1. Building & Keeping Strong Bones Adult Women The University of Georgia Cooperative Extension Service

2. Building Bones Building bones = building a bank account Calcium is “deposited” During childhood, teen & young adult years When consume enough calcium & vitamin D Calcium is “withdrawn” During older adult years When do not consume enough calcium & vitamin D

3. Calcium & Vitamin D Matter at Any Age Children For bone growth Teens and young adults For bone growth Maximizing bone mass Adults Maximizing bone mass Minimizing bone loss

4. What Is Osteoporosis? Porous bones Bones have lost calcium and other minerals Bones are fragile Bones fracture easily

5. Bone Structure Normal Bone Osteoporotic bone National Osteoporosis Foundation, http://www.nof.org/osteoporosis/bonehealth.htm

6. Risk Factors Female gender Increasing age Thin, small-boned - BMI < 19 Caucasian or Asian ethnicity Family history of fractures or osteoporosis

7. Risk Factors Abnormal menstrual history Late menarche Menstrual interruptions/irregularities Early menopause (< age 45) Have had an eating disorder or times of strict dieting

8. Risk Factors Medical conditions Bone fracture(s) after age 40 Rheumatoid arthritis Thyroid disorder Parathyroid disorder Poorly controlled Type 1 diabetes Lactose intolerance Digestion disorders

9. Risk Factors Medication use Long-term steroid use High doses thyroid hormone Anti-seizure or epilepsy medications Certain diuretics Excessive aluminum-containing antacids Gonadotrophin-releasing hormone agonist

10. Lifestyle Risk Factors Inactive lifestyle Diet low in calcium Little sun exposure and diet low in vitamin D Consume few fruits and vegetables Drink excess alcohol (> 7 drinks/week) Current or former smoker Consume large amounts of caffeine

11. 5 Steps to Strong Bones Avoid harmful habits BMD testing & medications Active lifestyle Regular sunshine Healthy diet

12. Step 1: Eat a Healthy Diet for Bones Diet rich in calcium & vitamin D 3 or more servings milk/dairy foods Calcium-fortified foods Calcium/vitamin D supplements Foods rich in other bone healthy nutrients 5 or more servings vegetables & fruits Potassium, magnesium, zinc, copper Vitamin K & vitamin C

13. Calcium & Vitamin D Recommendations 19 - 50 years 1,000 mg calcium 200 IU vitamin D 51 - 70 years 1,200 mg calcium 400 IU vitamin D Amounts supplied by 8 ounces milk 300 mg calcium 100 IU vitamin D

14. Choose Calcium-rich Foods Milk, yogurt, buttermilk, ricotta cheese, hard cheeses Calcium-fortified foods Orange juice, soy drinks Breakfast cereals, cereal bars Tofu made w/ calcium sulfate Canned salmon w/bones

15. Include Foods = 1/2 Calcium- rich Source 2 servings = 1 calcium-rich food 1/2 cup pudding 1/2 cup frozen yogurt or ice cream 1/2 cup mustard or turnip greens 1/2 cup cooked rhubarb 1/3 cup almonds 1 piece cornbread

16. Include Foods = 1/4 Calcium- rich Source 4 servings = 1 calcium-rich food 1/2 cup cottage cheese 1/2 cup broccoli, kale, or okra 1 cup romaine lettuce 1/2 cup cooked beans 1 medium orange 2 dried figs 3 oz fresh fish or seafood 1/2 English muffin

17. Calcium Check Up How many servings do you eat? Calcium-rich foods Servings x 1 = 1/2 calcium-rich foods Servings ÷ 2 = 1/4 calcium-rich foods Servings ÷ 4 = Are you getting enough calcium? Is your total = 3 or 4?

18. Do You Need Calcium/vitamin D Supplements? Lactose intolerant or allergic to milk? Avoid milk/dairy foods? On a strict weight-loss diet? Over age 50, consume little milk and/or do not get sun exposure? On long-term steroid therapy?

19. Upper Limits Calcium: 2500 mg/day Vitamin D: 2000 IU/day National Academy of Sciences 1997

20. Vitamin D Two sources Diet Fluid milk Fatty seafood, fish oils, eggs Other fortified foods, supplements Regular sunlight exposure Skin produces own vitamin D

21. Step 2: Get Regular Sun Exposure Helps you meet vitamin D needs Expose arms and/or legs for 10 - 15 minutes daily, without sunscreen Apply sunscreen after this time

22. Step 3: Maintain An Active Lifestyle Regular weight-bearing exercises Strength-training exercises Balance & stretching exercises

23. Weight-bearing Exercises 30 minutes daily, > 3 times weekly Walking, running or jogging Stair climbing, jumping rope, skating Aerobics, tennis Basketball, soccer, volleyball

24. Strength Training Exercises 2 times weekly Lifting weights Dumbbells (free weights), weight machines Resistance exercises Push ups, leg lifts Stomach curls/crunches Standing calf & toe raises Squats, lunges

25. Balance & Stretching Exercises 3 times weekly (or every day) Improve balance & flexibility Help reduce risk of falling Do stretches after other exercise

26. Step 4: Get a Bone Mineral Density (BMD) Test Men/women with signs of osteoporosis Fractures, chronic back pain Loss of height, humped back Men/women with significant risk factors Women who had early menopause & have other risk factors Women considering medication therapy to help BMD

27. Take Medication If Needed Calcium/vitamin D supplements Hormone replacement therapies Bisphosphonates Alendronate (Fosamax ® ) Risedronate (Actonel ® ) Calcitonin (Miacalcin ® ) Parathyroid hormone (PTH)

28. Avoid Harmful Habits Smoking Strict dieting Heavy drinking (alcohol) High caffeine consumption Diet low in calcium and vitamin D Inactive lifestyle

29. It’s Up To You! What are you going to do to have strong bones for a lifetime?

30. Thank You. Prepared by Marilyn O. Wright, MS, RD, LD Family Nutrition Program Specialist University of Georgia College of Family & Consumer Sciences Cooperative Extension Service

31. References Nelson, M.E. (2000) Strong Women, Strong Bones. Berkley Publishing Group (Perigee), New York. http://www.strongwomen.comhttp://www.strongwomen.com Nelson, M.E. (1997) Strong Women Stay Young. Bantam, New York. National Academy of Science Institute of Medicine (1999) Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D & Fluoride. National Academy Press, Washington, D.C. http://www.nap.edu/catalog/5776.htmlhttp://www.nap.edu/catalog/5776.html National Osteoporosis Foundation, http://www.nof.org/http://www.nof.org/ NIH Osteoporosis & Related Bone Disease National Resource Center, http://www.osteo.org/ http://www.osteo.org/ Duyff, R.L. (1996) The American Dietetic Association’s Complete Food & Nutrition Guide. Chronimed, Minneapolis. USDA Nutrient Data Laboratory, http://www.nal.usda.gov/fnic/foodcomp/http://www.nal.usda.gov/fnic/foodcomp/ Picado, C., & Luengo, M. (1996) Corticosteroid-induced bone loss. Prevention & management. Drug Saf, 15(5): 347-59.