Osteoporosis

Author:  Frank W. Jackson, M.D.


Purpose

Calcium is essential to the body.  It is the most common mineral in the body and is needed in tiny amounts for the function of most vital organs such as heart and brain.  However, the vast majority of calcium is used by the bones and teeth.  During early childhood and adolescence, vigorous bone growth occurs.  However, bone is a living tissue and calcium leaves the bone as new bone is being created.  By the mid 30’s, a shift occurs whereby more calcium begins to leave bone than is deposited.  Bones begin to weaken.  In the earliest stages, this is called osteopenia.  As it worsens, it becomes osteoporosis.  This is when bone fractures of the hip and spine begin to occur.  It is never too late to reverse this process, though starting early in life and when young will give you the best chance of having strong bones later in life.

Risk Factors for Osteoporosis and Osteopenia

  • Older age
  • Non-Hispanic, Caucasian and Asian ethnicity
  • Small bones – i.e. females
  • Family history of osteoporosis or osteopenia
  • Long-term estrogen hormone use
  • Cigarette smoking
  • Alcohol abuse
  • Sedentary lifestyle or bedridden
  • Low calcium intake
  • Low vitamin D blood level
  • Certain medications such as prednisone, excess thyroid, Dilantin and others

Gut Bacteria and Calcium

A remarkable new area of modern research is in the human colon.  Here, there are over 2000 species of bacteria and trillions upon trillions of bacteria.  They live and thrive in the colon and produce a large number of health benefits.  It is now known that when significant amounts of certain vegetable fibers or dietary supplements reach the colon that the very best bacteria grow vigorously.  These thriving bacteria in turn cause extra calcium to be absorbed through the colon wall.

Soluble Prebiotic Fiber

All plant fiber arrives in the colon unchanged.  There, it is the soluble (meaning water soluble) fibers that are used by certain of the gut’s bacteria to enhance the absorption of calcium.  The two fibers that have been most studied are inulin and oligofructose.  In fact, when a group of young teenagers took this fiber supplement daily, they had a 20% increase in bone density (bone strength) after one year.

Vitamin D

Vitamin D and calcium are intimately connected.  You need to have a good level of vitamin D in your blood to absorb and use calcium.  In Caucasian and light-skinned people, the sun’s rays will make vitamin D in the skin.  Dark-skinned people and African-Americans need to get their vitamin D from foods and vitamin D pills.  This is important as vitamin D deficiency is very common.  For detailed information on vitamin D from the National Institutes of Health, google search: Dietary supplement Fact Sheet: Vitamin D.

Selected Foods High in Vitamin D

  • Cod liver oil
  • Salmon, Mackerel, Sardines, Tuna
  • Vitamin D enriched milk, fruit juices, yogurt

What To Do – The Good Things

  • Consume 1000-1500 mg of calcium per day in food and/or a supplement
  • Active lifestyle – walking, bicycling, gym workout, etc.  You want to stress your bones.  Weight lifting by itself does not do this very well.
  • Eat soluble plant fiber or take a prebiotic supplement such as Prebiotin-Bone Health.
  • No cigarettes
  • Moderate alcohol only
  • Check your medications with your physicians.
  • Moderate caffeine intake – coffee and sodas

Calcium Intake

By far, the most important consideration is to get enough calcium into your body every day.  A minimum of 1000 mg a day is recommended going up to 1500 mg a day when needs are high, such as in recovery from fractures, athletics and pregnancy.  The chart below provides information on calcium content in various common foods.

Calcium Content of Foods
Foods Serving Size mg of Calcium
Yogurt, Low Fat 1 cup 450
Cheese, Grilled Sandwich  1 371
Cheese, Ricotta 1/2 cup 337
Sardines 7 322
Yogurt, Fruit 1 cup 315
Cheese, Cheddar 1 1/2 oz 305
Milk, Skim or 2% 1 cup 300
Orange Juice with Calcium 1 cup 300
Soy Beverage with Calcium 1 cup 250-300
Cheese, Gruyere 1 cup 287
Salmon 5 oz 278
Tofu, Firm 1/2 cup 240
Cheese, Mozzarella 1 ounce 207
Tofu, with Calcium 1/2 cup 204
Macaroni and Cheese 1/2 cup 179
Waffle, Homemade 1 179
Collard Greens, Frozen/Boiled 1/2 cup 179
Ice Cream, Vanilla 1 cup 176
English Muffin, Whole Wheat 1 175
Cheese, American 1 oz 174
Rhubarb, Cooked 1/2 cup 167
Oatmeal, Instant 3/4 cup 163
Cottage Cheese, 2% 1 cup 163
Rice Beverage with Calcium 1 cup 150-300
Pudding Made with Milk 1/2 cup 147-160
Custard, Baked 1/2 cup 149
Pizza, Cheese 1 slice 111-147
Molasses, Blackstrap 1 Tbsp 137
Spinach, Cooked or Frozen 1/2 cup 122
Tofu, Regular 1/2 cup 108
Yogurt, Frozen (Fat Free/Low Fat) 1/2 cup 105
Milk, Instant (Dry/Nonfat) 2 Tbsp 105
Almonds 1/4 cup 94
Broccoli, Cooked or Fresh 1 cup 90
Kale, Cooked 1/2 cup 90
Sesame Seeds, Dried 1 Tbsp 88
Taco, Chicken 1 87
Bok Choy, Cooked or Fresh 1/2 cup 80
Mustard Greens, Cooked 1/2 cup 75
Bread, White 2 slices 70
French Toast 1 slice 65
Hot Dog, Turkey 1 58
Orange, Medium 1 52
Halibut, Baked 3 oz 51
Fig Bar Cookie 4 40
Bread, Whole Wheat 2 slices 40
Cream Cheese 2 Tbsp 23
Cream, Half and Half 1 Tbsp 16
Chicken Breast, Baked 3 oz 14
Apple, Medium 1 10
 Pasta, Cooked 1 cup 10
Beef, Lean Ground 3 oz 9
Banana, Medium 1 7
Sample Menu

Breakfast

Lunch

Dinner

  • grapefruit,1/2
  • high fiber cereal (5-10 gm/serving)
  • banana, 1/2 cup
  • whole wheat toast, 2 slices
  • low saturated fat spread, 2 tsp
  • jelly or jam, 1 Tbsp
  • skim milk, 1 cup
  • decaffeinated coffee/tea
  • vegetable soup, 1 cup
  • lean hamburger patty, 2 oz
  • whole wheat hamburger bun
  • sliced tomato, 2 oz
  • lettuce with dressing, 1 Tbsp
  • fresh fruit salad, 1/2 cup
  • oatmeal cookie, 1
  • non-calorie beverage
  • tomato juice, 1 cup
  • broiled chicken breast, 2 oz
  • herbed brown rice, 1/2 cup
  • broccoli spears, 2
  • cheese sauce, 1/4 cup
  • hard dinner roll, 1
  • low saturated fat spread, 1 tsp
  • carrot/raisin salad made with lite mayonnaise, 1/2 cup
  • frozen strawberry yogurt, 1/2 cup
  • skim milk, 1 cup
This Sample Diet Provides the Following
Calcium

1200 mg

Fat

54 gm

Calories

2120 Kcal

Carbohydrates

326 gm

Protein

84 gm

Sodium

3130 mg

Calcium Supplements

There are many different forms of calcium preparations sitting on the pharmacy shelf. How do you decide which is best for you?  If you are getting, on average, 1000-1500 mg of calcium a day in your foods, you likely do not need a supplement.  However, to get this much calcium, the diet must be rich in dairy products such as milk, yogurt, some cheeses and fish.  If you select a calcium supplement, below are some key facts to consider.

There are two main preparations of calcium:

  • Calcium Carbonate
  • Calcium Citrate

Calcium is also available as calcium lactate and calcium gluconate.

Elemental Calcium – This is an important term.  The label may say calcium 1000 mg, but the important term is “elemental calcium“.  This is the amount of calcium that is actually available from the preparation.  For instance:

Weight            Elemental Calcium
Calcium Carbonate              1000 mg          400 mg (40%)
Calcium Citrate                   1000 mg          210 mg (21%)

If you do not find the two words “elemental calcium” on the label, assume you must multiply the calcium weight listed by 40% for calcium carbonate and 21% for calcium citrate to get the true amount of elemental calcium.

  • Expense – Calcium carbonate is the least expensive.  Calcium citrate is more expensive per pill while providing only half the elemental calcium that carbonate preparation does.
  • When and how to take it – Take calcium carbonate with meals, no more than 500 mg at a time.  Twice a day is a reasonable dosing.  Calcium citrate can generally be taken with or without food.

© Frank W. Jackson, M.D.