Counting on Calcium

Are you counting on calcium for proper bone structure, posture, and bodily functions?  If you don't normally consume 3 eight-ounce glasses of milk per day, then you're missing the most important mineral of all!  Of course milk isn't the only way to get calcium, but it is one of the BEST ways to consume calcium.

To find out whether or not you are at risk for osteoporosis, take the risk assessment quiz.

Why is calcium important?

Everyone needs calcium throughout the life span.  As we grow and develop from infants into adults, the body needs calcium for bone growth.  Peak bone mass is acquired at about the age of 20, and no matter what, bone density will diminish unless it is constantly replenished.  Bone density is maintained by a balance of diet, exercise, and hormones.  Anyone who does not consume enough calcium will not develop bones as strong as those who do.  Anyone who does not continue to actively bear weight on the large bones of the body will have difficulty building and maintaining bone strength.  At this time, one in every two women over the age of 50 will suffer an osteoporosis-related fracture because they never acquired enough bone density before the age of 20 or from diminished bone density due to poor self-care and lifestyle habits.

Who should be most concerned about calcium consumption?

Women have the added disadvantage of hormone fluctuations during the lifespan which influence calcium absorption and maintenance in the body.  Irregular menstrual cycles or cessation of menstruation (resulting from overexercising, DepoProvera shots, or menopause) places women at higher risk for osteoporosis than men.  Other high risk individuals are those who have had gluticosteroid or corticosteroid treatments for long periods of time.

How much calcium is needed by the body?

The amount of calcium needed depends on age, gender, and hormonal activity.  The National Osteoporosis Foundation recommends:

                                                            Calcium Requirements                        Equivalent to (about):
                 Birth-6 months                         210 mg/day                                 One 8 oz. glass of milk
                 6 months-1 year                       270 mg/day                                 One 8 oz. glass of milk
                 1-3 years of age                       500 mg/day                                 Two 8 oz. glasses of milk
                 4-8 years of age                       800 mg/day                                 2 1/2 eight oz. glasses of milk
                 9-18 years of age                    1300 mg/day                                Four 8 oz. glasses of milk
                19-50 years of age                   1000 mg/day                                3 1/2 eight oz. glasses of milk
                51+ years of age                      1200 mg/day                                Four 8 oz. glasses of milk

Do I need other nutrients to help my body absorb calcium?

Calcium must be accompanied by Vitamin D in order for it to be readily absorbed by the body.  Sunlight has ample amounts of Vitamin D, but due to seasonal changes and an increase in indoor activities as one lives and works, Vitamin D is often added to dairy products.

If I were to choose dairy products for my daily calcium, which are highest in calcium?

It is important to remember that fat content is not necessarily better when calcium consumption for bone growth and maintenance is the goal.  When fat is removed from dairy products, it does not diminish the calcium content.  The following is the calcium-copntent of dairy foods:

            1/4 cup of non-fat dry milk (powdered)   377 mg.
            1 cup (8 oz.) of skim milk                        302 mg.
            1 cup (8 oz.) of low-fat yogurt                 300-415 mg.
            1 oz. cheddar cheese (1 inch cube)          300 mg.
            1 cup buttermilk                                       285 mg.
            One waffle/pancake with milk added       179 mg.
            1/4 cup Ricotta cheese                             168 mg.
            2 cup cottage cheese                                155 mg.
            1/2 cup pudding made with milk              150 mg.

What if I'm lactose intolerant?

Most lactose intolerant individuals can tolerate yogurt and skim milk in small amounts.  It is best to start slow and gradually increase as tolerance permits.  Select hard, aged cheeses that are lower in lactose.  Look for cultured milk products like yogurt or buttermilk.

What other sources of calcium are there besides milk and dairy products?

There are several sources of calcium, but they must be consumed in larger amounts than milk or dairy products.  In fact, when a woman matures, she is better off consuming vegetable protein foods rather than animal protein foods to keep cholesterol low and sustain important estrogen hormones for optimal health.  Sources of calcium include:

        1 cup rhubarb                                                                               348 mg.
        1 cup soy milk                                                                              300 mg.
        1 cup rice milk, calcium-fortified                                                300 mg.
        calcium-fortified orange juice                                                      300 mg.
        1/2 cup tofu (soybean curd) processed with calcium sulfate        300 mg.
        1 cup kale                                                                                     179 mg.
        1/2 cup collard greens                                                                  175 mg.
        1 Tbls. blackstrap molasses                                                         170 mg.
        1 cup tomato soup (made with skim milk)                                    159 mg.
        2 oz. almonds                                                                               150 mg.
        1 Tbls. dark molasses                                                                   137 mg.
        5 dried figs                                                                                   135 mg.
        1/2 cup tofu (plain)                                                                       130 mg.
        1/4 cup soynuts                                                                             115 mg.
        1/2 cup cooked white beans                                                         100 mg.
        1/2 cup cooked turnip greens                                                        100 mg.
        One orange                                                                                     50 mg.
        One sweet potato                                                                            44 mg.
        Broccoli (raw or cooked)                                                               35 mg.

What about fish with bones and shellfish?

        3 canned sardines with bones                                                       300 mg.
        3 ounces of canned salmon with bones                                         181 mg.
        3.5 ounces of oysters                                                                    100 mg.

What about "calcium-fortified" products?"

Any food can be enriched by preparing it with milk; for example, pancakes or cereal.  Food manufacturers are now "fortifying" orange juice, bread, fruit punches, soy products, and rice milk products or those who prefer not to consume dairy products. There are also calcium fortified cereal bars, snack bars and candies which are very popular, expensive and contain high amounts of sugar.

What about taking a calcium supplement?

Calcium supplements are readily available.  For optimal absorption, take no more than 500 mg. of calcium at one time.  Make sure that Vitamin D is included.  Do NOT take an iron supplement at the same time as it interferes with calcium absorption.  The easiest calcium source to absorb is calcium citrate.  Calcium carbonate would be a close second.  Calcium carbonate requires a certain amount of gastric acid to digest and absorb properly.  Some individuals experience constipation and gas because they are unable to process it alone.  Most physicians recommend that calcium carbonate supplements be taken with meals.  Calcium supplements with oyster shell should be avoided because it is hard to absorb and contaminates have been found in some of them.  The following is a list of brand name supplements and their calcium content per tablet.  There are many generic versions that are just as good, but you must read the label.

                        Tums                                           200 mg.
                        Calcium Rich Rolaids                 220 mg.
                        Tums EX                                     300 mg.
                        Extra Strength Rolaids                400 mg.
                        Titralac                                       400 mg.
                        Os-Cal 500                                 500 mg.
                        Viactiv                                        500 mg.
                        Caltrate 600                                600 mg.

Are there things I can do to keep the calcium I already have in my bones?

Other things that make bone growth difficult to gain and maintain include long-term use of corticosteroids (such as Prednisone) and lifestyle habits which interfere with proper diet.  Those who smoke and drink often have poor diets which diminish the amount of calcium consumed.  Those who consume too much protein in the form of supplements to gain or lose weight are also at risk for bone loss.  Those who rely on carbonated drinks will lose calcium as a result of phosphoric acid consumption.

What is osteoporosis?

Osteoporosis is a porous bone condition that results when calcium is not used to gain or maintain bone strength or density.  It is often called the "silent killer" because many people do not know they have it until they break a bone.  The bone most often broken is a hip, which is a serious break for anyone who wants to be independent.  Other areas of the body most prone to fracture from osteoporosis are spinal vertebrae and wrists.

How would I know if I am "at risk" for osteoporosis?

More than 28 million Americans are at risk for osteoporosis.  Eighty percent of them are women.  Ten million already have the disease and 18 million more have low bone mass.

If you have a family history of osteoporosis, then you are more at risk than others.  Low calcium consumption, inactivity, and poor lifestyle habits contribute to its development.  It is most common in Caucasians and Asians.  If you want to be screened for osteoporosis, the easiest way is a "do-it-yourself" test.  First, keep track of your height.  If you begin to shrink an inch, you are likely to have osteoporosis.  Secondly, hold your arms outstretched out to your sides (even with the shoulders) and have someone measure from the tips of one hand to the tips of the other.  If your arms are longer than you are tall, then you may have osteoporosis.  There are heel scans and wrist scans (CRT is one type) that purport to measure bone density, but they are not as accurate as they could be.  If you are over the age of 50, post-menopausal, and shrinking, ask your doctor if you are a candidate for a bone density test.

What are the different types of bone scans and which is the best?

The most widely used technique is the dual energy x-ray absorpitiometry (DEXA-SCAN).  Orthopedic surgeons recommend this method for anyone who is menopausal or at "high risk" for osteoporosis.  Older methods do not predict hip fractures as well as DEXA. The procedure costs from $200-250 and will be covered by your medical insurance if it is ordered by a physician and you are over 50.

Ultrasonic tests that measures bone density in the calcaneous (heel bone) do not detect osteoporosis in the spine or hip.  These measures measure bone mass.

Quantitative computed tomography (QCT) measures must follow protocols stringently and at a mall or screening clinic, getting the same measure twice is difficult.

What is the best advice for someone concerned about bone health?

Make sure that calcium intake is an important part of your daily diet no matter what your age.   Continue to be physically active, or become more physically active if you are not.  Physical activity strengthens and maintain bones.  Physical activity is also crucial to maintaing a good sense of balance and preventing falls.  Do not substitute good health behaviors with negative health behaviors such as overconsumption of nicotine, caffeine, alcohol, carbonated beverages, or protein.  Everything should be done in moderation to stay healthy, but to gain bone health, calcium consumption must be sustained throughout the life span.

Are there any other good websites for more information?

Foundation for Osteoporosis Research and Education.  http://courses.washington.edu/bonephys
This website provides the most recent information, video "webcasts" you can view, a list of films/videos that can be purchased, and you can subscribe to their list for future announcements.

National Osteoporosis Foundation.  http://www.nof.org
This website provides comprehensive information about any topic related to osteoporosis, especially information on risks of various groups of individuals.  Information can be requested by anyone.

Osteoporosis and Bone Physiology Course at Washington University.  http://courses.washington.edu/bonephys
This website shows bone physiology so you can see the difference between normal bone, osteopenia, and osteoporosis.  Information about specific bone scan instruments is also available.

Osteoporosis Clinical Research Site.  http://www.osteoporosisstudy.com/
This California company conducts research and you can volunteer to be a subject with free osteoporosis tests, if you reside in an area where their research is conducted.

The National Institute of Health Osteoporosis and Related Bone Diseases National Resource Center
     (NIH ORBD NRD)  http://www.osteo.org
This website provides bibliographies on various topics related to osteoporosis and other resources available free or for a small amount.