More than 40 million adults in the United States already have or are at the brink of getting osteoporosis, Osteoporosis is a disease. It is marked by lower bone mass and literal deterioration of bone tissue that weakens the bone leading to the danger of possible bone fractures.

What are the main causes of osteoporosis? You guessed it: lack of calcium and Vitamin D are big ones. The most common cause of osteoporosis in women is estrogen deficiency. You might think that menopause is the only reason for this, but athletes who do strenuous training and anorexic girls also can compromise their bone density. Also, women who have their ovaries removed are more at risk of having fractures.

You’d be surprised to learn that men need hormones for bone health. Men actually convert enough testosterone into estrogen for their bones to remain healthy.

Because physical movement actually strengthens bone, the opposite is true that a sedentary life would lead to osteoporosis. Bad vices such as excess alcohol and smoking can also increase the risk of osteoporosis.

Also, as you age, your body produces less growth hormone, which you need to build strong bone. Other examples of less common causes include myeloma, hyperthyroidism and hyperparathyroidism. Certain medications such as steroids may also heighten the risk.

So what can you do to help prevent osteoporosis?

Calcium and vitamin D:
Osteoporosis is most often associated with inadequate calcium intakes, but insufficient vitamin D also adds to the problem. Put it simply, vitamin D helps us absorb calcium, and so if you don’t get enough vitamin D, you just won’t absorb calcium, and combined with the other problems such as low estrogen in the elderly, its lack leads to a higher risk of osteoporosis.

For bone health, calcium and vitamin D are two of the most vital nutrients. However, seniors are vulnerable to becoming deficient in calcium and vitamin D. Appetite decreases with age, and their general calcium intake will likewise decrease. But not only that, their intestines don’t absorb calcium as well. Calcium is less retained by aged kidneys as well. Also, elder people get less sun exposure, so the natural vitamin D produced by the skin is decreased. This is more so during winter months. To top it off, their skin also produces much less vitamin D despite sun exposure.

Because of this, elder people need 1200-1500 mg of calcium daily, about 500 mg more than younger people. Similarly, while young people need 600 IU of Vitamin D, elder people need 800 to 1000 IU’s daily.

You’d think they could make this up with a simple pill. However, as we just said, absorption is a problem, so 500 mg or less is advised. Salt and caffeine also increases the excretion of salt in the urine. Kidney stones may also be a risk with high levels of supplements.. New evidence also points to a possible link between heart problems and high calcium supplement usage. This is especially the case without adequate vitamin D to help absorb it. Theoretically some of this extra calcium will end up being deposited in the arteries instead of the bones.

Even though there are many foods containing calcium, very few foods in nature contain sufficient vitamin D levels. Salmon and tuna are good sources. However, many foods are also fortified with vitamin D in the U.S. For example, our milk is fortified with vitamin D, but also yogurt and orange juice.

Vitamin D in excess by itself can cause some problems such as arrhythmias of the heart. However, a serious cardio-vascular problem can arise at high rates: vascular and tissue calcification, with subsequent damage to the heart and kidneys. Kidney stones are another risk, as more calcium is being absorbed than they can excrete. However, this toxic intake level may be as much as four times more than the recommended 1000 IU’s daily for elder people.

Keep in mind that vitamin D is one of the “ADEK” vitamins, vitamins A, D, E and K that all require fat for absorption. So if you are not lactose intolerant, milk and yogurt get around this problem, as long as they aren’t from skim milk.

Still, you can get a good amount of calcium in the diet.

• Dairy: milk, yogurt, cheese, ice milk
• green vegetables: collard, broccoli, and kale
• fish:, canned salmon sardines and tuna
• fortified foods: almond milk, orange juice, oatmeal, breakfast cereals
• fruits: oranges and figs
• beans

What else can you do to prevent osteoporosis or its effects?

• Quit smoking: this can retard new bone growth and decrease natural estrogen levels
• limiting alcohol to 1 serving daily or less
• start exercise: a favorite is walking, but if you already have osteoporosis, be careful for falls; consider hip pads
• as we discussed before, stretching and balance exercises to increase flexibility and again to reduce the risk of falls
• get plenty of protein !

Protein and your Bones:
In a previous article I spoke of the relationship between protein intake in the elderly as it relates to frailty. “Sarcopenia” (a fancy word reduced muscle mass) surprisingly leads to a higher risk of falls, frailty, disability, functional impairment, and loss of independence, all associated with aging. Loss of muscle mass is due to mainly to decreased physical activity, malnutrition, hormonal changes. But not only is there a reduction in muscle mass, but also an countering percentage in the increase of body fat. Because of the increase of body fat, impaired glucose tolerance and eventual diabetes (mostly the acquired “type II” diabetes). Type-II diabetes affects nearly 20% of elderly adults. Not only that, but because there is a reduction in the number of “mitochondria”, the little engines located in their cells, metabolism is decreased, which in turn contributes to the development of diabetes.

Again, decreased muscle mass also leads to impaired bone health. Our bones depend on the daily movements and forces due to muscle contraction to continue strengthening of bone. In fact, there is evidence that there is “cross talk” between bone and muscle units. Factors that affect muscle buildup, including protein intake, also affect bone mass.

In addition, with the decrease in protein and onset of diabetes comes a risk of weight gain, which is an added risk of arthritis and even fracture. Also, weight gain is associated with less physical activity, another risk factor. However, it is not clear whether obesity in general has a direct effect on osteoporosis.

Concerns about dietary protein increasing urinary calcium appear to be offset by increases in absorption. But before making these or any changes in your diet, or taking any supplements, consult with your physician.

In summary, calcium and protein intake work together to affect our bones. Enough of both calcium (with vitamin D) and protein must be taken in the diet to fully take advantage of each nutrient on our bones. These are important steps in your elder parents’ health and wellbeing, and to help maintain their independence.