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Fractures and Osteoporosis

by Kimberly A. DeTour, RD

Most people don't realize the real reason for many fractures of the hip, spine and wrist. Bone loss, or Osteoporosis, contributes to 90% of hip fractures. Persons with disabilities which involve limitation of movement are especially prone to bone loss due to inactivity, prolonged casting or splinting, or paralysis. Osteoporosis occurs over a long period of time and often goes undetected until the fracture occurs. Nutrition is a key factor in maintaining bone health and quality of life.

When thinking about osteoporosis, calcium, especially from dairy products, is what comes to most people's minds. It was once thought that after young adulthood calcium was of questionable benefit but newer research and recommendations suggest otherwise. Good calcium intake early in life can reduce hip fractures by 50% in later life. It has also been found that lifetime attention to good calcium intake decreases the incidence of osteoporosis at an advanced age. In 1994 the National Institutes of Health put together a panel of calcium experts and came up with new recommendations that cover the life cycle.

New Calcium Recommendations (From the 1994 National Institutes of Health Consensus Conference)

The amount of dietary calcium recommended by the National Institutes of Health (NIH) is designed to provide the optimal amount of calcium needed at different ages and stages of life.

Just knowing you need more calcium is not enough. Calcium consumption, and intake of vitamin D that helps absorption, is often low, especially in American females. Many people needlessly stop eating or drinking dairy products out of concern for their cholesterol levels. Although whole milk dairy products contain saturated fat that can increase blood cholesterol, a switch to low fat or skim milk dairy products lowers fat but still provides the same calcium. Others avoid milk because of lactose intolerance. Many of these people can consume some amount of dairy products, i.e. cheese or yogurt without intestinal distress. The enzyme lactase is helpful and available in a commercial product called Lactaid. Lactaid drops, tablets or milk help many people resume eating dairy products comfortably. Others may have heard how many milligrams of calcium they need but not know what foods provide it and in what amounts. Here are some ideas:

Some people don't like dairy products or don't eat them, i.e. strict vegetarians. For these people, calcium fortified foods like orange juice (about 160 mg per 3/4 cup juice), bread and cereals are an option. Others may need to take a calcium supplement upon the advice of their doctor or registered dietitian.

While trying to build up your bones with calcium, keep these other things in mind:

• Vitamin D is needed for good calcium absorption and is found in vitamin D fortified milk, egg yolks and fatty fish. For Vitamin D to become biologically active in all of its forms, exposure to sunlight is required [vitamin D reacts with sunlight in the skin to become vitamin D2 --especially important to remember with someone who is spending much time indoors].

• Excessive amounts of caffeine, salt and alcohol can decrease calcium absorption.

• Physical activity and weight bearing exercises help prevent bone loss in all age groups. Your physician or physical therapist can help you design the best and safest exercise program for your needs.

Osteoporosis and related fractures affect 25 million people in the United States at a cost of 10 billion dollars per year. As we look for ways to control healthcare costs and keep people healthy, low cost interventions such as adequate nutrition and appropriate lifestyle changes make a great deal of sense.

For more information you may wish to contact these resources:

National Osteoporosis Foundation
1150 17th Street, N.W.
Washington, D.C. 20036-4603
Phone 1-800-223-9994

National Center for Nutrition and Dietetics
Consumer Nutrition Hot Line:
1-800-366-1655

For people with lactose intolerance:
Call 1-800-LACTAID

References:

1. Dairy Council Digest, Jan/Feb 1996, vol. 67, #1
2. Network/A Newsletter of Dietetics in Physical Medicine and Rehab, Winter 1996, vol. 16, #1
3. Nutrition and the MD, July 1995, vol. 21, #7 4. Mahan LK, Arlin MT, Kranse's Food, Nutrition and Diet Therapy, 8th edition, Philadelphia, PA: WB Saunders, 1992 (pp. 398-403).