Nutrition and Osteoporosis

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Nutrition and Osteoporosis
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Alice Henneman, MS, RD Lancaster
County Extension EducatorLinda Boeckner, PhD,
RD Extension Nutrition SpecialistUniversity of
Nebraska Cooperative Extension Institute of
Agriculture and Natural ResourcesJune
2001University of Nebraska Cooperative
Extension educational programsabide with the
nondiscrimination policies of the University of
Nebraska and the United States Department of
Agriculture
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Disclaimer

• The following information on the dietary
  aspects of osteoporosis is provided as
  information for general healthy eating and should
  not be considered a substitute for seeking
  dietary advice from your own healthcare provider.
  The calcium and vitamin D recommendations are
  based on those developed for the United States
  and Canada. They may not be appropriate for all
  countries due to differing dietary patterns and
  environmental factors.

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Comments from a 70 year old woman with
osteoporosis

• Ive lost six inches in height and none of my
  clothes fit me anymore. Plus, its hard to get
  clothes that look nice when my back is so hunched
  over.

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Comments continued

• It seemed like it took forever for my bone to
  heal when it broke. I dont want that to happen
  again. Its so frustrating always worrying about
  falling.

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Comments continued

• If somebody had told me sooner what I know now
  about osteoporosis, none of this might be
  happening to me!
• 
  

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Concerns

• 10 million Americans have osteoporosis and 18
  million have low bone mass placing them at risk
  of osteoporosis
• - National Osteoporosis Foundation (NOF)
• The silent disease
• First sign may be a fracture
• A sudden strain or bump can break a bone

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Concerns continued

• 80 of those affected are women
• A womans hip fracture risk equals her combined
  risk of breast, uterine and ovarian cancer
• 1 in 2 women and 1 in 8 men over 50 will have an
  osteoporosis-related fracture
• 24 of hip fracture patients 50 and over die
  during the year following their fracture

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The National Osteoporosis Foundation (NOF)
recommends a combination of 4 steps to help
prevent osteoporosis
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4 Prevention Steps (NOF)

• Balanced diet rich in calcium vitamin D

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4 Prevention Steps (NOF)

• Weight-bearing exercise

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4 Prevention Steps (NOF)

• Healthy lifestyle with no smoking or excessive
  alcohol use

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4 Prevention Steps (NOF)

• Bone density testing and medications when
  appropriate

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Osteoporosis is preventable for most people!

• Start building healthy bones while young
• Healthy diet and lifestyle are important for BOTH
  men women

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Todays presentation . . .

• Using food and supplement labels to assess
  calcium intake
• Recommended daily calcium and vitamin D
• Daily Value for calcium in common foods
• Additional dietary concerns
• Help for the lactose-intolerant person
• When you dont like to drink milk
• Calcium supplements
• Putting it all together

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Using food/supplement labels to assess
calcium intake
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Nutrition Labels Calcium

• FDA uses Percent Daily Value ( DV) to describe
  amount of calcium needed by general U.S.
  population daily
• 100 DV for calcium 1,000 mg
• Nutrition Facts on food labels
• Supplement Facts on vitamin/mineral labels

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Sample Nutrition Facts Label
Nutrition Facts Serving Size 1/2 cup (93
g) Servings Per Container 4 ---------------------
----------------------- Amount Per
Serving Calories 25 Calories from Fat
0 --------------------------------------------
Daily Value Total Fat 0 g 0
Saturated Fat 0 g 0 Cholesterol 0
mg 0 Sodium 20 mg 1 Total Carbohydrate 5
g 2 Dietary Fiber 3 g
12 Sugars 2 g Protein 3 g -----------------
--------------------------- Vitamin A 35
Vitamin C 60 Calcium 4 Iron
4 --------------------------------------------
Percent Daily Values are based on a 2,000 calorie
diet.
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Example of Daily Value

• If a food or supplement has 200 mg of calcium
  per serving, the "Nutrition Facts" or "Supplement
  Facts" panel shows 20 DV for
  calcium (200/1,000 20)

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Using Nutrition Facts label serving size

• Serving size on "Nutrition Facts" panel is based
  on what people typically eatits not a
  recommended amount
• Adjust calcium DV if you eat a different
  serving size than on label
• Example If label states a half cup serving of
  broccoli provides 4 DV, a cup would provide 8
  DV

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DV recommendations vary by age

• Example
• Individuals 51 years and older need to consume
  1,200 mg of calcium daily
• Their daily goal should be 120 of the calcium DV

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Example of calculating total DV for calcium

• Food DV
• Fruit yogurt 35
• Oatmeal 10
• Nachos 20
• Turnip greens 15
• Total DV 80

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Recommended daily calcium and vitamin D
intakes
Calcium
Vitamin D
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Recommended daily calcium and vitamin D intakes

• Remember
• The 100 DV for calcium is based on 1,000 mg
  calcium
• The 100 DV for vitamin D is based on 400 IU
  vitamin D
• Some people will need more or less than the 100
  DV value based on their age and reproductive
  status

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Upper limits calcium and vitamin D

• The National Academy of Sciences (NAS), 1997,
  suggests a tolerable upper intake level (UL) for
  persons age one and up for calcium no higher than
  2,500 mg daily and for vitamin D no higher than
  50 micrograms or 2,000 IU (40 IU 1 microgram)
  daily from foods and supplements combined.

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Recommended Daily Value calcium vitamin D

• Birth - 6 months210 mg calcium (21 DV)200 IU
  vitamin D (50 DV)
• 6 months - 1 year270 mg calcium (27 DV)200 IU
  vitamin D (50 DV)
• Values based on 1997 NAS recommendations

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Recommended Daily Value calcium vitamin D

• 1 - 3 years500 mg calcium (50 DV)200 IU
  vitamin D (50 DV)
• 4 - 8 years800 mg calcium (80 DV)200 IU
  vitamin D (50 DV)
• Values based on 1997 NAS recommendations

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Recommended Daily Value calcium vitamin D

• 9 - 18 years1,300 mg calcium (130 DV)200 IU
  vitamin D (50 DV)
• 19 - 50 years1,000 mg calcium (100 DV)200 IU
  vitamin D (50 DV)
• Values based on 1997 NAS recommendations

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Recommended Daily Value calcium vitamin D

• 51 - 70 years1,200 mg calcium (120 DV)400 IU
  vitamin D (100 DV)
• 71 and older1,200 mg calcium (120 DV)600 IU
  vitamin D (150 DV)
• Values based on 1997 NAS recommendations

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Recommended Daily Value calcium vitamin D

• Pregnant Lactating
• 14 - 18 years1,300 mg calcium (130 DV)200 IU
  vitamin D (50 DV)
• 19 - 50 years1,000 mg calcium (100 DV)200 IU
  vitamin D (50 DV)
• Values based on 1997 NAS recommendations

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Percent Daily Value (DV) for calcium in common
foods
Approximate DV for foods based in part on
information provided in Calcium! Do You Get
It? by U.S. FDA/CFSAN
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DV calcium Grain products group

• Ready-to-eat cereal, calcium- fortified. Serving
  size varies check product label.

calcium-fortified cereal
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DV calciumVegetable group

• Broccoli with cheese 1/2 cup 20 DV
• Collards 1/2 cup 20 DV
• Turnip greens 2/3 cup 15 DV
• Kale 2/3 cup 10 DV
• Bok choy 1/2 cup 10 DV
• Broccoli 1 stalk 6 DV

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DV calciumFruit group

• Orange juice, calcium-fortified 1 cup 30
  DV

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DV calciumMilk group

• Yogurt 8 oz. 35 DV
• Milk, whole, 2, 1, skim, chocolate 1 cup 30
  DV
• Cheese 1 oz. 20 DV
• Milk pudding 1/2 cup 10 DV
• Frozen yogurt 1/2 cup 10 DV
• Ice cream 1/2 cup 6 DV
• Soy milk, calcium-fortified 1 cup 30 DV

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DV calciumMeat Beans Group

• Tofu prepared with calcium sulfate 3 oz. 60
  DV check Nutrition Facts label
• Baked beans with sauce 1/2 cup 8 DV
• Pork beans with sauce 1/2 cup 6 DV

tofu with added calcium
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Vitamin D dietary sources

• The main dietary sources of vitamin D are
  fortified milk (400 IU per quart), some fortified
  cereals, cold saltwater fish (for example
  salmon, halibut, herring, tuna, oysters and
  shrimp) and some calcium and vitamin/mineral
  supplements.
• Also, vitamin D can be manufactured in your skin
  following direct exposure to sunlight. The amount
  varies according to such factors as time of day,
  season and latitude.

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Additional dietary concerns
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ConcernsFood is best calcium source

• There may be other factors found in calcium food
  sources that also affect absorption and
  utilization by the body

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ConcernsCalcium load at one time

• Body can best handle about 500 mg at one time
  from food and/or supplements
• Consume calcium sources throughout day vs. all at
  one time

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ConcernsFiber

• Excessive fiber can interfere with absorption
• Example sprinkling extra fiber on food at time
  of consuming a calcium source
• Natural fiber that is part of a food is probably
  not a problem

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ConcernsExcessive caffeine

• Can increase urinary calcium excretion
• Limit to about 400 mg daily
• About 100 mg/6 oz. coffee
• About 40 mg/6 oz. regular brewed tea may be less
  for green tea
• Some soft drinks comparable to tea
• Some medications have caffeine

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ConcernsExcessive sodium

• Can increase urinary calcium excretion
• Food and Nutrition Board recommends limit of
  2,400 mg daily
• Sodium given on Nutrition Facts panel on foods

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ConcernsAlcohol

• Consuming more than 7 drinks per week is
  associated with greater risk of
• low bone density
• falls
• fractures

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ConcernsOxalic acid

• In foods such as spinach, chard, beet greens and
  chocolate
• Binds calcium
• Doesnt seem to affect calcium in other foods,
  including chocolate milk
• These greens still good for you may help calcium
  absorption in other ways

Chocolate milk is OK!
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ConcernsHigh protein

• Unbalanced, excessively high protein diets could
  increase urinary excretion of calcium

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ConcernsSoy

• Not all soy milk is calcium-fortified check
  Nutrition Facts panel
• 4 8-oz. glasses of soy milk is usually equal to
  3 8-oz. glasses of cows milk in availability of
  calcium

Know your numbers
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ConcernsFruits and Vegetables

• Contribute to maintenance of bone mineral density
• Food Guide Pyramid recommendations
• 2 to 4 fruits daily
• 3 to 5 vegetables daily

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Help for the lactose-intolerant person
Some people lack the enzyme needed to digest
lactose (milk sugar) but still may be able to
obtain calcium from dairy products
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Help for the lactose- intolerant person

• Start with small portions of foods such as milk
  and gradually increase serving size

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Help for the lactose-intolerant person

• Eat dairy foods in combination with a meal or
  solid foods

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Help for the lactose-intolerant person

• Try dairy foods other than milk
• Many cheeses (Cheddar, Swiss, Parmesan) have less
  lactose than milk
• Yogurt made with live, active bacteria

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Help for the lactose-intolerant person

• It may be easier to digest lactose that is
  pre-digested or broken down to its simple sugar
  components (glucose and galactose)
• Lactose-hydrolyzed milk and dairy products
• Commercial lactase preparations

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When you dont like to drink milk
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When you dont like to drink milk

• Make oatmeal with milk instead of water
• Add milk to your coffee
• Make soups (tomato, chowders and cream-type) with
  milk instead of water
• Add powdered milk to food (1 tablespoon 50 mg
  of calcium)
• Make instant hot cocoa with milk

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When you dont like to drink milk

• Make instant hot cocoa with milk, not water
• Serve milk-based desserts (puddings, tapioca,
  frozen yogurt, custard, ice cream)
• Enjoy chocolate milk
• 8-oz. has only 2 - 7 mg caffeine
• Average glass of chocolate milk has only 60 more
  calories than unflavored milk

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When you dont like to drink milk

• Use plain/flavored yogurt as salad dressing
• Top baked potatoes with yogurt
• Enjoy smoothies for snacks
• Add 1/2 to 1 cup frozen fruit to 1 cup milk
  blend. Sweeten with 1 - 2 teaspoons sugar or
  honey, or use an artificial sweetener. Can add
  about 1/4 teaspoon vanilla. Drink right away.

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Calcium supplement considerations
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SupplementsCalcium carbonate vs. citrate

• Calcium carbonate
• Needs acid to dissolve and for absorption
• Less stomach acid as we age
• Often taken at meals when more stomach acid

• Calcium citrate
• Doesnt require stomach acid for absorption
• May be taken anytimecheck with your healthcare
  provider
• May cost more

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SupplementsVitamin D

• Vitamin D
• Choose a supplement with vitamin D unless youre
  getting vitamin D from other sources
• Consider amount for your age group
• Avoid going over a daily combined total of 50
  micrograms (2,000 IU)

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SupplementsTime of Day

• If you take calcium once daily, evening may be
  best. Miriam Nelson (author, Strong Women, Strong
  Bones) advises calcium carbonate at dinner time
  and calcium citrate before bed. Check with your
  healthcare provider.

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SupplementsCalcium load at one time

• Limit calcium intake at one time to about 500 mg
  from food and supplements combined
• Consume food and supplements throughout the day

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SupplementsAbsorption

• Absorption test put a calcium tablet in a cup of
  vinegar. Stir every 5 minutes. If it doesnt
  dissolve in 30 minutes, it probably wont
  dissolve in your stomach either.

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SupplementsIncrease amount slowly

• Start with 500 mg daily for about a week,
  gradually adding more
• Gas and constipation can be side effects
• Increase fluids and fibrous foods
• Try a different form if problems continue

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SupplementsCheck for interactions

• Check with physician or pharmacist for
  interactions with other prescriptions and
  over-the-counter drugs

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SupplementsFood is still important

• High calcium foods also contain other KEY
  nutrients that are important in the diet
• Try to obtain at least some of your calcium from
  your diet

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Putting it all together

• List foods/supplements you ate yesterday or in a
  typical day
• Determine DV of calcium/vitamin D
• Adjust DV if serving size was different than
  on label
• Total amounts compare score to recommended DV
  for age

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Putting it all together

• Consider also
• Other dietary factors
• Weight-bearing exercise
• A healthy lifestyle with no smoking or excessive
  alcohol use
• Getting recommended bone density tests and
  medications when appropriate

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Related materials

• For more information and/or a handout about
  the points discussed in this presentation, refer
  to the article Nutrition and Osteoporosis by
  Alice Henneman, MS, RD and Linda Boeckner, PhD,
  RD at
• lancaster.unl.edu/food/ftm-j01.htm

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For More Information

• National Osteoporosis Foundation www.nof.org
• Strong Women, Strong Bones by Miriam Nelson, Ph.D.

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Further questions?

• Alice Henneman, MS, RD Lancaster County
  Extension Educator
• ahenneman1_at_unl.edu
• Linda Boeckner, PhD, RD
• Extension Nutrition Specialist
• lboeckner1_at_unl.edu
• University of Nebraska Cooperative Extension
• Institute of Agriculture and Natural Resources

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Support your bones. They support you. -
Massachusetts Osteoporosis Awareness Program