How To Build Better Bones: Overview Of All The New Osteoporosis Options


Grandma has fallen. ... and yes, she can't get up, because she's broken her hip. This is an all-too-common occurrence in the U.S. today, where one of every two women (and one in eight men) over age 50 falls victim to an osteoporosis-related fracture at some point in their lives. Many of these fractures lead to disability and sometimes even death from medical complications, making this disease a true public health crisis.

Osteoporosis--literally "porous bones"--is a condition in which bones lack the minerals (bone mineral density) needed to make them strong. Tell-tale signs of the disease include diminishing height, stooped posture and loss of teeth.

Drugs and Diet Offer New Hope. Fortunately, the past few years have brought many advances in the treatment of osteoporosis, especially drugs that can actually build new bone. Moreover, researchers now have a better understanding of the numerous nutrients needed for bone health, making osteoporosis both a preventable and treatable disease.

While some risk factors, like genetics and gender, are beyond your control, there is much you can do to keep your bones healthy. Even better, it is never too late to take evasive action. Here's the lowdown on all the newest strategies for overcoming osteoporosis.

Calcium Considerations. Get as much calcium as you can from calcium-rich foods (see "EN's Do's and Don'ts for Better Bone Health," page 5). If you can't get enough--and most people don't--the solution is supplemental calcium. Here are the basics:

Space calcium supplements (or calcium-fortified foods) throughout the day for best absorption; more than 500 milligrams of calcium at a time is not well absorbed.
Don't worry about which form of calcium is best absorbed (differences are minimal). But if your supplement contains calcium carbonate, take it with meals to aid absorption; if it contains calcium citrate, it doesn't matter when you take it.
Avoid calcium from oyster shells, bone meal or dolomite; they are the most likely to be contaminated with large amounts of lead. (The more calcium you take in, the less lead your body absorbs, making inconsequential the low levels of lead you may have heard are in other forms of calcium.)
Vitamin D. Don't overlook this essential nutrient for bone health; it's vital for calcium absorption.

"About 40% of adults over age 50 are deficient in vitamin D, intensifying their osteoporosis risk," warns Michael Holick, M.D., Ph.D., director of the Bone Health Care Clinic at Boston University Medical Center. Holick is among the experts urging older people to get 800 to 1,000 International Units (IU) a day. Choose a calcium supplement that also provides D plus take a daily multivitamin. But do not exceed 2,000 IU of D a day.

Other Vitamins and Minerals. Researchers now believe vitamins C and K are also key to bone health. The minerals potassium and magnesium have garnered support as well. There is only limited evidence so far for boron, manganese and fluoride, though some researchers think they may someday prove to be an important part of a bone-building prescription.

Protein. This is one of the most under-appreciated nutrients for bone health. Researchers have long believed too much protein--especially animal protein--is detrimental to bone health. But not everyone is convinced that protein is a problem. In a recent Harvard study of older people, those who ate the least amount of protein (30 to 35 grams a day) lost significantly more bone than those who ate the most protein (about 100 grams). Aim to get at least the Recommended Dietary Allowance for protein (63 grams a day for men and 50 for women). Higher amounts of vegetable protein (but not more than 150 grams a day) may even be beneficial to bones, especially for older adults.

Soy. Soy foods hold promise for helping prevent osteoporosis. Naturally occurring phytoestrogens plus the presence of soy protein appear to be a boon to bones. Bone researcher Bahram Arjmandi, Ph.D., R.D., of Oklahoma State University, recommends 25 grams of soy protein a day--the amount in about two to three servings of soy foods.

Bad to the Bone. Studies show that beverages like soft drinks, coffee and alcoholic drinks can be bone busters if consumed in large quantities (see "EN's Do's and Don'ts for Better Bone Health," page 5). This might simply be because they take the place of dairy products. Caffeine doesn't seem to damage bones if calcium intake is up to par. The same is true for sodium, which saps strength from bones by acting as a calcium thief at high intakes. Additional calcium minimizes the effect.

Move Those Bones. When you exercise with weights or elastic bands, your muscles pull on your bones, strengthening them. Such strength training and any weight-bearing exercise, including walking, is a boon to bones because it stimulates new bone formation. And almost any physical activity is beneficial, because it enhances balance and flexibility, preventing falls.

Medications. Advances in bone-building drugs (see "Just What the Doctor Ordered," page 4) mark the biggest leap forward in osteoporosis prevention and treatment. Most medications work by minimizing the rate at which bone dissolves. (Your bones are constantly in flux, with some bone dissolving at the same time new bone is being formed. The trick is to build more bone than you lose.) A new genre of drugs on the horizon actually triggers the formation of new bone by regulating parathyroid hormone. But despite dramatic benefits, people taking osteoporosis drugs should not ignore diet and exercise. Bone-sparing medications are less effective if you don't take in adequate calcium and vitamin C, for instance.

EN's Bottom Line. To protect your bones, get regular weight-bearing exercise and eat a balanced diet that includes low-fat dairy products, fruits, vegetables, soy and adequate protein. Discuss bone density testing and medication options with your doctor.

Just What the Doctor Ordered: Rx to Benefit Your Bones
Legend for Chart:

A - Generic Name (brand name)
B - How It Works
C - Pluses
D - Minuses


Alendronate (Fosamax)

* Inhibits bone-destroying cell called osteoclasts.

* Significantly increases bone density.

* Not a good option for people with reflux or other
gastrointestinal problems; stomach upset less likely
with new version taken weekly.

Calcitonin (Miacalcin)

* Makes calcium more available to bones.

* Suppresses osteoclast activity.

* Naturally occurring hormone.

* Modestly increases bone density.

* Less effective than other options.

* Available as a nasal spray or by injection.

* Side effects include nasal congestion, runny
nose and skin rash.

Hormone Replacement Therapy (e.g. Premarin)

* Slows normal bone breakdown.

* Helps maintain bone thickness.

* Does not promote new bone formation.

* May increase risk of breast cancer with more
than five years of use; need to consider personal
health history.

Teriparatide (PTH 1-34) (Forteo) [*]
[*] Awaiting FDA approval

* Stimulates bone growth by regulating calcium
levels and bone cell activity.

* Actually stimulates new bone growth; may
restore lost bone density.

* Must be given by daily injection.

Raloxifene (Evista)

* Exerts estrogen-like effects on bone.

* Estrogen-like benefits to bone; an alternative
for women who can't take hormone replacement.

* No estrogen-like increase in cancer risk.

* Less potent a bone protector than hormone replacement.

* May trigger menopausal Symptoms, such as hot flashes.

Risedronate (Actonel)

* Inhibits osteoclasts (similar to alendronate).

* Significantly increases bone density.

* Gastrontestinal upset similar to daily dose
of alendronate; less likely in weekly form.
(c) Copyright, 2001 by Environmental Nutrition, Inc., 52 Riverside Drive, New York, NY 10024

Seeking Supplement Calcium
At a minimum, look for a supplement that gives you calcium plus vitamin D. (A choice like Tums is convenient and easy to take because it's chewable. But it only provides extra calcium.) It may be beneficial to take a bone supplement that also provides other important nutrients for bones besides vitamin D. Below, are recommendations for the total amount of bone-saving nutrients to aim for daily, from both diet and supplements.

EN's Daily Goals for Bone Health [*]
(Listed in approximate order of importance, based on the available evidence.)

Calcium 1,000 to 1,500 mg

Vitamin D 800-1,000 IU

Vitamin C [*] 200 mg

Vitamin K 80 mcg

Potassium [*] 2,000 mg

Magnesium 400 mg

Isoflavones [*] 90 mg

Manganese 2.5 to 5 mg

Boron 1-13 mg
* Easily available from foods.

Of the brands EN reviewed, those that come closest to meeting the nutrient goals above include: Schiff Bone Builder, Freeda Fem-cal, Dr. Ben's Formula O, Solgar Bone Support, Jarrow Bone-Up, KAL Bone Defense and Natural Balance Advanced Calcium/Osteoporosis Formula.

For a more detailed analysis of bone supplements, see EN, September 2000.

EN's Do's and Don'ts for Better Bone Health
(Listed alphabetically)

Legend for Chart:

A - Factor
B - How It Works
C - What to Do


What Help Build Bones


* Builds and maintains bone.

* Aim for a daily total of 1,000 mg (1,500 if over 50).

* Eat dairy foods, canned sardines and salmon (with the
bones), broccoli, dark leafy greens (e.g. kale) and
calcium-fortified soy foods and orange juice.

* Take a calcium or bone supplement.

Vitamin C

* Aids collagen production, which helps hold bones

* Aim for 200 mg a day.

* Eat citrus fruits and juices, broccoli, cantaloupe,
kiwifruit, mango, papaya, peppers, strawberries,
tomatoes and potatoes.

Vitamin D

* Absorbs and deposits calcium into bone.

* Aim for 800 to 1,000 IU daily.

* Drink vitamin D-fortified milk.

* Take a multivitamin and calcium with D or a bone

Vitamin K

* Activates osteocalcin, a protein necessary for bone

* Eat dark leafy greens (kale, Spinach, Swiss chard),
broccoli and Brussels sprouts.


* Aids bone formation.

* Eat almonds, avocados, bananas, dried beans, lentils,
nuts, peanut butter, soy, spinach, tofu, wheat germ
and Whole wheat bread.

* Take a bone supplement that contains 100 to 400
milligrams of magnesium.

Physical Activity

* Stimulates bone production.

* Facilitates flow of calcium into bone.

* Engage in weight-bearing exercise (e.g. walk, play
tennis) most days of the week.

* Strength train two to three days a week.


* Contributes to calcium retention.

* Eat apricots, bananas, dried beans, lentils, milk,
orange juice, potatoes, prunes, spinach and tomatoes.


* Assists in building bone cells.

* Eat two to three servings a day of low-fat dairy
foods, soy foods, nuts or dried beans plus occasional
servings of fish, lean meat, poultry.


* Supplies isoflavones, estrogen-like substances that
may boost bone density.

* Raises levels of an insulin-like growth factor linked
to better bone formation.

* Decreases activity of an enzyme associated with bone

* Aim for one to two servings daily (three to four a
week if you have estrogen-dependent breast cancer).
Limit to 100 mg isoflavones per day (check labels).
* Drink soymilk and eat soy nuts, tofu, miso and other
soy foods.

What May Harm Bones


* Decreases activity of osteoblasts, bone rebuilding

* Limit intake of beer, wine, mixed drinks to one per
day (women) or two per day (men).


* Excessive consumption triggers calcium excretion.

* Limit intake to three cups a day of coffee, tea or
soft drinks.

* Be sure calcium intake is adequate.


* Excessive consumption may trigger calcium excretion.
* Do not Exceed 150 grams per day.

* Limit animal protein; eat more vegetable protein.


* Reduces blood levels of estrogen and vitamin C.

* Interferes with the body's use of calcium.

* Stop smoking.


* Excessive consumption triggers calcium excretion.

* Limit intake of processed foods, pickles, sauerkraut,
cured meats

* Do not add salt at the table.

* Be sure calcium intake is adequate.

mg = milligrams
IU = International Units
Environmental Nutrition, Inc., 52 Riverside Drive, New York, NY 10024


By Linda Antinoro, J.D., R.D.

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