bleeding, irregular heartbeat, and kidney disease.

Being good to your bones doesn't necessarily mean eating cottage cheese every day for the
rest of your life. Many prepared foods, ranging from fortified orange juice to some kinds of
tortillas, contain calcium-based food additives. In fact, a wide variety of unexpected foods
contain some calcium. Depending on the quantities and combinations you consume, eating a
balanced diet can provide an adequate amount of calcium without restricting your choices to
dairy products. For example, just one slice of calcium-fortified bread provides as much calcium
as a glass of milk.
Read food labels carefully. You may be surprised at what you find. Following are some
examples of the amount of calcium present in a variety of foods

Food

Serving
size

Calcium
(milligrams)

Calories

Fat
(grams)

Dairy Products
Cheddar cheese

1 ounce

204

115

Mozzarella cheese
(part skim milk)

1 ounce

207

80

Cottage cheese
(lowfat 2%)

1 cup

155

200

Milk, Skim

1 cup

302

85

2%

1 cup

297

120

Whole

1 cup

291

150

1 cup

415

145

1 cup

345

230

Cheese pizza
(1/8 of 15 inch pie)

1 slice

220

290

Macaroni & cheese

1 cup

200

230

10

Salmon, pink
(canned, with bones)

3 ounces

167

120

4.6

Sardines
(in oil, with bones)

3 medium
(3 ounces)

370

175

Oatmeal
(instant, fortified)

1 packet

160

105

Pancakes (from mix)

one 4"
pancake

30

60

Wheat bread (enriched)

1 slice

30

65

1 spear

72

40

1cup

354

45

Collards, fresh, cooked, drained 1cup

357

30

Kale, fresh, cooked, drained

179

42

Yogurt, Plain, lowfat

Fruit-flavored, lowfat

Fish

Bread and Cereal

Vegetables
Broccoli, raw
cooked, chopped

1cup

Other
Hot cocoa

6 oz.

Tofu, 1 piece
(1-1/2 x 2-3/4 x 1 inch)

90

100

100

85

Tomato soup
(made with milk)

1 cup

160

160

Pork and beans

1 cup

140

310

Source: "USDA Nutritive Value of Foods." Washington, DC, Human Nutrition Information
Services, U.S. Department of Agriculture, 1985; 72. Home and Garden Bulletins.