What Can You Do to Preserve Your Bones? by, Dana Hayse, PhD
Updated: Nov 14, 2019
In last week’s post, we reviewed the importance of maintaining good bone health. This week, we will look at the specific things we can do to ensure optimal bone health as we age. Physical activity: As with other parts of our body, bones get stronger if we use them. Weight-bearing exercises that put stress on our bones, such as dancing, jogging, hiking and aerobics, can help to decrease bone loss and increase bone density. Weight-bearing exercises cause your body to break bone down and rebuild it at the same time. Resistance or strength-training exercises also help to keep bones strong. Aim for 30 minutes of weight-bearing exercise on most days of the week. Eat a well-balanced diet: Consuming a diet rich in healthy grains, fruits and vegetables, especially green leafy vegetables with adequate amounts of calcium and vitamin D, is critical for bone health. Get enough protein and vitamin A, but not too much. Too much protein can cause calcium to leach from bones. Get adequate calcium and vitamin D: Both calcium and vitamin D are essential for healthy bones. Determining just how much calcium we need is one of the most debated nutrition topics. Recommendations vary from country to country. See more on this topic below. Get enough vitamin K: Recent data from the Nurses’ Health Study suggest that vitamin K plays an essential role in bone health by regulating calcium and affecting formation and stabilization of bone. Vitamin K is found mostly in leafy greens, Brussels sprouts, broccoli, spinach and kale. If you have blood clotting issues, talk with your doctor first before increasing your intake of vitamin K. Don’t smoke: Smoking cigarettes accelerates bone loss. Limit alcohol and caffeine: Both have been associated with calcium loss from bones, which increases the risk of osteoporosis.
How much calcium and vitamin D do you need? Calcium Ninety-nine percent of our body’s calcium is found in our bones. It is why our bones are strong and dense. Calcium also affects muscle function, blood clotting and our nervous system. Our bodies cannot make calcium. We must either get it in our diet or via a supplement. While calcium is clearly critical for bone health, there is debate over the ideal optimal recommended daily amount (RDA). Some countries recommend as low as 300 mg/day, while the US RDA is 1000-1200 mg/day. As with most nutrients, it’s best to get calcium from food rather than supplements. It helps ensure that you get many other important nutrients along with the calcium, further contributing to bone health and overall general health. Dairy products tend to be the best sources of calcium: milk, yogurt, cottage cheese and hard cheeses. Other top food sources of calcium include dark, leafy greens, bok choy, canned salmon with bones, calcium-fortified soy products (tofu and soy milk), calcium-fortified nut milks, and some nuts and seeds. The National Osteoporosis Foundation also has a comprehensive table of calcium-rich foods here, or you can refer to the table, below.
If you can’t get the recommended daily amount of calcium from your diet, supplementing may be necessary. Talk with your health care provider about the best supplement for you. Ideally, take a supplement that also contains vitamin D and keep the calcium dosage to 600 mg or less at a time for better absorption. Antacids, such as Tums, are an easy way to get calcium, but they don’t contain vitamin D so consider a separate vitamin D supplement if you choose an antacid. Vitamin D Vitamin D increases the absorption of calcium (and phosphorous, which is also important for bones) in the intestine. It instructs the kidneys to keep these minerals so they don’t pass through in the urine. Vitamin D also affects mineralization of bone by slowing the breakdown of bone while boosting bone formation. Further, it improves muscle function and balance, which might help in reducing the risk of falls. We get vitamin D in three possible ways: from the sun, in foods, or by supplements. With concern about skin cancer, many people limit their sun exposure by covering up or by using sunscreen, which blocks the body’s ability to make vitamin D. Thus, most people need to get their vitamin D from food or supplements. Only a few foods contain vitamin D (fatty fish such as mackerel, salmon and tuna, vitamin D-fortified milk and some cereals) so most people will need to take a vitamin D supplement. There are two types of vitamin D supplements: D2 (ergocalciferol) and D3 (cholecalciferol), both of which are good for the bones. D3 is preferred, however, as it appears to raise blood serum levels more efficiently than D2 and is more precisely measured. Nearly all milk sold in the U.S. is fortified with vitamin D3. Determining the optimal vitamin D level is a complicated topic and one of great debate, with a lack of consensus even among vitamin D experts. UpToDate, a web resource that provides the most current review of medical topics and research with straightforward evidence-based conclusions, finds that some experts recommend serum vitamin D in the 20–40 ng/mL range while other experts prefer levels in the 30–50 ng/mL range. If you are at high risk for poor bone health or have other conditions affecting vitamin D metabolism (use of anti-convulsants, for example), higher levels might be warranted. Please consult your physician if you are concerned about your vitamin D levels.
Do calcium supplements increase risk for cardiovascular disease? The latest research indicates (and current thought agrees) that calcium supplements do not increase the risk of heart disease. Current guidelines from the National Osteoporosis Foundation and the American Society for Preventive Cardiology suggest that “Discontinuation of supplemental calcium for safety reasons is not necessary and may be harmful to bone health when intake from food is suboptimal.” (Berkeley Wellness Letter, Feb. 2017).
When should I have my bone mineral density (BMD) measured? In general, women should have their BMD tested by dual-energy x-ray absorptiometry (DEXA) at around age 65 and men at age 70. Medicare will pay for a BMD test every two years. However, if your bones are strong and healthy, then you can likely go longer (5–10 years) between measurements. If you are at high risk for osteoporosis, talk with your doctor, as you might need to have your bone density checked much earlier.
When should you consider taking drugs for bone health? If you have osteoporosis of the hip or spine as measured by DEXA or if you have a FRAX measurement that indicates a 20% chance of a major fracture or a 3% chance of a hip fracture over 10 years, you should talk with your physician about pharmacologic therapy. There are several drugs available to preserve bone mass and, in some cases, they increase it. The most common types of therapies are bisphosphonates (alendronate, risedronate) and SERMs (selective estrogen receptor modulators) such as raloxifene. And while hormone replacement therapy has been questioned in the recent past, it is now considered safe for the first 5–10 years post-menopause for many women. Talk with your clinician about the best options for you.
In summary, taking care of your bones is vital for overall good health. It is important to know you can take action to decrease your chances of developing osteoporosis and subsequent fracture. To reiterate, you should be doing the following:
engaging in weight-bearing and strength-training exercises;
eating a well-balanced, whole-foods diet with plenty of vegetables, fruits and whole grains;
getting adequate calcium and vitamin D, ideally from food;
avoiding too much protein, alcohol and caffeine as these can promote calcium loss from bones;
not smoking; and
talking with your physician, if you are at increased risk for osteoporosis.
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Dana Hayse, PhD
Dana is passionate about empowering people to lead healthy lives through good nutrition and physical activity. She is a former Associate Professor of Epidemiology at UCSF with a background in osteoporosis, heart disease, successful aging and obesity research. She currently works as a nutrition educator in the community and as a researcher in the Stanford Cancer Center Health library. Dana has a degree in Human Biology from Stanford University, a Masters in Epidemiology from the University of Massachusetts, Amherst, and a PhD in Epidemiology from the University of California, Berkeley. You can contact Dana at firstname.lastname@example.org with any questions about osteoporosis or overall general health and wellness.
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