Osteoporosis Prevention: Keeping Your Bones Healthy

Osteroporosis is a disease that affects your bones. The condition is caused by low bone mass and the weakening of bone, which can lead to broken bones (fractures). Calcium and vitamin D help keep your bones healthy. If you don’t get enough calcium from the food you eat, your body will take calcium out of your bones to get the amount that it needs. Vitamin D helps promote absorption of the calcium you eat and helps form and maintain strong bones. If you don’t get enough vitamin D, you can lose bone density because your body is not able to absorb all the calcium that it needs.

Building Strong Bones: Getting Enough Calcium and Vitamin D

Calcium is required to build healthy bones and teeth and helps your heart, muscles and nerves work properly while vitamin D helps your body absorb calcium. The amount of calcium and vitamin D that you need depends on your age, your health and how much you get from the foods you eat.

Age	Recommended Calcium Intake	Recommended Vitamin D Intake
Men and Women aged 19-50	1 000 mg	600 IU
Men aged 51-70	1 000 mg	600 IU
Women aged 51-70	1 200 mg	600 IU
Men and Women aged 71 and older	1 200 mg	800 IU

Osteoporosis Supplements: Meeting Calcium and Vitamin D Requirements

Understanding Calcium

It is best to get as much of your calcium intake as possible through food, avoiding large doses of calcium supplements. Subtract the amount of calcium you get daily in food from the calcium requirement recommended for your age. You will need to increase your intake through food and/or supplements by this amount.

Calcium in foods varies. In general, 2-3 servings of dairy products, liberal use of green vegetables and regular use of calcium-fortified foods like orange juice, soy products and breakfast cereals as well as eating a varied diet based on Canada’s Food Guide can provide enough calcium to meet daily requirements.

Calcium Sources

Calcium needs can be met using various calcium-rich food sources.

Dairy sources of calcium include: cheese, milk, yogurt and kefir (fermented milk product)
Non-dairy sources of calcium include: calcium-fortified beverages (soy milk, rice milk, almond milk, orange juice), canned fish with bones, tofu made with calcium sulfate, leafy green vegetables, beans, nuts and seeds

Understanding Vitamin D

Vitamin D can be found in food sources and can be made in the skin when it is exposed to sunlight. In most of Canada, from April through September, 10-15 minutes of sun exposure at least twice weekly (exposure to arms, hands, face or back without sunscreen) will allow your body to make as much vitamin D as it needs.

You may need to take a vitamin D supplement all year long due to a variety of factors including:

Limited amount of foods containing vitamin D
Limited sun exposure due to sunscreen use and other forms of sun protectione
Lack of sun exposure from October to March due to our geographical location in Canada

Vitamin D Sources

Vitamin D is found in limited food sources. However, it can be found in fatty fish (e.g. salmon, tuna, sardines and mackerel), egg yolks, beef liver, soft margarine, cow’s milk and vitamin D-fortified beverages (e.g. soy milk, almond milk, orange juice).

Calcium and Vitamin D Supplements

If you find it difficult to meet your calcium and vitamin D needs from food alone, you may benefit from a supplement.

Calcium Supplements

There are two main types of calcium supplements:

Calcium carbonate: taken with meals because it is best absorbed with food.
Calcium citrate: can be taken at any time and is easier to digest than calcium carbonate

Spreading calcium supplements out over the course of the day can reduce stomach upset and helps your body absorb the calcium better. Don't consume more than 500mg - 600mg of calcium at a time to maximize your calcium absorption from the supplement and reduce the chance of side effects. Calcium supplements are available in many forms such as pills, chewable tablets and liquids.

When choosing a calcium supplement:

Look for the amount of “elemental” calcium in each tablet. Elemental calcium is the amount of calcium that is available for your body to absorb. For example, a 1250mg tablet of calcium carbonate contains 500mg of elemental calcium.
Check for a Natural Product Number (NPN). This means that the product has been assessed by Health Canada and is considered safe, effective and of high quality.

Vitamin D Supplements

It is recommended that adults over age 50 take a vitamin D supplement of 400 IU daily. The most common kind of vitamin D found in supplements in Canada is cholecalciferol (D3). Vitamin D supplements are sold over the counter in various forms such as pills, chewable tablets and drops. Adults with osteopenia and osteoporosis should have their vitamin D levels checked by their doctor to help determine if a vitamin D supplement is needed.

The amount of calcium and vitamin D you get every day from all sources (diet and supplements) should not be more than the upper level intake shown in the table below. Be careful not to take more than you need.

Age	Upper Level Calcium Intake	Upper Level Vitamin D Intake
Men and Women aged 19-50	2 500 mg	4 000 IU
Men and Women aged 51 and older	2 000 mg	4 000 IU

Understanding Nutrition Labelling

When reading a nutrition label, consider the following:

Look at the reference serving size on the package (under the Nutrition Facts title) and calculate the amount of any nutrient on the label (e.g. sodium) by comparing it to the amount you are actually eating.
Example: If you look on a nutrition label and the reference serving size is 30g and the label indicates that serving size contains 125mg of sodium, eating 60g will mean you consume 250mg of sodium (125mg per serving x 2 servings).
% Daily Value (% DV) classifies nutrients on a scale from 0% to 100% and tells you if there is a little (5% DV or less) or a lot of a nutrient (15% DV or more) in one serving of a packaged food. You can also use this percentage to compare the nutrient content of different foods.
Choose products with high % DV of calcium per reference serving size.
The % DV of calcium is based on a reference daily value of 1100mg, so if the calcium % DV of a product is 23%, the amount of calcium per serving is about 250mg (1100 x 23% = 253mg).

Nutrition Tips To Manage Osteoporosis

Choose milk, calcium-fortified beverages or soy beverages as a beverage at meals
Shake all calcium-fortified beverages, such as orange juice and soy beverages, prior to consumption
Add chickpeas, beans such as kidney and navy beans, almonds or sesame seeds to salads and soups
Add canned salmon, including the bones, to sandwiches and salads
Use yogurt as a base for dips, spreads or dressings
Make soups with milk instead of water
Make a smoothie for breakfast or a snack using yogurt, milk or a soy beverage and mix with fresh or frozen fruit and ice

Healthy Behaviours to Manage Osteoporosis

Physical Activity

Regular physical activity is a key element for maintaining strong bones and good health. Everyone should aim for 150 minutes of moderate to vigorous activity each week. This amount is equal to 30 minutes of activity at least 5 days per week. Moderate intensity activities include: brisk walking, biking and gardening. Vigorous intensity activities include: jogging, cross-country skiing and aerobics.

Tips for maximizing your benefits from physical activity:

Pick an activity that you enjoy
Join an exercise class or plan regular activities with friends
Aim for a variety of physical activities that improve: endurance (walking, tennis), strength (lifting or weight bearing activities), flexibility (house work, golf) and balance (yoga, dance)

Limit Caffeine and Sodium Intake

Both caffeine and sodium, if consumed in excess, can reduce the strength of your bones.

Limit caffeine from all sources (coffee, tea, colas, energy drinks) to 400mg per day, the amount found in 4 small cups of coffee (8 oz each)
Limit your sodium intake from all sources to less than 2300mg per day

Limit Alcohol Consumption

Excess alcohol consumption is associated with health risks. Canada’s low-risk alcohol drinking guidelines provide limits to support a healthy lifestyle.

The guidelines are as follows:

Aim to limit alcohol to no more than 2 drinks per week
Visit Canada’s Guidance on Alcohol and Health for more information

Looking for more information?

With an abundance of health information available on the internet, it is important to look for reliable sources that provide accurate information. For further information on osteoporosis, review the following resources or speak with your healthcare provider.

Osteoporosis Canada: osteoporosis.ca

Osteoporosis - Canada.ca: http://www.canada.ca/en/public-health/services/chronic-diseases/osteoporosis.html

The information in this resource is for general information purposes only and is not intended to replace informed medical advice. Consume foods according to any dietary guidelines you have been provided from a health care professional. Metro Ontario Pharmacies Limited assumes no legal liability for the accuracy, completeness or usefulness of the information.