Calcium consumption down despite warnings; Osteoporosis: Women and girls have not heeded dietary guidelines and now face a greater risk of post-menopausal fractures.

THE BALTIMORE SUN

At dinner, Mom, your kid asks you how come you get to drink a soda while she has to drink milk.

"I'm done growing," you tell her. "Your bones are still growing; you need milk."

But you're wrong. Your kid is right, and you should be drinking milk, too -- and taking a calcium supplement and lifting weights. And if that kid takes a soda in her lunch, she is contributing to what promises to be a major national health crisis in years to come -- an epidemic of osteoporosis.

Health experts are alarmed by the fact that women -- and the young girls who will be women -- are getting less calcium than ever, even as the recommended daily allowances have increased to reflect the new understanding of bone growth, even as report after report has made osteoporosis a household word in recent years.

Researchers now know that bones don't stop growing once they attain their full length. Growth now is defined as the adding of bone mass, and that continues into a person's 30s. In fact, women's peak bone mass occurs at 30, says Vicki Lucas, vice president of Women's Services for Helix/Medlantic Health System in Baltimore.

Before then, you need to do all you can to increase your bone mass, because you are going to lose it with aging.

"If you haven't done weight-bearing exercise and taken appropriate vitamin D and calcium and all that jazz, then you haven't maximized your bone mass," Lucas says.

Women can expect to lose 10 percent of bone mass during menopause, or

about 1 percent a year, says Yvonne Bronner, a registered dietitian and assistant professor of family health sciences at the Johns Hopkins Medical Institutions.

About 28 million Americans have osteoporosis; 80 percent are women. There are 1.5 million fractures each year; 300,000 are hip fractures, and 30 percent of the hip-fracture victims will die.

The old diet guidelines called for women between 19 and 50 to consume 800 milligrams of calcium a day; that has been raised to 1,000. Children should get 1,300 milligrams -- up from 1,200 -- and people older than 50 should consume 1,200 milligrams a day. (People should not consume more than 2,500 milligrams -- that becomes toxic.)

Most women get only 600 to 700 milligrams a day, while teen-agers get only 500 to 600. That data is from 1996, and Bronner fears that the new data, expected to be released in 2000, will show even less calcium consumption.

Once, children easily drank a quart of milk a day, but now they're more likely to be drinking sodas -- a trend that's not dropping despite the omnipresent drink-milk campaign. Ironically, parents worried about too much fat contribute to the problem by packing juices instead of milk into their children's lunches. And older kids regard foods like milk, cheese and cereal -- foods rich in calcium -- as something little kids eat, and therefore not cool.

There are many sources of calcium -- collard greens, broccoli, fortified orange juices and cereals, salmon and tuna, and, of course, dairy products. An 8-ounce glass of 2 percent milk has 313 milligrams; skim milk has 302. A cup of collard greens has 148 milligrams. A Tums -- used by women as a quick source of calcium -- has 200 milligrams of calcium carbonate.

The body needs vitamin D to absorb calcium, and again the requirements have jumped; women 50 and older should get 10 micrograms a day, up from 5, while women older than 70 should get 15 micrograms.

Fifteen minutes of sunshine a day is one of the best sources for vitamin D, but a lifestyle centered around the office keeps women indoors more and more. Other good sources are dairy products -- milk, cheese, yogurt and ice cream.

Smoking and alcohol are risk factors for osteoporosis, too -- they de-mineralize bones -- and adolescent females, ever eager to be cool, are the fastest-growing group of smokers.

But a dowager's hump and a later life in a wheelchair aren't cool, either, and that's what today's teens are setting themselves up for.

Osteoporosis typically shows up in post-menopausal women. A bone scan of a woman with osteoporosis will reveal an image that looks like a spider web -- and is just as fragile. "They could plop down in a chair and fracture their hip," says Lucas.

One of the easiest ways to monitor for osteoporosis is simply to measure a women's height, something not routinely done at checkups. "Women don't notice they've lost so much bone density until their favorite skirt is now below their knees," says Lucas. They're losing height because the vertebrae in their spine are being crushed.

Lucas recommends that women between 30 and 40 get a baseline bone-density scan, a noninvasive procedure costing around $200 that takes about 15 minutes and does not require undressing.

Perhaps one of the most tragic things about osteoporosis is that it begins to strike women in their 50s, at an age when they still should have a decade or more of productive work life ahead of them.

The good news is that it is not too late for women of any age to make lifestyle changes.

Miriam E. Nelson is the director of the Center for Physical Fitness at Tufts University and author of "Strong Women Stay Young" (1997, Bantam). The book, which has been translated into nine languages and was a national best seller, outlines a program of exercises easily done at home with inexpensive hand and ankle weights, as well as exercises that improve balance.

Why balance?

"We know exercise and strengthening activities not only affect density, but they create better balance and a much greater resistance to having a fall," says Nelson. "If she doesn't fall, she's not going to break a bone."

"About 30 or 40 percent of women in their 40s have such diminished strength that walking up a flight of steps or carrying groceries is difficult," she says.

These women often realize that activities they've always loved, such as tennis, skiing or horseback riding, simply aren't as much fun as they used to be, but they don't know it's because they've lost muscle strength that can be regained.

Most of those sports are cardiovascular, not strength-building like weight workouts.

Nelson's book recommends starting with 3-pound ankle weights and 1-pound dumbbells.

Nor should the responsibility for all of this rest like a weight on women's shoulders. Bronner points out that the whole family needs to figure out ways to add calcium -- like a sprinkling of low-fat cheese -- to the family diet.

"Woman are not destined to have a dowager's hump," says Lucas. "Unfortunately, nobody pays attention to it until they've got this little old lady in a nursing home. We can prevent it, and we can start with our little girls."

INFORMATION

For more information on how to prevent osteoporosis:

* National Osteoporosis Foundation: Write to Department MQ, P.O.Box 96616, Washington, D.C. 20077-7456 (include self-addressed stamped envelope) or call 202-223-2226. Web site is nof.org.

* Helix women's health line: 888-740-BTLC

A SILENT DISEASE

Symptoms

Osteoporosis is often called a silent disease because most women have no symptoms until a bone breaks. Bones most likely to fracture are the hip, wrist and spine. Caucasian and Asian women are at a higher risk, as are small and thin-boned women.

Women may notice that they are not as tall as they used to be; the vertebrae in their back are painlessly crushing, causing them to lose height.

Women should have their height measured at their regular checkups, but the only way to diagnose osteoporosis is with a bone-mass measurement test. Noninvasive bone-density scans examine different areas of the body to determine bone density. Women should have a baseline scan between age 30 and 40. The National Osteoporosis Foundation recommends testing for everyone over 65.

Treatment

* Calcium.

* Exercise. Women with osteoporosis need to discuss safe ways to exercise with their physician.

* Estrogen replacement therapy.

Calcitronin, a protein taken in the form of an injection or nasal spray for women who can't take estrogen.

Alendronate, a class of drugs known as bisphosphonates, which are compounds that inhibit bone breakdown; one such drug, Fosamax, was approved by the FDA in 1997.

Raloxifen, which is a new class of drugs called selective receptor modulators, and is kind of a designer estrogen.

Alx-11, an experimental drug that mimics hormones and was tested by John Glenn in space to see if it would reverse the bone loss caused by being at zero gravity.

PREVENTIVE EXERCISES

Weight-bearing exercises help prevent osteoporosis. That doesn't necessarily mean lifting weights; it just refers to placing the pressure of gravity on the bones and joints.

Incorporate weights into your exercise routine. Consider holding a 2-pound weight as you do your aerobics. Or work with small free weights in simple exercises such as sitting in a chair and doing biceps curls. Using small ankle weights, while holding onto the back of a chair for support and safety, gently swing one leg out to the side to strengthen your hip.

Women should exercise three times a week for 35 minutes. And take the stairs instead of the elevator.

GETTING THE CALCIUM YOU NEED

Experts say women from ages 19 to 50 need 1,000 milligrams of calcium a day; older women need 1,200 and children need 1,300. There are many ways to get enough calcium in your diet. Here's a sample diet from the U.S. Department of Agriculture:

Breakfast

6 ounces orange juice: 20 or 225 milligrams of calcium if fortified

1 cup cereal: 56 or 250 if fortified

8 ounces skim milk: 302

Whole wheat toast (2 slices): 56

12 ounces water: 2 or 360 if calcium-fortified mineral water

Lunch

Whole wheat bread (2 slices): 56

Turkey: 6

1 ounce American cheese: 174

Few pieces leaf lettuce: 10

Tomato slices: 4

1 medium banana: 7

12 ounces water: 2 or 360 if calcium-fortified mineral water

Dinner

3 ounces canned salmon: 167

1/2 cup mashed potatoes: 27

Collard greens, 1 cup: 148

Corn bread, 2-inches square: 20

Fresh strawberries: 21

12 ounces water: 2 or 360 if calcium-fortified mineral water

Snack

1/2 cup low-fat yogurt: 173 or 345 if fortified

Total daily calcium intake

1,253 milligrams (or 2,898 if fortified. Note: Calcium intake above 2,500 milligrams can be toxic and result in calcification of soft tissue.)

Don't tolerate dairy well? Substitute soy milk (80 milligrams) at breakfast, a serving of baked beans (128 milligrams) at lunch and four fig bars (40 milligrams) for a snack.

CALCIUM AND PMS

Calcium does more than protect against osteoporosis. It helps control symptoms of PMS.

In a study published last August in the American Journal of Obstetrics and Gynecology, researchers lead by Dr. Susan Thys-Jacobs, an endocrinologist at St. Lukes- Roosevelt Hospital in New York, found that taking 1,200 milligrams of calcium daily reduced symptoms of mild to moderate premenstrual syndrome.

For the study, half of the 500 women enrolled took two Tums E-X (600 milligrams of calcium carbonate) twice daily, while the other half chewed a placebo. For three months, they kept a diary and tracked the four core symptoms of PMS: mood swings, bloating, food cravings and pain -- along with 17 symptoms ranging from depression to bloating to backache to craving salty foods.

All four of the core symptoms improved for the Tums group, as did 15 of the 17 other symptoms. The symptoms were reduced by almost half: For example, psychological symptoms were reduced by 45 percent while pain symptoms were reduced by 54 percent.

That irritable mood and in- ability to zip a pair of jeans may be more than just PMS; researchers theorize that the symptoms may serve as a warning that a woman isn't getting enough calcium, putting her at risk for osteoporosis later in life.

-- Nancy Menefee Jackson

Pub Date: 01/24/99

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