Bone mass
increases from birth until it reaches its maximum, known as peak bone mass,
which occurs for cortical bone at age 30 to 35 and earlier for trabecular bone.
Approximately 40% of adult bone mineral content is accumulated in adolescence.
After age
40, age-related bone loss occurs due to a slow loss of cortical bone in both
sexes. At menopause, women lose cortical bone at a rate of 2 to 3% per year,
which is superimposed upon the age-related loss.
While
osteoporotic changes are commonly thought to begin with menopause, in many
women half of the total vertebral (trabecular) bone loss occurs before
menopause.
The
cumulative lifetime losses of bone mass range from 20 to 30% in men to 40 to
50% in some women.
Diet:
A high
dietary intake of fruits and vegetables - 5 or more servings per day. A
Mediterranean type diet is one of the best to eat. Daily consumption of dairy
products (Calcium + vitamin D), fruit and vegetables (anti-oxidants and
phytoestrogenes) , with fish meals (Calcium + vitamin D+protein + n-3 fatty acids)
several times/week. Combined with daily outdoor activities providing sun
exposure (vitamin D) and physical training (bone and muscle strength) will most
likely build bone strength throughout life and reduce the fragility fracture
risk in the elderly.
Limit
protein intake to one gram of protein per kilogram of body weight (I kg equals
about 2.2 lbs.), which translates into around two to three ounces of protein
(equivalent to one chicken breast) daily for the average woman. High animal
protein diet and salt and sugar intake cause the body to excrete increased
amounts of calcium.
Avoid:
Excess
phosphorus and phosphate-containing foods and drinks, such as soda and alcohol.
Wheat bran, raw spinach, fructose (as in high-fructose corn syrup in soft
drinks), caffeine, salt, alcohol, and tobacco can all interfere with calcium
absorption.
Eat:
Avocado,
broccoli, cabbage, chestnuts, clams, dandelion greens, eggs, most dark green
leafy vegetables, flounder, hazelnuts, kale, kelp, molasses, oats, onions,
oysters, parsley, salmon, soy products, tahini, tofu, turnip greens, and wheat
germ.
Supplements:
Experts and
research recommend supplementation of the average American diet for vitamin D,
calcium, magnesium, silicon, vitamin K, and boron. The following supplements
are suggested but are not prescriptions.
Calcium: 800-1200 mg per day (levels
greater than 2,500 mg/day are not recommended)
Absorbability
of calcium supplements varies considerably, but it is thought by some that the
most absorbable type of calcium is microcrystalline hydroxyapatite compound
(MCHC). The second most absorbable is calcium citrate, which is not made from
animal bones. Bone meal contains absorbable forms of calcium, but it may be
contaminated with lead. Calcium carbonate should be taken with meals, as this
form of calcium needs a lot of acid (hydrochloric acid produced by the stomach
or as a supplement) for absorption. Calcium chloride is irritating to the
gastrointestinal tract. Other good forms of calcium are calcium aspartate,
calcium succinate, and calcium malate.
Some early
studies show that microcrystalline hydroxyapatite compound (MCHC) has prevented
bone loss and the progression of osteoporosis
The highest
bone resorption occurs during the night and reaching a peak at 7 a.m. It is
therefore appropriate for a large proportion of calcium supplements to be taken
at night.
Those
persons who have already had a kidney stone and who have absorptive
hypercalciuria should not take excess calcium. And those taking the drug
Digoxin, also known as Lanoxin, should avoid high doses of calcium ascorbate If
you are taking Thyroid hormone, anticoagulant drugs, or diuretics, consult your
prescribing physician before taking any calcium supplements.
Calcium
absorption is also increased by the parathyroid hormone, vitamin A, vitamin D,
and the amino acids lysine and arginine. Taking a calcium supplement with
vitamin C can significantly increase calcium absorption. Magnesium, phosphorus,
boron, selenium, iron, manganese and vitamin E are also important for calcium
metabolism.
Boron: (3 mg. maximum)
Studies have
shown that 3 milligrams (mg) of boron daily reduces urinary excretion of
calcium and magnesium, especially when dietary magnesium is low (note: if you
are taking a calcium complex containing boron, omit this supplement).
Vitamin D: (400 IU)
To ensure
adequate calcium absorption, a daily intake of 400-600 IU of vitamin D is
recommended, either through sun exposure or through diet or supplementation.
Magnesium: (400-600 mg.)
For each 100
mg of magnesium, take 200 mg of calcium, as this ratio increases the amount of
magnesium the body can use. Those with kidney problems should not exceed 3000
mg of magnesium a day. People who consume even moderate amounts of alcohol or
use proton pump inhibitors may have increased loss of magnesium in the urine
and may benefit from a supplement.
Ipriflavone: (600 mg.)
Similar to
the isoflavonoids found in soy foods. This helps bone resorption.
References:
Price CT,
Langford JR, Liporace FA. Essential Nutrients for Bone Health and a Review of
their Availability in the Average North American Diet. Open Orthop J.
2012;6:143-149.
Palacios,
Cristina. (2006). The Role of Nutrients in Bone Health, from A to Z. Critical
reviews in food science and nutrition. 46. 621-8.
Rizzoli R,
Biver E, Brennan-Speranza TC. Nutritional intake and bone health. Lancet
Diabetes Endocrinol. 2021 Sep;9(9):606-621. doi: 10.1016/S2213-8587(21)00119-4.
Epub 2021 Jul 6.
T.
Cederholm, 13 - Nutrition and bone health in the elderly, Editor(s): Monique
Raats, Lisette de Groot, Wija van Staveren, In Woodhead Publishing Series in
Food Science, Technology and Nutrition, Food for the Ageing Population,
Woodhead Publishing, 2009, Pages 252-270, ISBN 9781845691936,
Disclaimer
Material on this blog is provided for informational purposes only. It is general information that may not apply to you as an individual, and is not a substitute for your own doctor’s medical care or advice.
Reading this blog should not be construed to mean that you and I have a patient-physician relationship.
