Avoiding an osteoporosis epidemic
Checkup On Health
By Dayna Green-Burgeson, R.D, CDE
Everyone knows that osteoporosis, a disease of bone loss that leads to debilitating fractures, is a common problem in the elderly. But could it be considered a childhood disease? An increasing number of experts are answering with a resounding “yes.”
Dayna Green-Burgeson is a registered dietitian and certified diabetes educator with UC Davis Medical Group.
Doctors are not actually seeing children with signs of osteoporosis. They do, however, fear that the disease will reach epidemic proportions when today’s youngsters reach middle age.
Why? Over the past 20 years, studies have shown that kids in the U.S. are drinking increasing amounts of sodas and fruit juice and less milk. And while other foods contain calcium and vitamin D, which are so important to building strong bones, few deliver as much as a glass of milk.
What is calcium?
Calcium is essential for many purposes, including tooth formation and proper nerve and muscle functioning. Under normal circumstances, we maintain a certain level of calcium in our bloodstream no matter what our intake. Extra calcium is banked in bones, to be used when needed.
Most women know that precautions must be taken at menopause to protect against calcium loss and bone weakening. Many take medications to prevent loss and further boost their calcium intake with supplements. But few parents realize that children need to consume enough calcium while they are building bones to ensure a strong skeletal system.
How much calcium is enough?
Most people can get adequate calcium from their diet. While a few servings of dairy products are the easiest way of ensuring you’ll reach your daily requirements, other foods can help too.
How much is enough? Infants under 12 months old should be fed breast milk and need no special calcium supplementation. Children from 1 to 3 years old need 700 mg per day, and children from 4 to 8 years need 1,000 mg. Nine- to 18-year-olds need a hefty 1,300 mg.
Adults need 1,000 mg until after age 50. Women need 1,200 mg per day thereafter, while men need 1,000 mg per day until age 70, and 1,200 mg per day after that.
Most people can get adequate calcium from their diet. An 8-ounce glass of milk provides about 300 mg, and the same amount of yogurt can provide even more. Most cheese packs 200 mg per ounce.
While a few servings of these dairy products are the easiest way of ensuring you’ll reach your daily requirements, other foods can help too. Calcium-fortified orange juice is now available, as well as some brands of soy milk, tofu and non-dairy milk substitutes. Some fortified breakfast cereals can have high amount of calcium as well. Read the label, because amounts vary.
Other high sources are fish canned with bones, such as salmon and sardines. Spinach, broccoli, kale, soybeans, almonds and cooked dry beans also provide more moderate amounts.
Due to variability in natural production we are finding that many Americans are at risk of vitamin D deficiency, especially breast fed infants, the elderly, people with limited sun exposure, people with dark skin and people who are obese.
I advise parents to think of creative ways to slip more calcium into their children’s daily routine. Instead of packing a fruit juice box or pouch for lunch, consider lunchbox-size cartons of milk. Most school cafeterias allow kids to buy plain or chocolate milk, even if they have not ordered school lunch. Pudding or a packet of string cheese are other convenient, high-calcium lunch-box items.
Think about adding extra milk while cooking:
- Toss several spoonfuls of nonfat, powdered milk into tomato sauces, casseroles, mashed potatoes and pancake batter.
- Use milk instead of water when preparing oatmeal, bread or pizza dough, canned or packaged cream soups and sauces, and rice dishes.
- Sprinkle cheese on steamed vegetables, or make a cheesy dipping sauce for fresh veggie sticks.
- Most kids enjoy a snack of a freshly blended drink, made with combinations of their favorite fruits mixed with yogurt, milk or calcium-fortified soy milk.
Vitamin D and exercise also essential
Vitamin D is very important for bone health as well. Vitamin D is formed when skin is exposed to the sun, so most people get at least some of their vitamin D through this source. However the season of the year, the time of day, the length of day, cloud cover, skin color and use of sunscreen are all factors that may influence vitamin D production by the skin.
In addition, sun exposure through glass does not promote vitamin D production. Older adults may have reduced production of vitamin D by their skin.
Due to variability in natural production we are finding that many Americans are at risk of vitamin D deficiency, especially breast fed infants, the elderly, people with limited sun exposure, people with dark skin and people who are obese. Recently, the recommended requirements for vitamin D were raised due to increasing risk of deficiency in the US.
- Vitamin D is very low in most foods. Fatty fish are one of the few natural sources of vitamin D.
- Some foods that are supplemented with calcium also are supplemented with vitamin D.
- Although milk is always supplemented with vitamin D in the U.S., cheese, yogurt and other milk products are often not supplemented.
- Breast-fed infants should always be supplemented with vitamin D, and those in the high risk groups who do not drink milk may want to consider a supplement.
The new minimum vitamin D requirements are 600 international units or “IUs” for those under 70 years of age, and 800 units for those above 70 years of age.
Weight-bearing exercise is also essential in building strong bones. Many kids run around daily during school recess, but I also encourage families to make exercise, such as playing ball or taking walks, a part of their daily routines. Limiting screen time (TV and computer/video games) is another way to promote increased physical activity.
Households with carbonated sodas, juices and sports beverages on hand are also at special risk. Kids and teens tend to reach for these nutrient-poor drinks instead of milk.
Parents should take special precautions with adolescent daughters who are very athletic or who diet to the point of extreme thinness. If such behavior results in delayed or irregular menstruation, bone building may be affected. In such cases, I recommend consultation with a dietitian to ensure that adequate calories and nutrients are being met.
Households with carbonated sodas, juices and sports beverages on hand are also at special risk. Kids and teens tend to reach for these nutrient-poor drinks instead of milk. Consider serving milk as the beverage of choice with meals and snacks.
The traditional graham crackers with milk for an after school snack, or the occasional bedtime treat of an oatmeal cookie with milk, makes a wonderful calcium-rich experience that will build good memories — and bones — as your kids enter adulthood.