Osteoporosis - is it just a disease of old age?

Osteoporosis - is it just a disease of old age?

Osteoporosis - what is it?
The word osteoporosis means “porous bones”, which means that there is a decline in bone density, making them fragile and at increased risk of fracture.
This disease is silent, it develops over several years, without symptoms. And it is often only detected when there is a fracture.

Although osteoporosis is often associated with a disease that appears in old age, it begins to develop much earlier than that!

Therefore, it is important to take care of bone health from an early age, even in childhood.

Bone Peek Mass Bone mass reaches its peak in adolescence and up until the age of 30. From the age of 30, the decline in bone mass begins, in a very progressive manner. If up until then, the nutritional intake of calcium and vitamin D has been sufficient, you will have reached the maximum potential for bone mass, and thus will be at lower risk of reaching low bone density and fracturing a bone.

Menopause and bone health
During menopause, there is a decline in estrogen levels, which in turn accelerates the loss of bone mass. Therefore, women in postmenopausal age are at greater risk of developing osteoporosis.

Dietary recommendations for good bone health
1. Consume foods rich in calcium, reaching the following daily recommendations:

Recommendations for daily intake of calcium.

These recommendations may differ in specific cases, such as the following:

Recommendations for daily intake of calcium.

*Calcium intake recommendations vary by country, for example in Canada and the United States of America, the recommended daily intake of calcium is 1000mg for an adult, per day.

How to consume 700 mg of calcium per day (for example)?

Breakfast
1 yogurt (150 g) + 2 dried figs + 30 g almonds = 390 mg

Snacks
1 slice of cheddar cheese (30 g) or 100 g cottage cheese + 1 slice of whole-wheat bread (100 g) = 293 mg

Lunch or dinner
2 boiled eggs or 1 cup of fresh orange juice = 60 mg

TOTAL = 743 mg calcium

How to consume 700 mg of calcium per day (for example)?

Other sources of calcium:

• Canned sardines with bones, ½ can of 60 g = 273-407 mg calcium
• 1 yogurt (150 g) = 240 mg calcium
• 1 cup of milk (200 ml) = 240 mg calcium
• 2 slices of cheddar, gouda or edam cheese (30 g) = 240 mg calcium
• 2 triangles of cheese (15 g) or 100 g cottage cheese = 120 mg calcium
• 4 dried figs = 180 mg calcium
• 2 large slices of wholemeal bread (100 g) = 106 mg calcium
• 1 tablespoon of sesame seeds = 87 mg calcium
• 1 tablespoon of tahini = 63 mg calcium
• 1 jar of rice pudding 55 g = 60 mg calcium
• 2 oranges or orange juice = 60 mg calcium
• 30 g of almonds = 60 mg calcium
• 2 boiled eggs = 50 mg calcium
• 2 tablespoons of hummus = 20 mg calcium

Note: If you do not drink cow's milk, choose plant-based milks that are fortified with calcium. And shake the container well before consuming.

You can use the following link Calcium Calculator | Osteoporosis Canada to calculate your daily calcium intake.

Sources of calcium.

Calcium supplements
If your calcium intake does not meet the recommendations, you may want to consider taking a supplement. However, it is important to know that it is preferable to consume foods rich in calcium rather than taking supplements, since foods contain other minerals that are important for good bone health.

• Calcium citrate supplements can be taken at any time.
• Calcium carbonate supplements are best absorbed when taken with meal.
• Do not take more than 500-600 mg of a calcium supplement at one time.

Calcium absorption
Calcium absorption depends on several factors, such as age, adequate vitamin D, and individual calcium needs. On average, our bodies absorb about 25 to 75% of the calcium in our diet. For example, a child absorbs 75% of the calcium in their diet, while an elderly person absorbs about 25%.

Our bodies also adjust calcium absorption depending on the amount of calcium ingested. For example, if a diet is too rich in calcium, our bodies absorb less calcium from the diet, and the same goes for vice versa. Phytates present in nuts, seeds and cereals interfere with the absorption of calcium, as do phosphorus and magnesium from supplements.

2. Get enough vitamin D. Vitamin D is important for the absorption of calcium. If the amount of vitamin D is inadequate, calcium absorption decreases by about 10%. This can be obtained through:

• sufficient exposure to direct sunlight, between the months of April and October. It is recommended to expose arms and legs (without sunscreen!) to the sun for 30 minutes/day, between 11 am and 3 pm;
• Intake of foods rich in vitamin D. The recommended daily intake of vitamin D is 5 to 10 micrograms/day

Foods that provide 5 micrograms of vitamin D:

• Cod oil 2 g
• Grilled herring 30 g
• Tinned/steamed salmon 50 g
• Tinned sardines 60 g
• Margarine 60 g
• Egg yolk 100 g

If you do not consume foods that contain vitamin D on a daily basis, consider taking a daily vitamin D supplement of 400 IU (10 µg). If you have osteoporosis, the dose of vitamin D supplementation will be different. It is important to talk to your doctor to prescribe the appropriate dose.

Foods that provide 5 micrograms of vitamin D.

​3. Follow the Mediterranean diet to get all the nutrients you need for good health. This includes eating a variety of vegetables, fruits, whole grains such as barley, oats and quinoa, as well as protein foods such as dairy, legumes, nuts, seeds, eggs, fish, poultry and meat.

4. Eat enough protein from both animal and plant sources, and ¼ of your plate should be protein foods. This includes legumes such as beans, dried peas, lentils, peanuts, nuts and seeds (without added salt), butter, eggs, milk and dairy products including cheese and yogurt, lean meats, poultry and fish.

5. Avoid consuming large amounts of sugary foods and carbonated and sugar-sweetened beverages. This includes soda, fruit juices, punch or cocktails, sweetened coffee or tea.

6. Drink coffee in moderation. The recommended total amount of coffee is about three 250 ml cups per day (less than 400 mg of caffeine). Drinking more than this can decrease the amount of calcium your body stores.

Cola and energy drinks also contain caffeine. Black tea contains much less caffeine than coffee and may protect bone health. Green and black tea (regular and decaffeinated) contain natural plant compounds called polyphenols. These compounds may help build bone.

7. Reduce your alcohol intake. Drinking alcohol regularly can increase your risk of developing osteoporosis, which is a risk factor for fractures.

Other Considerations
If you have recently broken a bone, have celiac disease or inflammatory bowel disease, or have been taking prednisone (a glucocorticoid) for a long time, you may be at higher risk of developing or worsening osteoporosis. Talk to your dietitian about whether you need to make additional lifestyle changes.

Conclusion
Osteoporosis is not a disease that only appears in old age. This disease begins to develop much earlier than that, without any signs or symptoms. From childhood, the nutritional intake of calcium and vitamin D must be adequate for the individual to reach their maximum bone peak mass. After the age of 30, bone mass begins to decline.

A healthy diet, such as the Mediterranean diet, with adequate amounts of dairy products, protein and vitamin D, at all stages of life, as well as regular physical activity, are important for good bone health.

If you need help from a health care professional to help you develop a personalized diet to improve your bone health, please schedule a free consultation with me through my website.

References
Nutrition. Second edition, Paul Insel and others. American Dietetic Association.
Oxford handbook of Nutrition and dietetics, Second Edition, Webster-Gandy Madden Holdsworth. Oxford University Express.
PEN Nutrition Eating Guidelines to Prevent and Manage Osteoporosis (Adults)
BDA food fact sheets calcium Calcium - BDA

Author

I’m Joana, a Registered Dietitian in the UK. I’ve been helping busy adults lose weight by helping them to identify the small changes in their lifestyle that will bring results. Book a free call with me to learn how we can work together.