By Maye Musk, MSc(Dietetics), MSc(Nutritional Sciences), RD(Registered Dietitian)
About the writer….
Maye Musk is a New York City based registered dietitian, Ford model and 61-year-old grandmother of 7. She has had practices in San Francisco, Toronto and Johannesburg.
She is my role model who has taken the field of dietetics and nutrition to newer dimensions.
Thanks Maye for this wonderful article…To know more about Maye Musk, visit her site www.mayemusk.com
To look good and feel young, we need to have a lot of energy and stay healthy. Focusing on good eating and activity habits to prevent ageing diseases like osteoporosis, will keep us walking upright and aging beautifully.
WHAT IS OSTEOPOROSIS?
Osteoporosis is a silent bone disease that leads to loss of bone mass and is widely prevalent in India. Fractures are a common cause of morbidity and mortality in adult Indian men and women.
Hip fractures occur at a relatively earlier age in Indian males and females, compared to western counterparts; and a higher male-to-female ratio suggests that Indian males are at a higher risk for hip fractures. This may be because men seeking hospital attention is greater than that for women.
Up to 50 million Indians may be affected. Low vitamin D level and low calcium intake seem to be the major contributing factor to poor bone health and osteoporosis in India.
Clients come to see me with osteopenia, mild bone loss, out of fear of osteoporosis, a crippling disease resulting in a stooped back and bones that break easily. Besides the cost of this disease, losing independence and lowering quality of life is a concern.
– Bones are built up to maximum strength until age 30
– A bone feels like a rock but it isn’t, it’s living tissue. The body is continuously making new bone and replacing old bone. We need to give the body a constant supply of bone-building calcium to prevent bone loss.
– There is high prevalence of vitamin D deficiency in the Indian population despite the availability of abundant sunshine. This includes urban and semi-urban Indians, postmenopausal women, pregnant women, school children and newborns. Studies have shown that the majority of urban office workers and hospital staff have moderate to severe vitamin D deficiency.
– In a US study, the fracture rate in women with low bone density was nearly double that of women with normal bones, and four times higher in women with osteoporosis.
– In the USA, the incidence of osteoporosis is higher with women (25 – 30%) than with men (12 – 15%). Higher consumption of fruits, vegetables and cereals was associated with greater femoral bone mineral density in men in a study of 907 adults aged 69-93 years old.
– Family history: Genetics play a role as body types run in families.
– Frame: small and thin. Indians have low bone mineral density as compared to western Caucasians, which could be attributed to differences in skeletal size.
– Age: older people are at higher risk for fractures.
– Race: Caucasian of northern European descent and Asians are at higher risk.
– Menopause: After menopause, estrogen falls to the point where women can’t absorb enough calcium to replace the bone they naturally lose. A little plumpness after menopause increases estrogen levels and is good for her bones. Just a few extra pounds….
– Poor diet: Low calcium intake: This is the main mineral that builds up bone density. Other nutrient deficiencies increase the risk for osteoporosis such as vitamin D, magnesium, manganese, Vitamin K and boron.
– Anorexia: leads to low estrogen production and increased bone loss.
– High protein intake: High-protein foods tend to be high in phosphorus, a mineral that depletes calcium out of the bone. The more phosphorus you consume, the more calcium you need to maintain your bone mineral density.
– Soda: these beverages contain phosphorus. Also, soda replaces milk.
– Vegans (people who eat no animal products at all): As calcium in milk and dairy products is better absorbed than calcium found in vegetables or supplements, strict vegetarian diets containing no milk may increase risk.
– Certain vegetable compounds: The oxalates in spinach and sweet potatoes and phytates in legumes and grains decrease the absorption of calcium. These foods should be included in the diet as they contain some calcium which counteracts these compounds.
– Salt: a high salt intake increases loss of calcium in the urine.
– Coffee: More than two cups a day can decrease bone density in older women. Be sure to add milk or drink a café latte.
– Alcohol: maximum one serving a day.
– Excess Vitamin A supplementation.
– Smoking depletes minerals from bone and decreases bone-preserving estrogen in blood.
– Sedentary lifestyle.
– Drugs can rob the bones of calcium. These include: cortisone, prednisone, thyroid hormones, anticonvulsants and aluminum-based antacids.
You cannot change your sex, race, build and age, but you can change your eating habits and activity.
Healthy lifestyle (diet, exercise and sunlight exposure) can have a major positive impact on the bone metabolism and bone health of Indians. These public health measures are recommended for the population at large as they are efficacious, safe and cost-effective.
Plan daily intake of calcium-rich foods. See a registered dietitian for a healthy meal plan.
– Milk (including skim milk and 1% milk) is the best. Milk contains lactose and is enriched with vitamin D; both nutrients help with the absorption of calcium. Many people who have trouble digesting lactose can drink one or two servings of milk with solid food and not have problems. A recent study showed that women over 65 reduced bone loss by 12 to 25% over 2 years if they received adequate calcium intake.
– Cheese, fortified cottage cheese and yogurt are also good sources of calcium. Low fat options contain the same amount of calcium as high fat types.
– Canned salmon and sardines with bones.
– Calcium fortified orange juice
– Collards, turnip greens, rhubarb, broccoli, kale, oranges, almonds contain calcium.
– Vitamin D: in fortified milk, eggs, salmon and sardines with bones, cheese, fortified margarine and fortified breakfast cereals.
– Sun: although it’s best to keep out of the sun, a little can supply the essential vitamin D. Expose sun to hands, face and arms three times a week for 5 – 15 minutes before sunscreen is applied. That should be adequate as 80 – 90% of vitamin D comes from exposure to sunlight.
– Magnesium: seeds, soybeans, wheat germ, seafood.
– Manganese: nuts, avocados, oatmeal.
– Vitamin K: spinach, broccoli, green cabbage, tomatoes.
-Boron: applesauce, peaches, pears, cherries.
– Omega 3 fats: salmon, sardines, walnuts. Saturated fats can influence bone density negatively
– Soy protein and its isoflavones, genistein and daidzein: soy-type foods three times a week: edamame, soy burgers, miso soup, calcium-fortified tofu.
– Lower salt, soda, caffeine and alcohol intake.
Activity (important for bone strength)
– Walk or exercise every day for a 30 – 60 minutes.
– Swimming strengthens muscles and gives a good stretch.
– Stretching exercises to move joints.
– Weight-bearing exercises have been proven to prevent bone loss.
As a public health measure, it is important to encourage children to drink
milk and play in the sun. This will ensure adequate calcium intake, vitamin D synthesis, and exercise. These three are the crucial elements in determining peak bone mass. There is thus an urgent need for greater public awareness in this regard. The peak bone mass of the population can be increased significantly by appropriate and timely intervention in children.
See your dietitian before buying a supplement. A diet rich in bone-producing nutrients is your best choice.
Do I take supplements?
I’m Caucasian, 61 years old and grandmother of 7, and am not on estrogen replacement therapy.
I don’t take any calcium supplements because I love dairy foods: milk in my breakfast cereal and yogurt and cottage cheese during the day. I eat well most of the time, am active nearly every day, have never smoked, and have a moderate intake of caffeine and alcohol. My mother (95) started with osteoporosis three years ago so I plan to stay on track.
Your doctor will advise you on drugs after measuring bone mineral density, particularly in postmenopausal women who have had fractures or a family history of osteoporosis.
For the middle aged and elderly, early detection and treatment of osteoporosis with available agents can significantly reduce the risk of fractures and associated morbidity and mortality.
In India, and elsewhere, pharmacological interventions are expensive and should therefore be targeted to only those at high risk of fractures.
We need to eat well and be active. See a Registered Dietitian for your healthy, personalized meal and activity plan.
 Natl Med J India. 1996 Nov-Dec;9(6):268-74.Links Osteoporosis in India–the nutritional hypothesis. A. Gupta
 Indian J Med Res 127, March 2008, pp 263-268. Osteoporosis in Indians. N. Malhotra & A. Mithal
 Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study. Am J Clin Nutr 2002;76(1):245-252