Making bones...

Osteoporosis is a bone disease characterized by low bone mass and deterioration of bone structure. It may lead to hip, wrist or spinal fractures. According to the Ministry of Health Nutrition & Health survey reported in 2003, 7.5% of Jewish women and 0.7% of Jewish men questioned reported being diagnosed with osteoporosis. The breakdown by age for women is 1.4% for 35-44 year olds; there is a sharp rise to 19.8% for 55-64 year old women.

"D" whole story

The milk moustache commercial notwithstanding, the integrity of bone is a complex story, involving a lot more than calcium. Long term studies carried out on large populations in the US and Europe did NOT show significant drop in fracture risk with increased calcium intake. According to a study reported in the Journal of Nutrition, countries with the highest average calcium intake tend to have higher hip fracture rates. So, what’s “D” story?

Bone is an intricate substance containing several nutrients and requiring many elements for its synthesis. These include vitamin D, magnesium, phosphorous and weight bearing exercise.

Vitamin D helps calcium get absorbed into bones. There is a worldwide vitamin D deficiency epidemic. At risk for vitamin D deficiency are: overweight individuals (they store the vitamin in fat tissue), those who suffer from malabsorption of fats, liver and kidney disease sufferers, people who wear long sleeves year-round and those residing in locales with less sunshine. In addition, overuse of sunscreen may result in underproduction of vitamin D in the skin.

Another player often overlooked is magnesium. In addition to its role in bone mineralization, magnesium is also involved in about 300 reactions in the body. In research on magnesium, an inverse relationship was found between intake of the mineral and the development of metabolic syndrome. Only 1% of the body’s magnesium is in the blood. For this reason, a routine blood test will not inform you of your body’s magnesium status. One test, developed in Israel, calls for blood tests and 24-hour urine samples to be carried out twice at an interval of two weeks.

Phosphorus is the second most abundant mineral in bone after calcium. It works with calcium to form bone and had other functions as well. It is abundant in our daily diets being found in dairy products, poultry, nuts & seeds and grains.

A “kilometer” of prevention...

You can eat the recommended amounts of all of these minerals and vitamins, but… without weight-bearing exercise (like walking and weight training) several times per week, you won’t build and maintain the integrity of your bones. Studies on people who are bedridden, show that with the passing of time, minerals start leaching out of their bones.

Only sticks & stones can break your bones?

So can consuming too much protein, too much sodium and too much phosphorus. When protein is metabolized, it releases acid into the bloodstream. Calcium is drawn out of the bones to neutralize the acid. Studies have shown that the more protein we consume (and we consume too much!), the more calcium we excrete via urine. Sodium also causes calcium to be excreted in urine. It’s no secret that our society consumes too much salt in our diets, 80% of it coming from processed foods. Too much phosphorus can also deplete calcium stores as the body works to maintain the proper calcium to phosphorus ratio, which is about 1.2-2:1. Soft drinks contain large amounts of phosphorus, so keep soft drink consumption minimal.

Testing, testing...

A bone density scan can reveal whether you have osteoporosis and to what degree. Some kupot cholim have begun checking vitamin D status. If you are at risk for vitamin D deficiency, ask if you can be tested.

Risk factors for osteoporosis

Risk factors include factors that cannot control, such as gender, women are more likely to develop osteoporosis than men, age, the older you the more likely you are to lose bone mass, body size—small, thin-boned women are at greater risk and family history of the disease. There are also factors that we may be able to change: low estrogen (for women) or testosterone (for men) level, anorexia nervosa, calcium, vitamin D, magnesium and phosphorus intake, sedentary lifestyle or extended bedrest, cigarette smoking, certain medications (ask your physician if you switch meds) and depression.

You are what you eat... food sources of calcium, vitamin D and magnesium

Recommended sources of calcium include low-fat dairy products, as well as sardines, canned salmon, sesame butter/tehina, almond butter, broccoli and legumes.

Food sources of D include fatty fish, e.g. salmon, mackerel, sardines and egg yolk. If necessary, take a vitamin D supplement.

Often, magnesium is lacking in Western diets containing liberal amounts of processed foods. Good sources of magnesium include: whole grains, leafy, green vegetables, legumes, almonds, peanuts, bananas, fish and tap water.

Too much of a good thing?

The food industry has invested much time and money in developing calcium fortified foods (sometimes adding vitamin D as well). These items are more costly than their non-fortified sister products. Don’t automatically choose these products off the shelves. After reviewing the information here, every consumer must ask him/herself what may be lacking in their eating plan and lifestyle. On the basis of this, one can then form a wise decision about what products to purchase.

Submitted by Tamar Schriger, Clinical dietitian, Certified Adult Educator.