Preventing Osteoporosis

with Paul Burstein, M.D., obstetrics and gynecology, Columbia St. Mary's

Last Updated: Oct. 1, 2003

Although there are genetic risk factors for osteoporosis, whether or not an individual will develop it is due in a great part to lifestyle choices made when young. Educating parents and young adults is important in preventing osteoporosis later in one’s life.

The major mineral in bones is calcium. However, calcium is also needed in the blood where it regulates cardiac functioning, nerve conduction and muscle contractions.

The amount of calcium in the blood is carefully regulated by the body and varies only a minute amount. “But if our bodies don’t get a continuous daily intake of calcium, our bodies know to go to the piggy bank to get more. In our bodies that piggy bank is our bones and our teeth,” said Dr. Paul Burstein, an obstetrician and gynecologist with Columbia St. Mary’s.

Paul Burstein, M.D., obstetrics and gynecology, Columbia St. Mary's "When people are growing up with an unhealthy diet, it is a tremendous missed opportunity. We’re talking about something that essentially costs nothing. Everyone has to eat and a gallon of milk costs less than a six-pack of soda." Dr. Burstein presents: Osteoporosis: Prevention, Diagnosis & Treatment January 15, 2004 7-8 p.m. Columbia St. Mary's Columbia Campus, Auditorium Search for additional events

The role of calcium
The amount of calcium needed by individuals each day varies by age. Children ages 1 to 3 years old need 500 mg. Those 4 to 8 need 800 mg. Children during the peak growing years of 9 to 18 need 1,300 mg. Adults from age 50 to 65 need 1,200 mg daily. Men and women over 65 years of age need 1,500 mg daily.

“My belief is that prevention of osteoporosis begins very early in life, before someone even goes to preschool. Among children two to eight, about eighty percent are getting enough calcium. Among those nine to eighteen, only about twenty percent get as much as they should and the problem is most severe among adolescent girls,” the doctor said.

Dieting is one cause for too little dietary calcium, but bad food choices are also common. “Small kids are given juice boxes instead of milk. And if everyone is drinking soda, it just isn’t cool to ask for milk,” Dr. Burstein said.

A related problem for some is lactose intolerance. Fortunately, soy milk and other beverages such as some brands of orange juice contain added calcium, as do yogurt and cheese. And for those not sure about their or their calcium intake, there are chewable supplements.

“My personal belief is that one type of calcium is no better than another. However with older people there may not be enough stomach acid for good absorption, so calcium citrate may be their best choice,” the doctor said.

In addition, he recommends that calcium supplements come from a well-known source. “The name brand types have very little lead. However, some health food brands from bone meal, oyster shell, and dolomite may have higher lead levels. The coral calcium industry has been chastised by the FDA (Federal Drug Administration) for unsubstantiated claims. This is a case where natural isn’t necessarily better,” Dr. Burstein said.

Calcium-rich foods
Calcium is found in a number of different foods. However, the most efficient way to obtain calcium is through eating dairy products. An 8-oz. glass of milk has approximately 300 mg of calcium so a serving for each meal along with a few servings of other calcium-containing foods, such as broccoli, Brussels sprouts, green leafy vegetables, oranges or calcium-fortified bread and cereals, will likely be enough to meet these daily requirements.

For proper calcium absorption, Vitamin D is also needed. Dr. Burstein noted that vitamin D is added to milk or comes naturally with even a short exposure to the sun. Magnesium plays a minor role in bone health and is obtained in the normal diet with little need for supplementation.

The role of exercise
In addition to calcium, bones need to be stressed to be strong. For that, everyone needs exercise. Unfortunately, sedentary lifestyles are becoming the norm for everyone from small children to older adults.

“Everyone needs to do weight-bearing exercises to keep bones strong. As people age they should also add exercises that increase coordination and stability. This will help to keep them from falling. For adults, free-weight exercises are also excellent to help maintain muscle mass,” Dr. Burstein said.

However, too much exercise can also cause problems. While most young men will pay close attention to diet to build strength, young women may not be as health conscious. “Female athletes may exercise to such a degree that they stop menstruating. This creates a negative metabolic balance. They actually burn muscle and bone mass. Triathletes, marathoners, even dance students may start having fractures,” Dr. Burstein said.

Bone density scans
Bone density tests are rarely needed on women younger than 65 except in special cases. One of these is to measure bone density for women considering taking hormone supplements or other therapy to retard rate of bone loss, something hormones are proven to do.

“If the bone density was normal, we could recheck in five years. Other risk factors that would make earlier testing appropriate would be low calcium use, non-traumatic fractures which might indicate a density problem, and drugs that might affect density,” he said.

“After Fosamax was developed, physicians were just happy to have bone density scanning and an objective way of determining who should be taking medication. Fortunately, the drug therapy works in over ninety-eight percent of cases,” Dr. Burstein said.

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