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.
