Osteoporosis Bone Density Testing and Nutrition Considerations 03/08/09

Approximately one in four women and one in eight men over the age of 50 develop osteoporosis in our modern societies.

These are alarming statistic, as 25% of individuals who sustain an osteoporotic hip fracture die within the first year from related complications.

In Canada, more women die each year from the consequences of hip fractures than from the combined death rate from breast and ovarian cancer (Osteoporosis Society Of Canada). Studies indicate that much of this problem is preventable using proper nutrition and lifestyle practices, including ingesting sufficient amounts of calcium, vitamin D, magnesium, protein, as well as other nutrients such as zinc, manganese, copper, silicon, soy isoflavones, vitamin K, folic acid and vitamin B6. It is especially important to ensure adequate intake of calcium and vitamin D, as the majority of individuals do not ingest optimal amounts of these vital nutrients.

Studies suggest that the sub-optimal intake of calcium and vitamin D account for a high percentage of osteoporosis cases. To prevent osteoporosis, The National Institutes Of Health state that young men and women between ages 11-24 should consume 1200 mg of calcium per day. For women 25-50, the recommendation is 1000 mg per day and women over 50 (not using hormone replacement therapy) should increase their intake to 1500 mg per day. Men between 25 and 65 years of age should consume 1000 mg per day and increase their calcium intake to 1500 mg per day after age 65.  On average, the majority of adults in our society fall short of their calcium needs by at least 500 mg. As such, most people should increase their intake of low fat calcium-rich foods that are low in saturated fat and transfats (see calcium and vitamin D food charts on the Website) and consider taking a high potency multiple vitamin and mineral supplement that contains 500 mg of calcium per day. In many cases, an additional bone support supplement providing another 500 – 1,000 mg of calcium and other bone support nutrients may be required to optimize osteoporosis prevention, based upon one’s age and dietary patterns.

In the case of vitamin D, which is necessary for the absorption and utilization of calcium, a high potency multiple vitamin and mineral supplement should contain 400 IU of vitamin D. This amount may be adequate up to age 40-45, whereby many osteoporosis and cancer experts suggest increasing vitamin D supplementation to at least 800-1,000 IU per day. This dosage has been shown to decrease hip fractures up to 43%. More recently, studies have shown that individuals ingesting 1000 IU of vitamin D per day, from nutritional supplements, also reduce their overall cancer risk (Lappe JM et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85:1586-91).  Many studies have highlighted the fact that higher blood levels of vitamin D are associated with decreased risk of breast, prostate and colon cancer, as well multiple sclerosis. Thus, cancer prevention is another reason to consider supplementing with 1000 IU of vitamin D during all years of adult life.

I suggest you consult the calcium and vitamin D charts below as a reference from which you can better assess your patient’s average daily intake of calcium and vitamin D. A review of these charts can also help assist in determining how to help patients increase their food intake of these important nutrients (from healthy food choices) in order to meet their daily calcium and vitamin D targets

Keep in mind that patients are a candidate for a Bone Mineral Density Test if any of the following statements apply to them, as these factors are known to be associated with increased risk of osteoporosis:

• Are you a woman over the age of 50?
• Are you a woman, who entered into early menopause (40-45), or premature menopause (before 40)?
• Are you a woman who has had both ovaries surgically removed before normal menopause (45-55)?
• Are you a woman under 45 years of age who routinely misses menstrual cycles or has greatly diminished menstrual flow due to estrogen and/or progesterone deficiency?
• At some point in your life did you suffer from anorexia nervosa, bulimia or an eating disorder?
• Are you a woman who at some time in your life exercised excessively or competitively to the point where your body fat was very low?
• Have you undergone treatment with oral glucocorticosteroid (prednisone, cortisone etc.) drug for more than 3 months at some time in your life?
• Have you been diagnosed with hyperparathyroidism?
• Are you a woman and your biological mother or sister(s) develop osteoporosis?
• Are you a man over 65 years of age?
• Are you older than 45 and your doctor has told you that you are underweight?
• In general, do you have poor muscular development and strength?
• Have you taken anticonvulsant medication for 5 years or longer at some point in your life.
• Do you have rheumatoid arthritis or ankylosing spondylitis?
• Do you take the drug methotrexate (usually for rheumatoid arthritis or cancer)?
• Have you had a previous fracture in adult years from minimal trauma or had a previous fracture of a vertebra, wrist, hip, or pelvis?
• Are you taking thyroid replacement therapy (thyroid hormone)?

Calcium and Vitamin D Food Charts

Instructions: After reviewing the Calcium and Vitamin D tables below estimate your daily average of intake of these two vital bone support and cancer prevention nutrients. If your daily intake falls short of the desirable levels for your age and gender then you should strongly consider setting out a strategy to acquire the missing levels of Calcium and/or Vitamin D from healthy food choices and/or supplementation, as a crucial aspect of a disease prevention and longevity program. Ingesting sufficient and optimal amounts of calcium and vitamin D has the potential to extend your lifetime and greatly reduce your risk of certain life-threatening degenerative diseases, do please examine the above information carefully and follow through. Note that individuals who suffer from sarcoidosis or hyperparathyroidism should not take vitamin D-containing supplements without their physician’s knowledge (this includes multiple vitamins as well as other vitamin D-containing supplements)

Sources of Calcium From Common Healthy Foods

Food Portion Size Amount of Calcium (mg)

Low Fat Yogurt                                                      1 cup                                           415
Low Fat Milk (nonfat,1%)                                   1 cup                                           300
Low Fat Cottage Cheese                                      ½ cup                                         75
Sardines with bones                                             3 oz                                              370
Salmon with bones (canned)                            3 oz                                              165
Processed Tofu with calcium sulfate             4 oz                                              145
Canned Shrimp                                                       3 oz                                              100
Cooked Lentils                                                        1 cup                                            75
Chicken Breast                                                        3 oz                                              10
Tuna                                                                            3 oz                                               5
Collard Greens                                                       ½ cup                                          180
Spinach                                                                     ½ cup                                           85
Stalk of Broccoli                                                   1 medium                                    70
Orange                                                                     1 medium                                     55
Green Beans                                                           ½ cup                                           30
Lettuce                                                                     ½ head                                        15
Orange Juice                                                          ½ cup                                          10
Apple                                                                        1 medium                                    10
Whole Wheat Bread                                             1 slice                                           20
Cooked Spaghetti                                                 1 cup                                             15
Cooked Rice                                                            ½ cup                                          10
Apricots, raw, dried                                            4-6 halves                                  24
Dates                                                                          3-4                                                22
Figs Canned                                                             3                                                    35
Figs Dried                                                                 2                                                    56
Grapefruit                                                                1 medium                                  40
Prunes, dried raw                                                 5                                                    27
Raisins                                                                       ¼ cup                                         31
Raspberries                                                            2/3 cup                                       40
Strawberries                                                          1 cup                                             42
Roasted Almonds                                                1 oz                                                80
Kale                                                                           ½ cup                                           47
Baked Beans                                                           ½ cup                                           78
White Beans                                                           ½ cup                                           96
Dry-roasted soybean nuts                               ½ cup                                           232

Sources of Vitamin D From Common Healthy Foods

Food                                                                        Portion                                      Amount of Vitamin D (IU)
Low Fat Cheese (less than 4% milk fat)      3-1/2 oz                                       12-15
Halibut                                                                      3-1/2 oz                                       44
Herring                                                                     3-1/2 oz                                        320
Mackerel (raw)                                                     3-1/2 oz                                       1100
Salmon (fresh)                                                       3-1/2 oz                                        450
Salmon (canned)                                                  3-1/2 oz                                        1300
Shrimps                                                                    3-1/2 oz                                        150
Oysters                                                                     3-4 medium sized                     5
Non fat, Skim Milk and 1% Milk                      8 oz                                                 100

Note that other than Vitamin D fortified dairy products, the only other good source of dietary Vitamin D are fish that feed on plankton living near the surface of the sea, which is exposed to sunlight. Sunlight, in turn, stimulates the production of Vitamin D in plankton. Exposure of human skin to direct sunlight also stimulates the production of Vitamin D within the skin. However, in cold climate areas (all regions north of the midpoint of the United States) there is insufficient sunlight intensity from October to May to produce Vitamin D in the skin to any appreciable degree. Thus, individuals living in these areas of North America must pay special attention to acquiring optimal amounts of Vitamin D from any combination of Vitamin D fortified dairy products, fish, seafood and Vitamin D-containing supplements. The same is true for individuals living far south from the equator (in the southern hemisphere) in climates that have cold winters lasting more than 2-3 months.

James Meschino DC, MS, ND