Everything you need to know about Osteoporosis

Why should you care?

About half of all women and a third of all men over 60 will have a diagnosed osteoporotic fracture during their lifetime. The true figure is significantly higher since 80% of osteoporotic fractures are silent, cause no symptoms and are therefore undetected. Osteoporosis is a disease of aging, which manifests when sex hormones (oestrogen in women and testosterone in men) diminish. For women, the protective effect of oestrogen ends with menopause.

    Risk factors:

–  Being female. Women are at a much higher risk of osteoporosis than men

–  Insufficient calcium intake during bone building years and around menopause especially

–  Vitamin D deficiency. Vitamin D is essential for calcium absorption. If you’re deficient – get your levels up.

–  Smoking. Smoking decreases oestrogen production (remember? Oestrogen is protective, so anything that reduces it can’t be good). Women who smoke reach menopause 1.5-2 years earlier. Smoking also interferes with calcium absorption.

–  Alcohol excess reduces mineral absorption and increases urinary excretion of calcium.

– Low body weight / slight frame.

– Sex hormone deficiency (oestrogen in women, testosterone in men).

– Underlying genetic risk – if you have family history of osteoporosis your risk is increased.

– Malabsorption syndromes, such as Crohn’s disease, Coeliac disease, ulcerative colitis, chronic diarrhoea – will reduce mineral absorption, thus leading to lower bone mass.

– Endocrine disorders (Cushings syndrome, hyperprolactinaemia, hyperthyroidism, hyperparathyroidism).

Medications may also increase the risk of secondary osteoporosis.

These include: long-term corticosteroids (patients using 7.5mgs of prednisolone daily can lose up to 15% of bone density in a year), aromatase inhibitors which are used after breast cancer, the glitazones used in the treatment of diabetes, some antiepileptic medications and proton pump inhibitors used to treat gastro-oesophageal reflux.

Bones and Calcium

Bones are not static structures, they are continuously being rebuilt, which is essential for their structural stability. However this process (like many others) becomes much less effective when we age. Peak bone mass is achieved between the ages of 20-30 (which is when you need to focus your efforts on achieving the maximum bone mass possible) and then it’s all downhill from there.

To sum this up, your risk of suffering an oseoporotic fracture is dependent on 2 things: the bone mass at maturity and the rate at which you lose bone thereafter. If you’re in your twenties, ensure you do everything you can to build bone mass. If you’re older – make sure you slow bone loss as much as you can. I will explain how to do this a little later.

Bone has a primary structural requirement for calcium but it also acts as a reservoir for the rest of the body’s calcium requirements. If calcium is not available to the organs, which require it for their optimal functioning, it will be withdrawn from bones. That’s why measuring calcium levels in the blood is deceptive – the body will draw calcium out of bones to maintain constant blood levels. Calcium is continuously released from the bone and filtered through the kidneys, only to be absorbed back into the bones (ideally). The older we get, the more calcium we lose through the urine.

What factors reduce calcium absorption?

– high fibre diets. Women who have excessively high fibre diets have lower oestrogen levels and lower bone density. There is also a compound found mainly in grains (phytic acid) which binds to minerals in food and prevents absorption. This is only an issue if fibre intake is EXCESSIVE, most women don’t consume enough fibre.

What factors increase calcium loss?

–       high protein diets

–       ageing

–       high sodium intake (salt)

–       high sugar intake

Everything you need to know about calcium

The amount of calcium you need to have daily is roughly 1000 mg per day when you’re young, and 1500 mg per day when you’re menopausal. This is an estimate, based on research, each individual woman’s requirements will vary. Also according to research, Australian women consume half of that amount, at best. When you’re not getting enough calcium with your diet, your body (remainder) will pull it from your bones and teeth to utilise it in essential functions. Your body doesn’t think it’s that important to keep much of it in bones, because evolutionarily your body doesn’t expect you to live as long as modern times allow.

Where do you get the calcium from?

Dairy is a widely known source of calcium. But is it the best? Is it essential? Yes, the amount of Calcium in milk is reasonably high, 300 – 350 mg of calcium per serve. If you enjoy dairy products and have no intolerances or allergies – go ahead. If, for some reason, you’re choosing not to have dairy, don’t be too concerned. For starters, our belief that dairy is essential for calcium is the result of advertising rather than actual fact. Otherwise Asian women, whose dairy consumption is almost non existent, would all be suffering tremendous osteoporosis, whereas in fact, their rates are MUCH lower than ours. Moreover, calcium from milk is not very well absorbed, for reasons I won’t go into now (this piece is getting too long as it is). Especially useless (in terms of calcium absorption) is the low fat milk. Don’t drink (or eat) anything low-fat. Please. But I digress.

Following is a list of foods you can obtain your calcium from:

Best sources:

Almonds – 250 mg per 100 g, Brasil nuts – 180 mg per 100 g, Unhulled sesame seeds – 1160mg per 100 g.

Food	Milligrams (mg) per serving
Sardines, canned in oil, with bones, 85g	324
Cheddar cheese, 45g	306
Orange juice, calcium-fortified, 170g	200-260
Tofu, firm, made with calcium sulfate, ½ cup	204
Salmon, pink, canned, solids with bone, 85g	181
Tofu, soft, made with calcium sulfate, ½ cup	138
Spinach, cooked, ½ cup	120
Ready-to-eat cereal, calcium-fortified, 1 cup	100-1,000
Turnip greens, boiled, ½ cup	99
Kale, cooked, 1 cup	94
Soy beverage, calcium-fortified, 230g	80-500
Chinese cabbage, raw, 1 cup	74
Broccoli, raw, ½ cup	21
Bread, whole-grain, 1 slice	20

Calcium supplements

The most commonly prescribed calcium supplement on the market is Caltrate. I suggest you look elsewhere for your calcium supplementation, and I’ll explain why.

Firstly, check out the ingredients in Caltrate:

Dextrose, Calcium Carbonate, Maltodextrin. Contains < 2%: Adipic Acid, BHT, Cholecalciferol (Vit. D₃), Corn Starch, Crospovidone, Cupric Oxide, FD&C Blue No. 2 Aluminum Lake, FD&C Red No. 40 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake, Gelatin, Hypromellose, Magnesium Oxide, Magnesium Stearate, Manganese Sulfate, Mineral Oil, Modified Food Starch, Natural and Artificial Flavor, Partially Hydrogenated Soybean Oil, Powdered Cellulose, Sodium Borate, Stearic Acid (Soybean), Sucrose, Tocopherols, Zinc Oxide. Contains: Soybean.

Now, I don’t know about you, but I don’t need that many chemicals and additives as a side dish to my calcium (quite a few of which have evidence of being harmful).

Secondly, the form of calcium in Caltrate is calcium carbonate. It’s the cheapest form which is very poorly absorbed. In fact, I’ll go as far as to say it’s practically useless, because it requires high levels of stomach acid to digest it, but a protein meal (which generates acid production) will suppress absorption. So you can’t really win with Caltrate. As little as 4% absorption has been demostrated in individuals with low gastric acid secretion. Don’t buy it. Sorry, Caltrate makers, I’m sure you’ll make your money on other things.

Better forms of calcium are calcium citrate, calcium gluconate and calcium lactate. Look for those. Have them with meals, and in divided doses throughout the day. Better yet, discuss your calcium needs and supplementation with a professional.

Don’t forget to keep your vitamin D levels high (you can have a blood test to check those) and go in the sun without sunscreen (for no more than 10-15 minutes a day, or as little as 5 if you’re very fair and burn easily. Preferably exposure should be in the middle of the day, and, in case you didn’t know, sunscreen BLOCKS vitamin D production. Which is why the population of our sunny country is so deficient.

Another important factor in bone density is acid – alkaline balance. I will explain this one in the next article. Hope you learned something, and I welcome (and appreciate) all and any feedback.

Thank you!