If you're over 50, chances are you've heard about osteoporosis - the bone-thinning disease that increases the risk of fractures, particularly of the hip, spine and wrist.
It's estimated that 1.4 million Canadians, including one in four women and at least one in eight men aged 50 and older, have the disease.
According to a recent survey conducted by Ipsos Reid on behalf of Osteoporosis Canada, almost 90 per cent of Canadians over 50 know about osteoporosis, but only 30 per cent have been tested for the disease.
And while more than half of respondents were aware a lack of calcium and exercise were risk factors, far fewer could identify adequate vitamin D, a healthy diet and taking supplements as risk-reduction strategies.
It seems the issue is not making Canadians aware of osteoporosis, but getting those at risk to adopt habits to keep their bones strong.
Major risk factors for osteoporosis include being 65 or older, suffering a fracture after age 40, a family history of hip fractures, early menopause, having a medical condition that inhibits nutrient absorption (such as celiac disease or Crohn's disease), and long-term use of steroid medications such as prednisone.
When it comes to diet, too little calcium and vitamin D, excess caffeine and alcohol, and being underweight can also boost risk.
If you're at risk for osteoporosis, a bone mineral density test will tell you whether or not you have the condition and how likely you are to develop it in the future.
Osteoporosis affects mainly older adults, but it can strike at any age. It's never too late - or too early - to implement nutritional strategies that can prevent bone loss and fractures. As you'll see, it takes more than calcium to guard against osteoporosis.
CALCIUM
If your diet lacks calcium, the mineral will be moved from your bones into your bloodstream, where it's needed to conduct nerve impulses, contract muscles, assist in blood clotting and secrete hormones.
Adults aged 19 to 50 need 1,000 milligrams a day, while older adults need 1,500 milligrams. One cup (250 millilitres) of milk or fortified soy beverage, ¾cup (175 ml) plain yogurt or 1.5 ounces (45 grams) of cheese delivers roughly 300 milligrams of calcium. Almonds, leafy greens, canned salmon (with bones) and tofu also supply calcium.
If you aren't getting what you need from diet, make up the difference by taking a calcium supplement. If you need to take more than one calcium pill, divide your dose over the course of the day.
VITAMIN D
This nutrient maintains calcium balance in the bloodstream by enhancing calcium absorption from the foods you eat. Recent studies indicate that Canadians of all ages - even children - have insufficient levels of vitamin D because of our long winters and lack of sun exposure. (The body can synthesize vitamin D from the sun's ultraviolet rays.) Osteoporosis Canada recommends adults aged 19 to 50 get 400 international units of vitamin D each day and adults over 50 consume 800 IU. (The Canadian Cancer Society advises adults consider taking 1,000 IU of the nutrient in the fall and winter to help reduce cancer risk.)
Foods fortified with vitamin D include milk, soy and rice beverages (100 IU per 250 ml). Vitamin D is naturally present in oily fish, liver, egg yolks and butter. A 3.5-ounce (100-gram) serving of salmon has 360 IU of vitamin D; the same portion of sardines has 270 IU.
Because vitamin D is found in only a few foods - and our skin doesn't produce any in winter - get your daily vitamin D from supplements - a multivitamin, calcium pills and/or a separate vitamin D pill (Vitamin D3 comes in 400, 800, and 1,000 IU doses).
MAGNESIUM
The fact that one-half of the body's magnesium is stored in our skeleton underscores its importance in bone health. In a recent study, older men and women who consumed more magnesium had significantly higher bone densities than those whose diets contained the least. A lack of magnesium is thought to impair the production of hormones involved in calcium balance.
The daily recommended intake for magnesium is 320 milligrams for women and 420 milligrams for men - an amount that many people don't get from their diet.
The best food sources include wheat germ, whole grain breads and cereals, almonds, sunflower seeds, black beans, soybeans, tofu and figs.
VITAMIN K
Best known for its ability to help the blood clot, vitamin K also stimulates the production of osteoclacin, a protein that strengthens bone. Research suggests that an intake of 150 to 250 micrograms per day guards against hip fracture in women.
The recommended daily intake for vitamin K is 90 and 120 micrograms, for women and men respectively. (Scientists suspect it takes about 200 micrograms daily to protect the bones.) The best food sources include leafy greens, cabbage and milk. Some multivitamins contain up to 120 micrograms.
PROTEIN
By maintaining the structural integrity of bone, consuming enough protein may help reduce the risk of hip fracture. Research even suggests that extra protein - 20 grams daily - can help speed recovery from hip fracture. Include a serving of protein at each meal. Food sources include poultry, fish, lean meat, eggs, legumes, nuts, soy foods and dairy products.
Leslie Beck, a Toronto-based
dietitian at the Medcan Clinic,
is on CTV's Canada AM every Wednesday. Visit her website
at lesliebeck.com.
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Less is best
It's not just what you eat that keeps your bones strong as you age. What you don't eat can also play a role in osteoporosis prevention.
CAFFEINE
Caffeine's bone-depleting effects are probably most detrimental for people who don't get enough calcium. Limit your daily intake to no more than 400 milligrams of caffeine - about three small cups (8 ounces each) of brewed coffee or 9 cups of tea.
SODIUM
Like caffeine, sodium also causes your kidneys to excrete calcium. Limit your daily intake to no more than 2,300 milligrams (one teaspoon of table salt). Eating potassium-rich foods such as fruits and vegetables can help offset the calcium-depleting effect of sodium.
ALCOHOL
Consuming alcohol acts directly on your bones and suppresses bone formation.
VITAMIN A
While we need some vitamin A for bone health, too much may increase the risk of hip fracture. Studies show that consuming more than 5,000 IU of retinol, the form of vitamin A in meat and dairy products, fortified foods and supplements, increases the risk of hip fracture.
Unless you eat liver regularly - or drink more than 5 cups of milk each day - it's unlikely you'll get too much vitamin A from foods. The concern rests with supplements. Make sure your multivitamin contains no more than 2,500 IU of vitamin A. Beta-carotene (which the body turns some into vitamin A) does not increase fracture risk.
Leslie Beck