Osteoporosis Prevention throughout the Lifespan
Although fractures due to thinning bones are rare before age 65, the risk of this common and often debilitating condition is heavily influenced by choices we make decades earlier. Each phase of life offers a unique set of challenges and opportunities to maximize bone density or minimize bone loss.
Even as teens approach their mature height, bone density and thickness continue to increase. Maximizing bone mineral acquisition early in life increases lifetime peak bone mass and reduces the risk of osteoporosis in later years; calcium enhances the rate of bone mineral acquisition by providing more of the material of which bones are made.
Unfortunately, only 42 percent of teenage boys and 13 percent of teenage girls get the recommended daily intake of 1,300 milligrams per day of calcium.
In the past, studies reported an inverse correlation between soda consumption and bone mass, leading many to hypothesize that phosphoric acid or other components of soda (such as caffeine) may rob bones of calcium. Subsequent research suggests the negative effect on bone density is more likely due to the fact that teens who drink more soda also consume less calcium.
Recommendation: Make the most of the rapid-rate bone formation throughout teen years by prioritizing foods rich in calcium and vitamin D.
Bone mass continues to increase but the rate of bone acquisition begins to slow. Research has found that white women may reach their peak lifetime bone mass up to five years sooner than non-white women and men.
Young adults are often living on their own for the first time and are more likely to engage in behaviors such as binge drinking and social smoking, both of which can have a lasting and detrimental impact on bone health.
Extreme dieting and other disordered eating patterns also are common at this age, especially in women. Weight loss leads to bone loss, and a history of repeated weight loss, such as yo-yo dieting, has been shown to have negative consequences on bone density later in life.
Recommendation: Continue to prioritize adequate calcium and vitamin D intake and avoid behaviors such as smoking, excessive drinking and yo-yo dieting, which rob the bones of minerals.
By the early 30s, bone density has typically reached its maximum level. Osteoporosis prevention shifts from maximizing bone acquisition to maintaining strong bones.
Caffeine consumption typically increases throughout adulthood and is known to increase urinary calcium losses. The effect is relatively modest, however; a cup of coffee may result in the loss of 2 to 3 milligrams of calcium. As long as calcium intake is adequate, the effect on bone density appears to be minimal.
Epidemiological surveys also report a positive association between fruit and vegetable consumption and bone health later in life. Unfortunately, those in their 30s consume less produce than any other age group.
Recommendation: Focus on eating more fruits and vegetables as part of a balanced diet. Heavy caffeine consumers should take extra care to ensure adequate calcium consumption.
Total body bone density continues its gradual decline in both men and women throughout this decade. Weight-bearing exercise, which includes walking, jogging, tennis, hiking and strength training (but not swimming or biking), is one of the best ways to preserve bone mass.
Although the percentage of Americans who exercise regularly has increased over the last decade, only one in four men and one in five women in their 40s get the recommended amount of exercise.
Typical sodium consumption for Americans in their 40s is about 3,800 milligrams per day, which is 65 percent higher than the recommended daily consumption of 2,300 milligrams per day. In addition to increasing the risk of hypertension, high-sodium diets also increase urinary calcium excretion.
Recommendations: Develop or maintain a regular exercise habit, and be mindful of sodium consumption. Increase intake of fruits, vegetables and calcium-rich foods to mitigate the effects of sodium on blood pressure and bones.
Although bone mass may decline gradually in both men and women after the early 30s, the rate of bone loss begins to accelerate dramatically when women reach menopause. The recommended daily intake of calcium for adults over 50 increases from 1,000 milligrams per day to 1,200 milligrams.
Not surprisingly, women older than 50 are more likely than men or younger women to take calcium supplements, but several recent studies have found supplementation is of questionable benefit.
Other researchers have noted an association between calcium supplementation and increased risk of cardiovascular events in men and women over the age of 50.
Recommendation: Get as much calcium as possible from foods rather than supplements. Leafy greens, such as kale and collards, are good sources of calcium and are rich in vitamin K, which helps move calcium out of the arteries and into the bones. However, some greens (particularly spinach and beet greens) also are high in oxalates, which can bind to calcium. Oxalates can be significantly reduced by cooking.
Bone density continues to decline gradually in men and resumes a more gradual decline in postmenopausal women. As total bone density decreases, fracture rate increases, but fracture risk also increases with age, independent of bone density. A 65-year-old woman is at greater risk of fracture than a 45-year-old woman with the same bone density.
Sixty-eight percent of men and 61 percent of women in their 60s fail to get the recommended daily amounts of calcium. Declining protein consumption among older adults also may contribute to bone density loss.
Although protein consumption can increase urinary calcium excretion, it also increases absorption of calcium from the gut. A prospective study of healthy men and women in their 60s found that higher protein intake was associated with higher bone density and that supplementation with calcium provided no bone benefit in those with low protein consumption.
Recommendations: Increasing protein consumption can help preserve bone density and muscle mass. Develop an exercise routine that includes activities to improve balance and flexibility.
Seventies and Beyond
Age-related osteoporosis occurs at approximately 70 years old and beyond. One in five women have osteoporosis by age 70; by age 90, it’s one out of every three.
Although men never completely "catch up" with women in terms of osteoporosis risk, those living into their 80s and 90s are increasingly likely to be affected.
Elderly men and women who consume more protein have a reduced rate of bone loss. Vitamin D deficiency, which accelerates bone loss, affects 80 percent of those older than 70.
Recommendations: Although calorie needs decline with age, protein requirements do not. Be sure to keep protein intake up, even as total food consumption diminishes. A vitamin D supplement may be necessary to maintain adequate levels.
Monica Reinagel, MS, LD/N, CNS, is the author of Nutrition Diva's Secrets for a Healthy Diet: What to Eat, What to Avoid, and What to Stop Worrying About (St. Martin’s Griffin 2011).