CALCIUM
Q: I know dairy foods have
calcium, but what are other good food sources?
A: Calcium is necessary for bones
to stay strong, and every cell in the
body needs calcium to work properly.
Maintaining an adequate calcium intake
is an important step towards good bone
health throughout life. Luckily, there
are many foods that contain calcium.Most people know dairy foods contain
calcium but are unaware that low-fat and
fat-free milk, yogurt and cheese
actually have more calcium per serving
than the regular versions. But did you
know a cup of frozen broccoli has 94 mg
of calcium? Or that 10 dried figs 270
mg? Dry roasted almonds pack 75 mg into
each ounce.
Many foods are made with added calcium.
Look for calcium-fortified orange juice,
cereals, breads and other foods. Check
your local library for books on foods
and their nutritional content, or visit
the U.S. Department of Agriculture's
Food and Nutrition Center's Nutrient
Data Laboratory on-line at
www.nal.usda.gov/fnic/foodcomp.
Q: How do I choose the calcium
supplement that is right for me?
A: Many people consume all the
calcium they need from their diet, but
others rely on a combination of
calcium-rich foods and calcium
supplements or on supplements alone to
meet their daily needs. There are many
supplements from which to choose,
allowing each person to find the one
that is easiest for her/him to use.
Calcium supplements are available as
pills, capsules, chewable tablets,
chewable candies, powders and tablets
that dissolve in water.
In nature, calcium is found only in
combination with another substance, such
as carbonate, citrate or gluconate.
These combinations, or compounds, form
calcium “salts” that vary in the amount
of actual (elemental) calcium they
contain. For example, calcium carbonate
is 40 percent elemental calcium and
calcium citrate contains 20 percent
elemental calcium.
If a tablet contains 1250 mg of calcium
carbonate, it contains 500 mg of
elemental calcium (40 percent of 1250 =
500 mg).
An easier way to figure out how much
calcium each preparation contains is to
look at the label and find the heading
titled, “percent daily value.” If the
percent daily value is 20, add a ‘0’ to
the 20. Taking the recommended number of
tablets will provide 200 mg of elemental
calcium.
If the percent daily value is 40, add a
‘0’ to the 40. The recommended number of
tablets will provide 400 mg of elemental
calcium.
If the percent daily value is 50, add a
‘0’ to the 50. The recommended number of
tablets will provide 500 mg of elemental
calcium.
Suggestions for choosing a supplement
that is right for you:
- Determine your
daily calcium intake from foods.
- If calcium intake
is around 1,000 - 1,200 mg a day, keep up the
good work. If additional calcium is
needed from a supplement, determine
which supplement provides closest to
the amount needed. (One that provides
200 mg, 400 mg, or 500 mg per pill)
- Decide the form of
calcium that will be easiest for you
to take.
- You now know how
much calcium you need and the form you
would prefer. Choose a recognized
brand name or check with the
pharmacist in a local store.
- Calcium is easier
to absorb when it is consumed in small
doses throughout the day. Think about
dividing your calcium intake between
breakfast and dinner or bedtime. Most
calcium supplements, with the
exception of calcium citrates, are
better absorbed if taken with food.
- Remember, calcium
alone does not protect your bones.
Vitamin D is
necessary for calcium absorption, but
the vitamin D does not have to be
included with the calcium. Many people
take a daily multivitamin that
provides 400 IU of vitamin D. Other
sources of vitamin D include fortified
foods, fatty fish and skin production
with sun exposure. Exercise also plays
an important role in lifelong bone
health.
Click here for NOF's updated Calcium
and Vitamin D recommendations.
Q: Advertisements for coral
calcium supplements appear to be
everywhere. The ads claim that this
calcium not only helps bones but also
cures many other medical conditions. Is
coral calcium better than any other
kind?
A: Coral calcium supplements are
made from limestone, which is a form of
calcium carbonate. Another common form
of calcium is calcium citrate. While all
calcium supplements preserve bone
health, some individuals selling coral
calcium have made health claims that go
beyond the current research findings.
Because those coral calcium marketers
were making health claims that were not
supported by scientific research, they
came under investigation by the Federal
Trade Commission (FTC) and the Food and
Drug Administration (FDA). Two marketers
were ordered to stop their infomercials
touting unsupported health claims and to
return money made as a result of those
ads. In addition, the FTC warned several
additional coral calcium marketers to
remove misleading statements from their
web sites.
In another report, researchers presented
results of a study on a variety of
well-known calcium supplements. They
looked at whether or not the calcium in
the bottle measured up to the claims on
the label, and their results were
disappointing. In some instances the
amount of calcium in the supplement did
not match the amount stated on the
label. In other cases the supplements
contained unacceptable levels of lead
contamination and some did not dissolve
fully in the stomach.
NOF recommends that you read labels
carefully and choose purified calcium
carbonate or calcium citrate.
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EXERCISE
NOTE: Do not start any exercise program
without first consulting with your
healthcare professional.
Q: I have
been clumsy all my life, tripping and
falling down a lot. Now that I have
osteoporosis, I’m worried about breaking
a bone when I fall. What can I do to
improve my poor balance?
A: People can improve their
balance and reduce their risk for
falling by repeating a few simple
exercises every day.
Exercise 1
While standing and facing a counter top
or the back of a sturdy chair, hold on
and stand on one leg at a time for one
minute. Switch sides and repeat.
Exercise 2
While standing and facing a counter top
or the back of a sturdy chair, hold on
and rock up onto your toes for a count
of ten, roll back onto your heels for a
count of ten. Repeat ten times.
Start each exercise at Level 1 below
and, when you can do it comfortably,
progress to the next level.
Level 1: Hold on with both hands during
exercise
Level 2: Hold on with one hand only
Level 3: Hold on with one fingertip only
Level 4: Keep both hands two inches
above a chair or table
Level 5: Close your eyes and keep both
hands two inches above a chair or table.
You may also want to consider NOF's
exercise video,
Be BoneWise: Exercise.
This unique routine avoids movements
that are unsafe for people with
osteoporosis, such as twisting or
jarring the spine or bending forward
from the waist.
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HIP
FRACTURE RECOVERY
Q: My 70 year old mother is recovering from
surgery to fix a broken hip. How can I
help her become independent again?
A: Identifying the reason for the
broken hip is a good first step. Your
mother is likely to have underlying
osteoporosis, which can be diagnosed by
having a bone mineral density (BMD)
test. If the test shows significant bone
loss from osteoporosis, your mother’s
doctor will encourage her to consume 1,200 mg of calcium a day and
800 - 1,000 IU of vitamin D a day.
The doctor should also consider
prescribing a medication to treat her
bone loss and reduce risk of future
fractures.
Rehabilitation and a slow return to
exercise are vital after breaking a
bone, especially a hip bone. At first,
walking may be difficult. For this
reason, many patients are transferred
from the hospital to a rehabilitation
facility. A good rehabilitation center
has staff specially trained to help your
mother work hard so that she becomes
stronger and more active every day.
Initially, she may need a walker to move
herself a few steps, but slowly her
balance and strength will improve, and
she will graduate from the walker to a
cane. Before your mother returns home,
you may wish to check her house to make
sure it is fall-proof. A few basic home
safety tips include:
- Remove all
obstacles from the floor such as loose
throw rugs, long electrical and phone
cords and clutter.
- Install railings
next to the tub and toilet.
- Do not wear
backless shoes or slippers.
- Use 100 watt bulbs
in place of low level lighting.
- Add
light-sensitive night lights in the
bedroom, hall and bathroom.
- Consider
subscribing to an at-home monitoring
service.
- Review all
medications with the doctor as many
medications can cause dizziness and
increase risk of falling.
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to the top
MEDICATIONS
Q: Can all osteoporosis
medications build bone?
A: Yes. Osteoporosis occurs when
the process that removes old bone and
replaces it with new bone becomes
imbalanced. Bone is resorbed more
quickly than it is replaced so bones
weaken and may break. Today, medications
that prevent or treat osteoporosis act
on either bone resorption
(anti-resorptive) or bone formation
(anabolic.
Anti-resorptive medications slow the
rate of bone resorption without changing
the rate of bone formation. Bone
formation continues as usual, resulting
in a small increase in bone.
Anti-resorptive medications approved by
the Food and Drug Administration for the
prevention and/or treatment of
osteoporosis include bisphosphonates
(alendronate, ibandronate and risedronate),
calcitonin, estrogen/hormone therapies
and selective estrogen receptor
modulators, called SERMs (raloxifene).
There is one anabolic medication that
acts on the bone formation part of the
cycle. Parathyroid hormone injections
stimulate new bone formation, which
strengthens bone and reduces fracture
risk.
Remember, if you are age 50 or older, no matter what medication you
may be prescribed, it is important to
get 1,200 mg of calcium and 800 - 1,000 International Units of vitamin D every day. Regular weight-bearing
exercise also is an essential part of
any osteoprosis prevention or treatment
plan. People with osteoporosis should be
sure to review any exercise program with
a healthcare provider.
Q: Can you explain how
parathyroid hormone injections make
bones stronger when too much parathyroid
hormone made by the body weakens bones?
A: Parathyroid hormone (PTH) is
produced by four small parathyroid
glands in the neck that control how much
calcium is in the blood and tissues.
Calcium is necessary not only for bone
health but also for normal heart, muscle
and nerve function and normal blood
clotting. Every day, calcium lost in
urine, feces and sweat, or shed in skin,
hair and nails must be replaced by
calcium from food and/or calcium
supplements. When there is too little
calcium to make up for these normal
losses, the body senses the low calcium
level in the blood and tissues, and
responds by releasing special hormones,
including PTH. PTH breaks down or
resorbs bone tissue to release calcium
into the blood and tissues so that the
body continues to function normally.
Higher PTH levels bring the calcium
level back to normal in one of three
ways:
- By breaking down
bone, which releases calcium into the
blood and tissues
- By making it easier
for calcium from calcium-rich foods or
supplements to be absorbed from the
intestines
- By slowing the loss
of calcium through the kidneys and
urine so more can be absorbed
When the calcium level
in the blood and tissues returns to
normal, PTH levels drop again.
Hyperparathyroidism is a medical
condition that results when one or more
of the four parathyroid glands becomes
overactive. This leads to the constant
release of too much PTH, which continues
to break down bone and release calcium
into the blood and tissues. Over time,
excess bone breakdown can lead to
osteoporosis and related fractures.
While continuous exposure to PTH causes
bone loss, studies have shown that
once-a-day injections of PTH have the
opposite effect and build new bone. The
different effect on bone cells seems to
be related to the rapid rise and fall of
PTH in the blood when it is given as an
osteoporosis treatment, as opposed to
the constant high levels of PTH in the
blood when someone has
hyperparathyroidism.
Parathyroid hormone injections
(teriparatide) form new bone, increase
bone mineral density and bone strength,
and reduce risk for osteoporotic
fractures. This is the first
bone-building treatment for
osteoporosis.
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OSTEONECROSIS OF THE JAW
Q. What is osteonecrosis of the jaw?
A.
Osteonecrosis refers to death of bone tissue. The
condition results in chronic pain and
disfigurement and is resistant to
treatment. Early diagnosis may reduce
morbidity. Symptoms of osteonecrosis of
the jaw include:
- Toothache
- Possible altered
sensation
- Jaw pain
- Loose teeth
- Recurrent
soft-tissue infection.
- Exposed bone
If you experience any
of these symptoms, be sure to report
them to your healthcare professional.
Click here
for NOF's statement on osteonecrosis.
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RISK
Q: I am overweight for my
height. Does this mean I am less likely
to get osteoporosis?
A: While being ‘a bit’ overweight
might offer some protection against
osteoporosis, the serious chronic
medical conditions that are closely
related to carrying extra pounds
outweigh any benefits to bone.
After menopause, women produce estrogen
in fat tissues, so thin women are likely
to produce lower levels of their own
natural estrogens than are heavier
women, and estrogens are known to
prevent osteoporosis and related
fractures.
In addition, most research studies that
evaluate the influence of body weight on
bone health focus on the risks of low
body weight. Women who weigh less than
127 pounds are at greater risk for
developing osteoporosis than are women
who weigh more. Women who suffer from
eating disorders significant enough to
alter their normal menstrual cycles also
are at greater risk for developing
osteoporosis.
In short, weight that falls within the
normal range is best for overall health.
NOF encourages women to eat a balanced
diet, exercise regularly and maintain
their body weight within normal limits
for their height. Medical problems
develop when body weight falls below or
climbs above those limits.
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