Osteoporosis
osteoporosisFor some people, especially women, osteoporosis is just one of the tolls you may expect to pay for living a good long life. Gradual bone loss, which proceeds at an accelerated pace among women after the age of menopause, is a silent, unseen process. Unless you have a bone density test, you may not even be aware that it’s going on. But when bones are weakened, they fracture more easily, which is often the result of osteoporosis.
We’re all at risk for bone loss as we age, but women are hit the hardest. That’s because bone density is strongly influenced by the amount of estrogen in a woman’s body.
For about the first five years after menopause, when a woman’s body stops producing as much estrogen, the rate of bone loss may be as high as 2 to 5 percent a year. The people who are most at risk are thin, small-boned women who are fair-skinned and of northern European or Asian descent, says Lorilee Schoenbeck, N.D., a naturopathic doctor with the Champlain Centers for Natural Medicine in Shelburne and Middlebury, Vermont.
Whatever your risk of osteoporosis, there’s no reason to wait for a bone density test to bring you the bad news. Early steps to save your skeleton can have a big payoff in later years. The best defense you can mount is one of prevention, says Dr. Schoenbeck.
"A balanced diet and regular, weight-bearing exercise can go a long way in preventing osteoporosis," she notes. Most women don’t get enough of the nutrients they need to prevent osteoporosis from diet alone, she says. That’s where supplements come in.
The specific nutrients that you should consider supplementing are the minerals calcium, magnesium, and boron, plus vitamins D and K. "I always recommend that people keep a food diary for a few days so we can get an idea of their intake of calcium and other nutrients," Dr. Schoenbeck says.
Calcium: The Nonnegotiable Nutrient
Most women get about 500 milligrams of calcium a day from food, says Dr. Schoenbeck. Much of that comes from dairy sources. If you happen to be lactose intolerant and therefore avoid most dairy products, you’re probably getting even less than the average. In any case, you should probably have two or three times as much calcium as you’re getting from food.
"Calcium is a nonnegotiable part of every regimen I set up to help women avoid or slow the rate of osteoporosis," says Dr. Schoenbeck.
Almost every bit of calcium in your body is stored in your bones. There is also some in your blood that’s used to regulate your heartbeat and keep muscle and nerve function and blood clotting at optimal levels. Your body’s top priority is to maintain adequate levels of blood calcium. When these levels decline, your body will begin mining calcium from the next available source—your bones.
Knowing this, researchers have been probing to discover the optimal amount of calcium supplementation that most women need. At University Hospital in Ghent, Belgium, doctors found that a calcium intake of 1,500 milligrams a day helped protect postmenopausal women from bone loss. Another study, at Winthrop-University Hospital in Mineola, New York, showed that giving 1,700 milligrams a day of calcium to women who were past menopause significantly slowed their rate of bone loss. Other studies show calcium’s protective role against osteoporosis, but there are varying estimates of how much you need to take.
Dr. Schoenbeck recommends 1,000 milligrams a day for women who haven’t gone through menopause and for men of all ages. Women who are pregnant should plan on taking around 1,200 milligrams a day. Women who are in menopause or have passed through it should take 1,500 milligrams every day.
Whatever the amount you’re taking, you want a supplement that provides the most easily absorbed form. Your body is better able to absorb and use calcium if it’s in the form of citrate or aspartate, says Samantha Brody, N.D., a naturopathic doctor specializing in women’s health in Portland, Oregon.
While some doctors say that you can get what you need from antacid tablets, Dr. Schoenbeck notes that the calcium in antacids is less absorbable than calcium citrate. Another form you’ll see on drugstore shelves is calcium carbonate, but that’s the least absorbable, she says.
Nutrient Combos
"Taking a calcium supplement is good, but it’s not as good as taking a supplement that combines calcium with all of the other nutrients that help your body absorb and use it," says Dr. Schoenbeck. Those other valuable nutrients include vitamin D, magnesium, vitamin K, and boron.
Vitamin D helps your body absorb calcium. A deficiency of D can lead to soft bones, which in turn could lead to fractures. Studies suggest that vitamin D is related to bone mineral density. Researchers at the Institute for Research in Extramural Medicine in Amsterdam studied 81 women age 70 or older. They found that women who were given 400 international units (IU) of vitamin D for at least two years had significantly higher bone mineral densities than women who were not given any.
Research at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston showed that vitamin D enhances the effectiveness of supplemental calcium. Researchers in this study concluded that anywhere from 400 to 800 IU of vitamin D a day (taken with 1,000 to 1,500 milligrams of calcium) is necessary to minimize bone loss. "I recommend 400 IU a day of vitamin D to address osteoporosis concerns," Dr. Schoenbeck says.
Magnesium serves a different function than vitamin D. This mineral is important because it transports calcium to the bones. It also helps convert vitamin D to its active form in the body.
A study from Israel found that 22 of 31 postmenopausal women who were given anywhere from 250 to 750 milligrams of magnesium for 6 months, then 250 milligrams a day for 18 months, increased their bone density by 1 to 8 percent. Comparatively, a group of women who didn’t receive any supplementation over the same period had rapid loss of bone density.
To figure out how much magnesium you need, just take your calcium dose and divide it in half, suggests Dr. Schoenbeck. If you’re taking 1,000 milligrams of calcium, for instance, you should take about 500 milligrams of magnesium.
The least absorbable form of magnesium is magnesium oxide, says Dr. Brody. You’ll do better with magnesium aspartate, she says.
Add K and Boron
Vitamin K is a bit of a forgotten vitamin. It certainly doesn’t get much mention in the media, but it’s very important for maintaining bone health. It helps reduce the amount of calcium you lose through urine, says Dr. Schoenbeck.
Vitamin K is also crucial to the formation of osteocalcin, a protein that is the matrix upon which calcium is put into the bone. "Vitamin K is kind of like the foundation that calcium builds on," Dr. Schoenbeck says.
The Daily Value for vitamin K is 80 micrograms. Since this vitamin is abundant in green leafy vegetables and whole grains, a diet rich in these foods may supply you with your daily quota.
Boron, a trace mineral that is found in many vegetables and fruits, helps reduce the amount of calcium and possibly magnesium that you excrete in your urine. It may also help to slightly raise estrogen levels, which could prevent bone loss as well, says Dr. Schoenbeck. Because of that same estrogen-increasing property, however, women with breast cancer should avoid it, she says. A safe daily amount for women with no breast cancer history is three milligrams, says Dr. Schoenbeck.