Bone Mass Loss… An area that needs to be addressed in males, younger females and those in the change of life (December 2016)
How many times have you thought that osteoporosis is something that only older women get? We hear our moms, aunts, teachers and grandmothers speak about taking calcium supplements to minimize the chances of developing that condition, but probably never realize that habits during the teenager years could lead to later-in-life development of osteopenia (lower than normal peak bone density) or osteoporosis (bone disease in which too much bone tissue is lost, the body is producing too little bone tissue, or both).
As a certified eating disorder dietitian who specializes in eating disorders and medical conditions I see various types of clients in my practice. It is typical for me to see a male in his twenties with osteoporosis related to a history of an eating disorder, or a young woman in her thirties with osteopenia and osteoporosis resulting from years of dieting, smoking, and insufficient quantities of calcium in her diet. Any of these life-style habits could cause bone loss in both men and women. This insight paper focuses on calcium intake across the lifespan including recommendations for the amounts of calcium to consume. I will also address what can happen to the body when it does not receive the amount of calcium that it should. Other aspects of the lifestyle will be touched on as they impact the bone mass density of individuals.
The teenage years are a crucial time period for bone development. Teens are growing in height and their bone density (or thickness) continues to increase. Research shows that if peak bone mass is achieved during this stage of life, the chances of developing osteoporosis later in life are significantly reduced. It is also important to note that dietary calcium enhances the rate of bone mineral development, i.e. increases bone mass by increasing the availability of the building blocks for bone tissue.
The recommended amount of calcium for teenagers is 1,300 mg/day. Forty-two percent of teenage boys and 13% of teenage girls consume the recommended amounts. But studies also show that teens consume significant amounts of soda, all of which contain phosphoric acid, a compound known to remove calcium from the bone. Caffeine containing sodas, such as cola drinks, also remove calcium from the bones. Research further shows that teens who consume large amounts of soda usually consume small amounts of calcium. A recommendation I would give to parents would be to have calcium as well as vitamin D rich foods available at home. Vitamin D helps the body maximize the absorption of calcium from the foods that are consumed and utilize that calcium in the body. Snack options to have on hand include yogurt, almond milk, edamame (soy beans), and cheese sticks. Dinner options could include sautéed spinach, broccoli, or other green vegetables. It is understood that during the teen years, kids are beginning to be less dependent on their parents and are likely to formulate their own meal/snack options, but having healthful choices available could help them in the long run.
When individuals are in their twenties, bone mass will increase but at a slower rate than during the previous decade. When the twenty-something group begins to live on their own it is not unusual that behaviors evolve such as smoking, drinking, and making food choices that are different from what was available at home. Drinking, smoking, and dieting (for weight loss) in young adults can lead to delayed damage such as bone mass loss later in life. Restaurant options, fast food meals, and food choices available in college cafeterias may not be adequately balanced. The goal is to include some calcium/vitamin D rich foods in the diet and to develop a healthy relationship with food to reduce the risk of delayed problems such as bone mass loss.
The bone mass of the 30-something individual has typically reached its maximum level. At this life-stage, often found to include the beginning of a career, the primary goal needs to be to minimize losing bone mass rather than to build it. Long work hours frequently are accompanied by an increase in caffeine intake which has been found to facilitate the bone loss (aka: urinary calcium losses). The research states that in this age bracket insufficient amounts of vegetables and fruits are consumed. My professional opinion is that as individuals work on getting established in their careers and personal lives, more meals are out at restaurants than at home, making awareness of nutrient content difficult. In addition, they do not seem to be particularly focused on nutrient intake. It would be beneficial for many members of this age category to consider calcium supplementation. Supplementation is especially important when (a) the lifestyle includes consumption of more than 16 ounces of caffeine containing beverages per day, (b) food-intake lacks calcium-rich selections, and (c) very little weight bearing activities, such as Pilates and weight-lifting, are engaged in. Weight-bearing activities help preserve the density of bone tissue.
As you may have guessed bone mass continues to drop in the forties as most people do not keep up their weight bearing and aerobic activities, both of which impact overall bone health. Examples of weight bearing activities are mentioned in the previous paragraph. Aerobic activities include such things as cycling, swimming, and jogging. Recommendations for individuals in their 30s carry over to the decade of the 40s.
Women in their fifties can expect accelerated bone mass loss once they have gone through menopause. For men bone mass had already begun to decrease after age thirty. The calcium recommendation increases from 1,000 mg/day to 1,200 mg/day for both men and women who are in their 50s. It is ideal to obtain our calcium from food as some research questions whether or not calcium supplements slow down bone density loss during this stage of life. In addition, there is research that associates calcium supplements with increased risk of cardiovascular events in women and men over the age of 50. Whether or not to take calcium supplements is a topic that is best discussed with your internist and your cardiologist. My goal is to assist you in reducing the risk of your bone mass diminishing to the point that your skeletal structure resembles Swiss cheese.
In our senior population, age 60 and beyond, the bone density continues to drop gradually in men and steadily in postmenopausal women. As the total bone density decreases there is a high risk for fracture. In other words, as one ages the fracture risk increases. Did you know that 68% of men and 61% of women in their 60s do not meet their recommended daily intake amounts of calcium? Unfortunately, a decrease in protein consumption, often observed in older adults, also increases this risk for bone density loss. Evidence-based recommendations are challenging to make as the research about the nutritional needs for our senior population is not as prolific as it is for other age categories. The good news is that we are seeing an increase in the research focusing on the nutritional needs for the senior population, which will help me make more specialized recommendations in the near future.
It is crucial that we all focus on calcium intake over the course of the lifespan while helping our family-members and friends do the same. In addition, we must not forget the role vitamin D takes in helping our bodies use that calcium. Even though vitamin D is known as the “sunshine vitamin” because our bodies manufacture it while we are exposed to sunshine, there is question as to whether or not we are able to manufacture enough to assure adequate bone health so supplementation might be advisable. All that said, the goal is to avoid weak bones which can be deadly according to National Institutes of Health resources about osteoporosis and related bone diseases. Knowing what to do to avoid that weakness is important no matter what age you are.
- National Institutes of Health, https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
- American Academy of Orthopedic Surgeons, http://orthoinfo.aaos.org/topic.cfm?topic=a00127
- Ross, A. Catherine, “Dietary Reference Intake for Calcium and Vitamin D, Washington DC, National Academies Press (US), 2011.