The Credit Valley Hospital

Osteoporosis - The Fragile Truth

Over a lifetime, osteoporosis affects up to 40% of women and 1/3 as many men. Dowager's Hump, hip fractures, deformity and disability all result from this disease, which affects 1.4 million Canadians.

Osteoporosis is characterized by a loss of minerals from the skeleton. As the disease progresses, bones become porous, resembling a sponge. Bones become thin and very susceptible to fracture.

Osteoporosis cannot be cured - it can only be prevented or its progression delayed.

What are the Risks?

The more risk factors you have, the greater your chance of developing osteoporosis:

Genetic

Female
Caucasian or Asian
Family History of Osteoporosis
Fair Complexion
Small Frame

Age-Related

Menopause
Advanced Age

Medical

Surgical Menopause (ovaries removed)
Prolonged Hormonal Imbalance (e.g. hyperthyroidism)
Excessive Use of Certain Medications (e.g. Prednisone or aluminum-containing antacids)

Nutrition
Low Intake: Calcium, Vitamin D
High Intake: Caffeine, Alcohol, Sodium, Protein

Lifestyle

Smoking
Lack of Exercise
Excessive Exercise (causing amennorhea)
Childlessness
Breastfeeding > 1 year with inadequate calcium intake

Bone Mass Basics

Consuming adequate calcium in the diet from pre-adolescence through young adulthood is critical for building bone mass. Bone continues to be laid down until about 30 years of age. Between age 30 and menopause, bone mass remains quite steady.

After menopause, the story changes. Women lose 2 to 5% of their bone mass each year until about 5 years after menopause. Bone loss becomes more gradual after that.

The need for calcium increases for pregnant and nursing women to meet their own needs and those of their baby.

Prevention: The Best Medicine

Experts agree that the best way to prevent this disease is to build strong bones early in life - primarily by eating a well-balanced, calcium-rich diet and getting daily exercise. Women should try to maximize bone mass when they are young.

In post-menopausal women, hormone replacement therapy (HRT) is the single most effective way to prevent bone loss, especially in early menopause, when calcium loss is the greatest. Not all women are suitable for HRT, however. Your doctor can determine whether HRT can be used for you.

You can help prevent bone loss by following these bone insurance tips:

Increase: Calcium, Vitamin D & Exercise
Decrease: Alcohol, Caffeine, Sodium & Protein
Quit Smoking

How Much Calcium Do You Need?

Daily Calcium Needs

Age	Male	Female
1 year	500 mg	500 mg
2-3 years	550 mg	550 mg
4-6 year	600 mg	600 mg
7-9 years	700 mg	700 mg
10-12 years	900 mg	900 mg
13-15 years	1100 mg	1100 mg
16-18 years	900 mg	900 mg
19-49 years	800 mg	800 mg
50+ years	800 mg	800 mg
Pregnant and nursing	-	500 mg EXTRA

Health and Welfare Canada. Nutrition Recommendations, The Report of the Scientific Review Committee, 1990.
* The Osteoporosis Society of Canada now recommends from 900-1400 mg of calcium a day between the ages of 10-16, 1200 mg for thos aged 17 and 18, 1000 mg for ages 19-49 and from 1000-1500 mg for those over 49, depending on their bone density and risk of bone loss. (1993 Consensus Statement on Calcium Nutrition.)

Most researchers agree that the rapid bone loss that follows early menopause cannot be prevented by calcium intake, but consuming around 1500 mg a day of calcium can reduce bone loss in the later years.

Food vs. Pills
Eating foods that contain plenty of calcium is the best way to meet your calcium needs. Food sources of calcium, such as milk, also provide other important nutrients like Vitamin D, magnesium and phosphorous, which your bones and body also need.

Calcium Top Ten List

Food	Content
Firm Cheese (50 g)	350 mg
Plain Yogurt (175 g)	300 mg
Milk (250 mL)	300 mg
Fruit Yogurt (175 g)	260 mg
Salmon - canned, bones (100 g)	230 mg
Sardines - canned, bones (55 g)	210 mg
Almonds (125 mL)	200 mg
Bok choy - cooked (250 mL)	170 mg
Tofu with calcium (100 g)	150 mg
Broccoli - cooked (250 mL)	100 mg

If you cannot eat enough calcium from your diet alone, then calcium supplements are recommended:

Choose calcium citrate or calcium carbonate as they are more readily absorbed.
More calcium is absorbed if you take small doses several times a day; for example, 250 mg, four times a day, rather than 1000 mg all at once.
Take your calcium supplement with meals.
Take a supplement with Vitamin D as it enhances calcium absorption.

A Final Word

While some bone loss is inevitable after menopause, hip fractures are not. Take an active part in preventing osteoporosis by boning up on exercise, a healthy diet and HRT where appropriate.

Sharon Rodrigues
Registered Dietititian
The Credit Valley Hospital

Back