When I began writing this book, I did not know how the final section would “put it all together.” Along the way, I received many questions and requests for information about what to do for the whole family. As a result, this final section provides tips for you and your family by age or stage of life. Many of these points will be useful throughout your life. They are good not only for your bone health but for your overall health and longevity. Talk with your doctor about bone health during your and your family's regular check-ups. Staying bone healthy is a lifetime endeavor.
EXPECTANT MOTHERS
Amid all the planning and excitement of anticipating your baby's birth, osteoporosis and hip fractures are unlikely to be on your mind. However, during your pregnancy is a good time to start thinking about prevention of those later-life problems that may be impacted by what happens in the womb.
Optimize calcium intake. The total requirement for calcium during pregnancy is 1,000 mg daily. Check the label of your prenatal vitamins. Most brands contain 200 to 300 mg of calcium. Figure out how much calcium is in your typical diet. If it does not provide enough calcium, either add to your dietary sources or take a calcium supplement to meet the 1,000 mg goal.
Measure your vitamin D level. Prenatal vitamins alone do not supply enough vitamin D. Most brands contain only 200 to 400 IU. Additional supplementation is often needed to maintain an adequate vitamin D blood level above 30 ng/ml. The only accurate way to know how much vitamin D you should be taking is by knowing your blood level. Talk with your doctor to arrange a blood test.
NEW MOTHERS
Add vitamin D with breastfeeding. Your baby needs vitamin D supplements each day if you are breastfeeding. As a new mother, life is hectic and it is easy to forget to give the vitamin drops to your baby. Set up a system to help you remember, and do not forget your vitamin D either. If you are using both formula and breast milk, you will still need to supplement. A total of 400 IU is the daily vitamin D dose for your infant. Bottle-fed babies are supplied with enough vitamin D from the fortified formula.
Continue to optimize your calcium intake. During breastfeeding you tend to lose bone even when you take sufficient calcium. The loss is temporary and bone will be regained after weaning. Maintain your daily calcium intake of 1,000 mg through your diet and supplements. Continue this amount each day until menopause, when your total calcium intake increases to 1,200 mg daily.
YOUR CHILDREN
The first two decades of life are the window of opportunity to establish the strongest bones possible. Think of osteoporosis as a childhood disease that is manifested in late life with fractures. It is hard to maintain focus on such a distant horizon, but it may help to remember that the payoff is not only in years to come but also in the short term, as good bone health will decrease the chances of childhood fractures. Getting a healthy start is key to strong bones and establishing healthy lifelong habits.
Toddlers (ages 1-3)
Start healthy eating habits. Introduce healthy foods into the diet. Stay away from fast foods that are high in calories, fat, and salt.
Eat calcium rich foods. Dairy foods are rich in calcium and protein for growing bones. About two eight-ounce glasses of milk or the equivalent will supply the recommended 700 mg of daily calcium.
Kids (ages 4-8)
Educate about healthy choices. Teaching your kids how to make good nutritional choices is key to establishing good lifelong habits. Start the morning with a bone-healthy breakfast of yogurt and fruit. The recommended dietary allowance for calcium for kids in this age group increases to 1,000 mg a day, which is about three glasses of milk or its equivalent.
Limit soft drinks. Soft drinks tend to displace milk drinking. Kids lose the bone-building benefits of calcium, vitamin D, and protein from milk. Other drinks, like juices and fruit drinks, need to be limited, too. Offer water as an alternative choice after their daily calcium intake has been met.
Play outdoors. Spending time outdoors each day encourages physical activity. Sunshine during the summer months gives some bonus vitamin D.
Tweens (ages 9-13)
Increase calcium in the diet. This is when the growth spurt starts. More than 40 percent of children's eventual adult bone mass is attained from about age nine to thirteen in girls and nine to fourteen in boys. More calcium is needed to support their bone growth. About four glasses of milk or the equivalent is needed to meet the goal of 1,300 mg of calcium a day.
Jump. Jumping activities increase bone density more than the typical physical exercises in gym class. Weight-bearing exercises, which put a mechanical load on bones, are the best bone builders. Encourage activities that involve jumping up and down or running.
Participate in team sports. Team sports help maintain fitness. Working as part of a team provides great lessons and discipline for life.
Limit television and electronics time. The sedentary activities of television, computers, and video games take away from physical activity time. Encourage physical activity during the day and limit electronics to a few hours in the evening.
Teens
Encourage healthy habits. The teen years are the most difficult time for parental influence. Peer pressure and independent thinking may trump healthy habits. Take advantage of the influence you still have by providing healthy choices in the home.
Keep up calcium intake. Calcium is essential for growing bones. Teens tend to substitute soft drinks or other noncalcium-containing beverages for milk. If drinking milk is not their thing, substitute yogurt or nondairy sources to get 1,300 mg of calcium a day.
Consider a vitamin D supplement. If your teens are not drinking milk, they may not be getting enough vitamin D. As a fat-soluble vitamin, it does not have to be taken every day. Once a week will suffice. They may be able to skip the supplement during the summer months if they are spending time outdoors.
Maintain a healthy weight. Weight is a balance between too little and too much. Neither being underweight nor being overweight is healthy for bones. Maintaining a healthy weight is essential for girls to have regular menstrual periods and the estrogen support needed for growing bones.
Don't start smoking. Cigarette smoking may seem “cool,” but it is addictive. Cigarettes are expensive, not only to buy, but for healthcare in the long run. Help your teens avoid this risk.
YOUR 20s
During this time, a person gains a small amount of bone in the range of 5 to 10 percent. This is the “consolidation” phase, which ends with the achievement of peak bone mass by the end of your twenties. As you embark on your career or further training, you must make time to take care of yourself. The demands of a new job or school may be overwhelming but don't let your healthy lifestyle lapse.
Limit alcohol. Finally, you hit the legal drinking age, although there is a good chance you already have been imbibing. Despite reports that beer is good for your bones, do not overdo it. Limit the number of alcoholic beverages to no more than one or two a day, if you drink at all.
Exercise regularly. Establishing a regular exercise regimen is key. Figure out how to fit daily exercise into your job or school schedule. Put exercise on your calendar just like meetings or appointments.
Eat your vegetables. Meals “on the go” tend to be high in protein and fat and scant on vegetables. Avoid fast foods. They tend to be loaded with hidden salt. Your mother's advice was right, of course.
Find out about your family history. Connect the dots. Talk with your parents and grandparents about their health histories and the histories of other family members. Ask specifically about fractures and falls. Knowing about your grandfather's slip on the ice and hip fracture is important for your health. Being aware of your family history can help reinforce your healthy habits. By making the right choices to optimize your health you decrease the chances of having the same problems that affected your parents or grandparents.
YOUR 30s
Your peak bone mass has been established. Now it is vital to hang on to what you have. A healthy lifestyle has never been more crucial. Juggling your career and family may have you stressed out. You cannot forget about taking care of yourself.
Avoid yo-yo dieting. The battle of the bulge may be a problem. Pregnancy or a lapse in your physical activity may have added a few unwanted pounds. Weight loss of even a few pounds can cause bone loss. Try to maintain a stable healthy weight.
Counter caffeine with calcium. Gourmet coffee shops are ubiquitous. They tempt us with supersized cups of coffee that deliver big jolts of caffeine. Some of the specialty drinks are loaded with calories as well. Drinking coffee and other caffeine-containing drinks tends to promote loss of calcium through your urine, particularly if you have a low calcium intake. Add some milk or order a latte to help compensate.
Look for hidden salt. These days, the salt shaker is not the main source of salt in your diet. Unfortunately, prepared and packaged foods are. You can get a couple days worth of salt in one Chinese take-out dish. Less obvious sources of hidden salt are tomato juice, canned beans, and pepperoni pizza. Identify sources of salt in your diet. Read the nutrition facts on the labels of foods to identify the sodium content before you purchase. Consume less than 2,300 mg a day of dietary sodium.
YOUR 40s
Estrogen upheaval is looming. About half of women will transition to menopause during this decade. Menopausal transition is typically from your late forties to early fifties. Perimenopause may be symptomatic for some of you. Waking up with soaking night sweats is no fun. Hang on for the hormone roller coaster; it can be a wild ride or not bad at all.
Get a DXA bone density scan. Once you are perimenopausal or early postmenopausal, a baseline bone density measurement is recommended if you have risk factors for osteoporosis. The “DXA” scan should include both your hip and spine. Talk with your doctor about when it is time to arrange for this quick and painless test.
Assess your fracture risk. Your fracture risk is assessed in concert with your bone density results. A fracture assessment questionnaire, called FRAX, is a helpful tool for determining your risk of major osteoporotic and hip fractures in the next ten years. Important risk factors, along with the results from your bone density, go into the calculation. The results serve as a starting point for discussion with your doctor. Guidelines from the National Osteoporosis Foundation define the characteristics of higher risk individuals who should consider treatment with bone-specific medicines.
Measure your height. Have your height measured every year at your doctor's office when you have your annual exam. A loss of one inch for men or two inches for women may be a sign of silent spine fractures.
YOUR 50s
In postmenopause, the goal is to reduce the loss of bone associated with loss of estrogen. Bone loss may slow after early menopause. Decrease your fracture risk with general measures of nutrition, calcium, vitamin D, and exercise. Consider bone-specific medicines when general bone measures are not enough.
Increase your daily calcium. The recommendation for daily calcium increases to 1,200 mg for women over fifty. It is difficult to achieve that goal with diet alone, but do not overdo it either. The total of dietary plus supplemental calcium intake should be 1,200 mg.
Reassess your vitamin D intake. As you increase your calcium, you should add up how much vitamin D you are taking each day. Most calcium supplements have vitamin D added. Check the supplement facts on the back of your calcium and vitamin supplements. Having a blood test for vitamin D is the most accurate way to know if you are taking enough to maintain adequate levels.
Increase physical activity. With loss of estrogen, your metabolism resets. More exercise is needed to burn calories and keep toned. Schedule your exercise for at least sixty minutes, six days a week. Work on under-challenged muscles in your upper body to help prevent rounding of your shoulders. A combination of weight resistance and weight-bearing cardio activities is the best regimen. Keep changing your routine to optimize the effects of exercise on the bone.
Consider low-dose estrogen. If your hot flashes and night sweats are too much to handle, think about short-term use of estrogen. Estrogen is now available in lower doses. You can start with the lowest dose and gradually increase as needed. Low-dose estrogen prevents bone loss.
YOUR 60s
Schedule a DXA bone density scan. For women, a bone density measurement of your hip and spine is recommended at age sixty-five, if you haven't already had one. In addition, a scan of your entire spine to look for silent spine fractures can be done on most DXA machines. It is important to know if you have had a spine fracture so that you can take measures to prevent another one. Ask your doctor to include a “vertebral fracture assessment” or “VFA” as part of your bone density testing.
Consider osteoporosis medicines. If you have a fracture, your chance of another fracture within the next couple of years is high. The goal is to prevent fractures and stay fit. Effective medicines are available to help decrease your risk of fractures as part of your overall treatment plan. Discuss your options for osteoporosis medicines with your doctor.
Tell your children. Do not keep the results of your bone density secret. If your bone density is low or you start on osteoporosis medicines, share your medical information with your children. It is important for them to know their risk and it may motivate them to stay more attuned to their bone health.
Watch your medicines. Some prescription medicines or even over-the-counter medicines can play havoc and counteract all your other good bone-healthy habits. Take all your medicines, vitamins, and supplements with you to each visit with your doctor so he can review everything you are using.
Consider other health problems. Be aware of other problems that may have a bone impact. Virtually any disease or illness has the potential for affecting your bones. New connections with bone are being discovered in the research labs all the time.
Stay active. Staying active is more important than ever before. Regular exercise is the closest thing you have to a fountain of youth. Adopt “painless” habits, such as parking at the far end of the shopping mall or grocery store rather than trying to get the closest parking space.
YOUR 70s AND OLDER
These tips are important for all seniors in their seventies, eighties, and nineties. To avoid repetition, they are combined into a single group. Ninety percent of fractures are associated with a fall. Regardless of your bone density, fractures are unlikely to happen if you don't fall.
Limit your cocktail hour. You should have only one or two drinks at most each day. Not only is more alcohol bad for your bones, it affects your brain more than when you were younger. Drinking increases your risks for falls and injury.
Prevent falls. Fall-proof your home to lessen the chances of falling. Your home can be the most dangerous place for fractures. Work on balance and increasing strength in your core and leg muscles. Enlisting the help of a personal trainer is good way to start, or you might consider joining a class in a local fitness center.
Recheck your vitamin D. Vitamin D supports not only your bones but also your muscles. The simple measure of having an adequate vitamin D blood level lessens your chances of falls and supports your muscle strength.
Use it or lose it. Muscle loss is a major problem for those in this age range. Stay as physically active as possible. If you are unable to continue strength building activities, watch for the availability of a low-level, high frequency vibration platform to help maintain your bone density. If further research results are positive, standing on the low-intensity vibration platform for just minutes a day in your home may benefit your bones.
FOR MEN ONLY
Bone matters for men, too. Thirty percent of all fractures occur in men, including one-quarter of hip fractures. Men do not do well after sustaining hip fractures. In fact, one-third of men die within one year of having a hip fracture. Few diseases cause such high death rates. The same general principles for good bone health apply. Since men start out with more bone mass, it takes longer to become fragile. However, men are more likely to have habits that are harmful to bone, such as smoking and drinking.
Schedule a bone density scan. The National Osteoporosis Foundation recommends screening for all men at age seventy. You will need a DXA scan earlier if you have risk factors, medical problems, or medicines that increase your risk. For example, prostate cancer is a common chronic disease with aging. The treatments for prostate cancer may accelerate bone loss. Osteoporosis medicines may help prevent the associated bone loss.
FINAL WORDS
Achieving good bone health is simple but it's also hard work. If lifestyle changes were easy, everyone would be in tip-top shape. A few simple changes to your lifestyle will pay off in the long run. Start small and make gradual incremental changes. You do not need to do it all at once. Even some changes are better than none. Small changes can make a huge difference.
These bone-healthy measures do not exist in a vacuum. A bone-healthy lifestyle goes hand-in-hand with good health practices for lowering the risk of other major health problems like heart disease, breast cancer, and diabetes. Good bone health practices help achieve overall optimal health. However, it is also important to recognize when lifestyle changes are not enough.
New risk assessment tools integrate risk factors with bone density to estimate your fracture risk. If you have low bone density or “osteopenia,” these valuable tools help as a starting point for your decision-making discussions with your doctor. Osteoporosis medicines should be reserved for use when your risk for fracture is high or you have already fractured.
Although there is no “cure” for osteoporosis, more treatment options are available than ever before. Bone-specific medicines help decrease your risk of fractures but they do not eliminate it. These medicines are a portion of your overall treatment. You still need to do your part with nutrition, calcium, vitamin D, exercise, and fall prevention.
Please share what you have learned with your family and friends. Set a good example for them. It is never too early or too late to take care of your bone health—and your family's bone health.
Many questions remain unanswered and still more remain to be discovered. Further research is needed to clarify current controversies, and new controversies are sure to emerge. Stay up-to-date with the latest developments in bone health at 4BoneHealth.org. I look forward to continuing the dialogue with you there.
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The Bare Bones Tips for boosting bone health over your lifetime:
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