WHAT CAN YOU DO TO IMPROVE YOUR BONE HEALTH?
Include adequate amounts of calcium in your diet
Optimise your Vitamin D levels (according to your blood test)
Consider your magnesium intake
Do regular and appropriate exercise
Quit smoking
Keep sodium/salt, alcohol and caffeine intake to a minimum
Consider a 'falls prevention' program if at risk of falling
Avoid being underweight.
CALCIUM
Calcium is essential for bone health. Aim for 3 serves of dairy foods per day, as they are particularly rich in calcium, in a form which is more readily absorbed. Consider adding milk powder, milk, yoghurt or cheese to your cooking. Choose low fat dairy where possible.
REQUIREMENTS
All adults - 1000mg per day
Women over 50 and men over 70 - 1300mg per day.
SPECIAL CONSIDERATIONS
Calcium in the body is reduced by high sodium (salt), caffeine and alcohol in the diet.
Calcium absorption (and the absorption of many other vitamins and minerals) is assisted by acidity in the stomach, so calcium supplements are best taken with food. If you have low stomach acid, eg you are taking a medication to reduce acid (antacid, protein pump inhibitor such as omeprazole, Nexium, Pariet, Somac, or ranitidine) or have reduced acid due to stomach surgery, you are at increased risk of osteoporosis and vitamin/mineral deficiency and need to take care. Calcium citrate (eg Citracal) is a better supplement for you. Taking a juice such as cranberry or orange will also help absorb calcium from your food.
DIETARY SOURCES
Calcium (mg)
Anlene milk 250mg 500
Milk (skim slightly more) 250ml 300
PhysiCAL milk 250ml 437
Yoghurt 200g 300
Yellow cheese 40mg (2 cheeses slices) 300
White cheese 40mg 150
Calcium fortified soy/rice/oat milk 250ml 300
Sardines/salmon with bones 100g 300
Fortified cereals eg Special K 1 cup 200
Dried figs, 5 200
Dark green leafy vegetables 1 cup 150
Bok choy, Chinese broccoli, kale, chinese cabbage
Prawns 100g 130
Oats, raw 1/2 cup 100
Firm tofu 60g 100
Tahini 1tbs 80
Almonds 1/4 cup or 1 tbs paste 70
Broccoli 1 cup 70
Also look for calcium fortified foods such as juices, breads and cereals.
CALCIUM SUPPLEMENTS NB Consider a combination of calcium and Vitamin D
Calcium Carbonate: Active Calcium (mg)
Caltrate 600 (equiv 2 serves of milk)
Caltrate Plus D has 5mcg, 400IU Vit D
Caltrate Plus has Vit D, as well as Mg, Zn, Cu, Mn - all minerals important in bone health.
Active Calcium (mg)
CAL-600 600
Calcia Chewable 500 Also available with 200 or 400 IU Vit D.
Cal-Sup Chewable 500 or 650
Calvid - orange flavoured drink/sachet 1000 plus 880mg Vit D
Ostelin Vit D plus calcium 600 plus 500IU Vit D.
Calcium Citrate:
NB better absorbed for people with low stomach acid - eg on medication
for gastrooesophageal reflux (Losec, Nexium, Pariet, Zoton, Ranitidine, Famotidine).
Citracal 250 (equiv 1 serve milk)
Citracal + D 315 plus 500 IU vit D.
VITAMIN D
Vitamin D promotes absorption of calcium from the gut and its deposition into bones. It is also important in muscle health, and has implications in heart disease, diabetes, autoimmune disease and some cancers (colon, breast, prostate). It is very important in pregnancy, and women with dark skin or who are veiled usually require supplements during pregnancy. Vitamin D deficiency is associated with bone pain, muscle weakness, increased risk of falls, fractures and osteoporosis.
Vitamin D is produced by the action of sunlight (UV light) on skin, and another form of vitamin D is obtained in small amounts from the diet. It is almost impossible to obtain all of our vitamin D from diet alone, so people with reduced sunlight exposure are at high risk of deficiency.
REQUIREMENTS
Your blood level should be over 75.
How you achieve this depends on many things, including your current blood level, your diet, sun exposure, age and general health. People at high risk of vitamin D deficiency include those with:
Low sun exposure due to lifestyle, dress or conditions that require sun avoidance
Darker skin
Bowel conditions that reduce ability to absorb micronutrients.
Vitamin D needs to be optimal if you already have osteoporosis and are using specific medication.
SUNLIGHT EXPOSURE
Avoid sun exposure between 10am and 3pm in summer. Take care - the skin should not be exposed long enough to redden.
As a guide, in Melbourne, for a moderately fair skinned person, you need the following:
15% of body exposed (face, hands, arms), 3-4 times per week
December to January, at 10am or 2pm - 6-8 minutes
July to August, at 10am or 2pm - 32-52 minutes (noon 25 minutes).
Skin needs to be uncovered, with no sun screen and under direct sun, not through glass or perspex.
People with darker skin need longer sun exposure.
Older people should aim for daily exposure, as the ability to make and store Vitamin D diminishes with age.
People with skin conditions that require sun avoidance need to take supplements.
DIETARY SOURCES
Vitamin D
Physical milk 250ml 1.25mcg (50 IU)
Anlene milk 250ml 5mcg (200 IU)
Other sources include mackerel, sardines, tuna, salmon, herring, liver, margarine (fortified with vitamin D), eggs, fish liver oils.
SUPPLEMENTS
May be needed according to your vitamin D blood test. Regular testing will help determine the correct dose for you and the success of your dietary and sunlight measures.
mcg IU
Caltrate plus D 5 400
Caltrate plus 5 400
Calcia +D 200 or 400
Citracal +D 12.5 500
Ostelin Vit D plus calcium 12.5 500 plus 600mg calcium carbonate
Calvid - orange flavoured drink 880 plus 1000mg calcium carbonate
Ostelin 1000 25 1000
Ostevit D 25 1000
MAGNESIUM
Important for the absorption of calcium, and the activation of vitamin D.
People at risk of magnesium deficiency include people with diabetes, osteoporosis, asthma, heart disease, people taking diuretics, laxatives and with excessive alcohol intake.
REQUIREMENTS
RDI 300-400mg
Supplements should never exceed 200mg per day.
DIETARY SOURCES
Magnesium (mg)
Dark chocolate 50g 200
Anlene milk 250ml 80
Dark green leafy vegetables 1 cup 120
Magnesium (mg)
Wholegrain bread 4 slices 90
Greek coffee 1 cup 90
1 cup baked beans 80
Tofu 80g 80
Corn cob 80
Cashews, almonds, pumpkin seeds 20mg 60
Oats, barley, brown rice 1/2 cup raw 50
Banana, 1/2 cup avocado 40
Weetbix, 2 also bran, other cereals 35
SUPPLEMENTS
Caltrate Plus 50
Anlene milk 250mg 80
Supplements should not exceed 200mg per day.
EXERCISE
Regular exercise reduces your risk of developing osteoporosis or fractures by:
Maintaining and improving bone strength
Increasing muscle strength
Improving coordination and balance, reducing the risk of falls.
Include the 2 main types of exercise:
Weight bearing exercise - such as walking, running, dancing, tennis, golf, aerobics. This places stress on the bones by having to work against gravity, making them stronger.
Resistance exercise or strength training - using your muscles to push your limbs against a force or weight - such as swimming, cycling, weight training. This stresses the bones by the muscles pulling on them.
If you have established osteoporosis, you should avoid:
Jarring, twisting movements
High impact exercise
Sudden movements
Sit-ups
Forward bending from the waist
Heavy lifting
Extremes of movement.
Excellent forms of exercise might include yoga, tai chi, hydrotherapy or water aerobics or gentle weights, perhaps under the supervision of a physiotherapist.
USEFUL WEBSITES (and other resources acknowledged in producing this document)
Anlene.com.au
Osteoporosis Australia www.osteoporosis.org.au
Antigone Kouris, Dietician.
nhmrc.gov.au Recommended Dietary Intakes, 2006.
eMJA Vitamin D position statement. AFP Vitamin D, A review, Dec 2008.
Prepared June, 2008. Updated April 2010.