What Is Osteoporosis?

Every structure requires a sturdy frame and the human body is no different. The bones of the human skeleton serve as the firm yet flexible support for the entire body. Having healthy bones is a vital part of maintaining optimal health and well-being. Bones protect vital organs and the spinal chord against injury. They serve as the site of production for red blood cells that nourish and oxygenate body tissues. The skeleton acts as the body’s storehouse for calcium, the mineral essential for regulation of heart, muscle and nerve function. Strong bones protect and serve the body in so many ways.
Osteoporosis is a disease that directly threatens the skeleton’s ability to protect the body. It weakens bones, leads to decreased bone mass, and to an increased susceptibility to fractures (broken bones). Osteoporosis results when calcium leeches from bones faster than it is replaced. It is known as a “silent disease,” as there are no obvious outward symptoms. All too often, the first warning that a person has osteoporosis comes when some kind of bump or fall causes brittle bones weakened by the disease to break, at which point the disease is already far advanced. The good news is that osteoporosis is preventable and effective treatments exist for those living with the disease.
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Prevalence

Approximately 10 million Americans live with osteoporosis. An additional 34 million people are at increased risk of developing the disease due to low bone mass. Eighty percent of people with the disease are women. Osteoporosis constitutes a significant national health threat accounting for 1.5 million fractures each year. One quarter of all men and half of all women over the age of 50 will experience an osteoporosis-related fracture in their lifetime. Hip fractures are particularly devastating. Up to one-third of people who suffer an osteoporosis-related hip fracture will die within one year of the event. The direct cost of hospital visits and nursing home care due to osteoporosis totals more than $14 billion annually.
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Risk Factors

A common misconception about osteoporosis is that it only affects older women with small frames. While age and gender are among the risk factors that predispose an individual toward developing the disease, the truth is that osteoporosis can strike anyone, at any age. Everyone is at risk.

Among the risk factors for osteoporosis are:

• Personal history of fracture after age 50

• Current low bone mass

• History of fracture in a close relative

• Being female

• Being thin and/or having a small frame

• Advanced age

• A family history of osteoporosis

• Estrogen deficiency as a result of menopause, especially early or surgically-induced

• Abnormal absence of menstrual periods (amenorrhea)

• Anorexia nervosa

• Low lifetime calcium intake

• Use of certain medications, such as corticosteroids and anticonvulsants

• Low testosterone levels in men

• An inactive lifestyle

• Current cigarette smoking

• Excessive use of alcohol

• Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well

As can be seen from this list, while some of the above risk factors are beyond human control, others, such as calcium intake, cigarette and alcohol use, and level of physical activity, are definitely open to change. It is important to identify ones own risk factors, and to modify behaviors wherever possible to reduce the risk of developing osteoporosis.

 

What Causes Osteoporosis?

While bones look and feel solid, microscopic examination reveals a much different picture. Bones are living, growing tissue composed of a soft, lattice-like protein framework and minerals that lend strength. An abundant protein called collagen forms the flexible scaffolding upon which minerals are deposited and harvested according to the body’s needs. Two processes cooperate to ensure continuous renewal of the skeleton. Resorption is the process of breaking bone down while remineralization is the process of building new bone tissue. The skeleton renews itself on the average of every seven years.
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Calcium is Key

The principle mineral constituent of bone is calcium. Teeth and bones contain 99% of the body’s calcium. The remaining 1% is found in the bloodstream. The average adult human skeleton contains three pounds of calcium, making it one of the most abundant minerals in the body.

While calcium gives teeth and bones their much-needed strength, the mineral also fulfills several other less well-known but equally vital functions in the human body. Calcium plays a pivotal role in blood clotting. The body requires the mineral for proper regulation of heart and muscle function. Calcium is necessary for the transmission of nerve impulses and helps regulate blood pressure. Calcium is also in high demand when a woman is pregnant, as the growing fetus needs the nutrient for bone formation.

The body demands a steady supply of calcium to fulfill these crucial duties. When calcium stores in the blood become depleted, the mineral is stripped from the body’s calcium repository – the bones. Adequate daily calcium intake helps ensure preservation of bone mass and guards against osteoporosis.

The Estrogen/Testosterone Factor

The hormones estrogen and testosterone, vital to the human reproductive cycle, also play an important role in osteoporosis. The leading causes of the onset of osteoporosis are a drop in estrogen in women at the time of menopause, and a drop in testosterone in men.
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Preventing Osteoporosis

Getting Enough Calcium

The U.S. Food and Drug Administration (FDA) uses the term Daily Value (DV) to describe the amount of a nutrient the average person requires on a daily basis. Current guidelines established by the National Academy of Sciences recommend the average person consume 1,000 mg of calcium per day. An individual may require more or less calcium depending on a variety of factors including age and health status. Generally speaking, women require more calcium than men.

Through Diet

While dairy products including milk, cheese and yogurt are excellent sources of calcium, many people find it difficult or undesirable to consume large quantities of these foods due to their high caloric and saturated fat content. Low or non-fat dairy products are better choices. The best way to meet your daily calcium requirement is by eating a variety of foods. Remember, foods labeled “high in calcium” contain at least 20% of the Daily Value while foods labeled as “good sources of calcium” contain 10-19% of the Daily Value.

Check the tables below to learn the calcium content of some common foods. All values are adapted from the
USDA National Nutrient Database for Standard Reference
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http://www.nal.usda.gov/fnic/foodcomp/search/

Dairy

Food	Serving size	Calcium content (mg)
Parmesan Cheese	1 Tbsp.	55
Light Vanilla Ice Cream	1/2 Cup	77
Light Vanilla Soft Serve	1/2 Cup	113
Feta Cheese	1 oz.	140
Blue Cheese	1 oz.	150
Low Fat Cottage Cheese	1 Cup	156
American Cheese	1 oz.	156
Muenster Cheese	1 oz.	203
Cheddar Cheese	1 oz.	204
Mozzarella Cheese	1 oz.	207
Hot Fudge Sundae	1 Sundae	207
Provolone Cheese	1 oz.	214
Swiss Cheese	1 oz.	224
Low Fat Milk	1 Cup	271
Low Fat Chocolate Milk	1 Cup	288
Low Fat Plain Yogurt	8 oz.	415
Vanilla Milk Shake	11 fl. oz.	457
Part Skim Ricotta	1 Cup	669

 

Breakfast Favorites

Food	Serving size	Calcium content (mg)
Custard Filled Éclair	1 Éclair	63
Danish Cheese Pastry	1 Pastry	70
French Toast with Butter	2 Slices	73
Plain Frozen Waffle	1 Waffle	77
Plain Toasted English Muffin	1 Muffin	98
Cheerios	1 Cup	100
Blueberry Muffin Prepared from Recipe	1 Muffin	108
Pancakes with Butter and Syrup	2 Pancakes	128
Perrier Mineral Water	N/A	147 mg/l
English Muffin with Egg, Cheese and Canadian Bacon	1 Muffin	151
Croissant with Egg, Cheese and Bacon	1 Croissant	151
San Pellegrino Mineral Water	N/A	208 mg/l
Biscuits Prepared from Recipe	One 4’’ Round Biscuit	237
Low Fat Milk	1 Cup	271
Calcium-Fortified Orange Juice	1 Cup	350
Low Fat Plain Yogurt	8 oz.	415
Total Raisin Bran Cereal	1 Cup	1000

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American Favorites

Food	Serving size	Calcium content (mg)
Cocoa Mix	1 Serving	90
Milk Chocolate with Almonds	1.45 oz. (1 Bar)	92
Tapioca Pudding	4 oz.	95
Corndog	1 Corndog	102
Chocolate Pudding	4 oz.	102
White Long-Grain Enriched Rice	1 Cup	111
Macaroni and Cheese	1 Cup	113
Cheese Pizza	1 Slice	117
Hamburger with Condiments	1 Hamburger	126
Trail Mix with Chocolate Chips, Nuts and Seeds	1 Cup	159
Cornbread Prepared from Recipe	1 Piece	162
Fish Sandwich with Tartar Sauce and Cheese	1 Sandwich	185
Submarine Sandwich with Cold Cuts	One 6’’ Sandwich	189
Cheeseburger with Single Patty	1 Cheeseburger	206

Mexican Favorite

Food	Serving size	Calcium content (mg)
Chili Con Carne with Beans	1 Cup	67
Bean and Cheese Burrito	1 Burrito	107
Frijoles with Cheese	1 Cup	189
Tostada with Guacamole	1 Tostada	211
Nachos with Cheese	6-8 Nachos	272
Cheese Enchilada	1 Enchilada	324
Fast Food Taco	1 Large	339

 
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Vegetables and Legumes

Food	Serving size	Calcium content (mg)
Cooked Broccoli	1 Cup	62
Cooked Artichokes	1 Cup	76
Canned Chickpeas	1 Cup	77
Canned Red Ripe Tomatoes	1 Cup	87
Canned Refried Beans	1 Cup	88
Cooked Kale	1 Cup	94
Cooked Frozen Peas	1 Cup	94
Canned Baked Beans	1 Cup	127
Navy Beans	1 Cup	127
Firm Tofu	1 slice (84 gms)	27
Scalloped Potatoes	1 Cup	140
Cooked Chinese Cabbage	1 Cup	158
Beet Greens	1 Cup	164
Cooked Frozen Okra	1 Cup	177
Cooked Frozen Kale	1 Cup	179
Canned White Beans	1 Cup	191
Potatoes Au Gratin (from mix)	1 Cup	203
Black-eyed Peas	1 Cup	211
Cooked Frozen Turnip Greens	1 Cup	249
Green Cooked Soybeans	1 Cup	261
Canned Spinach	1 Cup	272
Cooked Frozen Rhubarb	1 Cup	348
Cooked Frozen Collards	1 Cup	357

Getting Calcium Through Supplements

Many people find it difficult to meet the Daily Value for calcium through diet alone. In those cases, calcium supplementation is a good idea. But with so many different kinds of calcium supplements on the market, how does one choose the which is right for one’s particular case? Each person’s case and tastes vary.

Most experts would agree that the best calcium supplement tastes palatable and will be taken every day. A supplement containing a bioavailable form of calcium—that is, a form that is readily absorbed and utilized by the body, should be chosen. Some researchers contend that the so-called chelated forms of calcium, such as calcium citrate, are best. The chewable antacids taken regularly by many individuals contain calcium carbonate, another effective form. One should steer clear of supplements made from bone meal or oyster shell, as they may contain significant levels of lead, a toxic metal. Since the body can only absorb a limited amount of calcium at a time, it is best to take calcium supplements with food in divided doses throughout the day.

Vitamin D is a fat-soluble vitamin that aids in calcium absorption and bone formation. Drinking vitamin D fortified milk will help ensure that the recommended daily value of 400 IU (International Units) is met. Vitamin D can also be obtained by spending time outdoors, because the skin synthesizes vitamin D upon exposure to sunlight. Fifteen minutes of sun exposure three times per week should supply most people with adequate levels of this essential vitamin.
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Calcium Blockers

It is important to be aware that a number of nutrients can have a negative effect on the absorption and utilization of calcium. High levels of sodium, caffeine and protein can contribute to calcium loss. Fiber, phytic acid (found in whole grains and nuts), and oxalic acid (found in tea and cocoa) all interfere with calcium absorption. Calcium and magnesium compete with each other for absorption in the gastrointestinal tract. If supplementing both minerals, one should be sure to take them in a ratio of 2:1 (calcium:magnesium) for optimal absorption of each.

A number of medications can also interfere with the absorption, utilization or excretion of calcium, including (but not limited to) the following:

Medication	Examples
Corticosteroids	Prednisone, hydrocortisone
Thyroid replacement hormone	Synthroid®, Levoxyl®
Anticonvulsants	Dilantin®
Antibiotics	Erythromycin, cycloserine
Antacids (containing aluminum)	Maalox®, Mylanta®

When using any of these medications, one should speak to a health care provider about steps to be taken in order to be sure that calcium intake is adequate.
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Getting Enough Calcium Through Exercise

In addition to ensuring ones intake of sufficient calcium, exercise is another tool to be used to stave off osteoporosis. Studies have shown that regular exercise that works against gravity or gets muscles to pull against bones causes those bones to retain and even increase their density.

Women who walk a mile a day have been found to have four to seven more years of bone in reserve than women who don’t. Some exercises recommended to guard against osteoporosis include:

• Weight-bearing exercises -- walking, jogging, playing tennis, dancing

• Resistance exercises -- free weights, weight machines, rubber stretch bands

• Balancing exercises -- tai chi, yoga

• Riding stationary bicycles

• Using rowing machines

• Walking

• Jogging

As always, it is extremely important to check with a health care provider before starting any new exercise regimen. This is especially the case if signs of osteoporosis are already evident. A health care provider is qualified to help a patient to choose forms of exercise that do not create or put one at a risk of falling and breaking bones.
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Resources

National Osteoporosis Foundation
1232 22nd Street N.W. • Washington, D.C., 20037-1292
Phone: (202) 223-2226
http://www.nof.org

“The National Osteoporosis Foundation (NOF) is the leading nonprofit, voluntary health organization dedicated to promoting lifelong bone health.”

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National Institutes of Health Osteoporosis and Related Bone Diseases
National Resource Center
2 AMS Circle • Bethesda, MD 20892-0344
Phone: (800) 624-BONE • (202) 223-0344
http://www.osteo.org

“The National Resource Center is dedicated to increasing the awareness, knowledge and understanding of physicians, health professionals, patients, underserved and at-risk populations (such as Hispanic and Asian women, adolescents, and men) and the general public about the prevention, early detection and treatment of osteoporosis and related bone diseases.”

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International Osteoporosis Foundation
5 Rue Perdtemps
1260 Nvon
Switzerland
Phone: 41-22-994-0100
Fax: 41-22-994-0101
http://www.osteofound.org

“IOF's mission is to advance the understanding of osteoporosis and to promote prevention, diagnosis and treatment of the disease worldwide.”

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MEDLINEplus
A service of the U.S. National Library of Medicine and the National Institutes of Health
http://www.nlm.nih.gov/medlineplus/osteoporosis.html

“MEDLINEplus, a goldmine of good health information from the world's largest medical library, the National Library of Medicine. Health professionals and consumers alike can depend on it for information that is authoritative and up to date. MEDLINEplus has extensive information from the National Institutes of Health and other trusted sources on over 600 diseases and conditions.”

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Foundation for Osteoporosis Research and Education (FORE)
300 27th Street, Suite #103 • Oakland, CA 94612
Phone: 510-832-2663
888-266-3015
http://www.fore.org

“Founded in 1990, FORE is a non-profit resource center dedicated to eliminating osteoporosis through our research, education and bone density testing programs."
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