Dear Doctor: Last fall at my annual checkup, my doctor ordered a bone density test. Besides talking to me about osteoporosis in general, she also suggested calcium supplements. I wonder if you have any advice about which supplements are best, and also about maintaining bone health.
Dear Reader: You’ve already taken the first step to protecting bone health by getting a bone density test. This is a simple scan that, as the name suggests, measures bone mineral density.
Although they seem static, our bones are metabolically active organs. They are in constant flux, with old bone being removed and new bone being made. Most of us reach peak bone mass in our late 20s to mid-30s. At that point, the balance of bone metabolism shifts. Bone loss gradually begins to exceed bone creation. Factors such as menopause, inactivity and certain medications can accelerate bone loss. A bone density test gives you an idea of where you are in the process. It does this via a score that compares your bone density to that of a young adult, measuring your bone health on a scale that ranges from normal through low bone mass and to established osteoporosis. It is recommended that all women age 65 and older and men age 70 and older should have a bone density test.
While calcium supplements have their place in keeping our bones strong and healthy as we age, they’re just one part of a broader strategy. To maintain skeletal health and integrity, we also need to focus on a nutritious diet that includes sources of not only adequate calcium, but also potassium, magnesium and vitamin D. That means eating from a wide range of fresh fruits, vegetables, leafy greens, lean meats, dairy products, healthful oils, seeds, beans and legumes.
To help meet their calcium needs, postmenopausal women may need to turn to supplements. Guidelines suggest getting from 1,000 to 1,200 milligrams of calcium daily, with at least half of that coming from dietary sources. Calcium carbonate, at 40% elemental calcium, and calcium citrate, at 21% elemental calcium, are the two main forms of supplements. Newer research has hinted at potential cardiovascular risks linked to the overuse of calcium supplements. With that in mind, we recommend meeting as much of your calcium need as possible through diet, and limiting daily supplements to a maximum of 500 mg per day.
The final piece of the bone-health puzzle is exercise. Specifically, strength training and weight-bearing exercises. Research shows that bone responds to load-bearing exercise by remodeling, which is the complex process that results in the formation of new bone. This includes exercises such as lifting weights, climbing stairs, skipping rope, dancing, running or playing tennis, to name just a few. Regular exercise also improves balance and coordination, which are important to prevent falls. It’s always important to check with your doctor about the type of physical activity that is appropriate for your unique situation. This is particularly true for anyone who is frail or has been diagnosed with thinning bone or osteoporosis.
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