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Q Recently, my great-aunt completed her DEXA scan and was diagnosed with osteopenia. How can we best support her so she does not progress to osteoporosis? — QT, Greenville
A Kyajia Mourning and Michael Denning are second- and fourth-year medical students who wanted to explore the relationship between nutrition and bone health throughout life to be able to help their future patients and their own families. Here is their advice to you.
Growing up, our grandmas often said, “Enjoy your youth, because one day growing pains will turn into groaning pains.” As kids, we were often told to drink milk and eat cheese to grow big and strong, showing us early on how valuable bone health is. Our bones give our bodies structure, protect our organs and help us move. As we get older, it is important to take the right steps to keep our bones strong.
Bones begin to form before we are born and continue until our early to mid-20s. Even after we have stopped growing, our bones are always breaking down and rebuilding. This lifelong process is called “remodeling,” and it helps our bones grow and fixes damage caused by daily activities.
As we age, there are two conditions that older people should know about — osteoporosis and osteopenia. Osteoporosis is a disease where bones have less thickness and poor structure. It makes the bones weak and more likely to break. It is often called a “silent” disease because it may not be noticed until a fracture occurs. Osteopenia is when bones are weakened but are not yet as weak as in osteoporosis. It is often a warning sign that osteoporosis could happen later.
There are some key nutrients that are important for keeping our bones strong. Calcium is the most important. Our bodies do not make calcium, so we must get it through food or supplements. Not having enough calcium can lead to the body taking it from our bones, which weakens them over time. If you are following a vegan or plant-forward diet, watching and maintaining one’s calcium levels are even more necessary. Normally, women over 50 need 1,200 milligrams each day and men over 50 need 1,000 to 1,200 milligrams.
Some good sources of calcium are fortified orange juice (300 milligrams per cup), fortified plant-based milk such as almond, rice or soy milk (350-400 mg per 8-ounce serving), canned salmon (180 mg per 3-ounce serving) and leafy green vegetables like kale (90 milligrams per cup) and broccoli (43 milligrams per cup). Since there are only a limited number of foods that deliver calcium and vitamin D, we suggest reading Nutrition Facts Labels to check the vitamins in your meals and add up your intake from meals and snacks. If you notice you are not meeting the recommended amount of calcium and are never in the sunshine, feel free to connect with your health care provider to discuss if you would benefit from calcium or other supplements.
Vitamin D is another important nutrient for bone health. It helps our bodies absorb calcium. It also helps control blood levels of calcium and phosphorus, both needed for making bone. Vitamin D is not naturally found in many foods but can be taken in from fortified milk, fortified cereal and fatty fish. Our bodies can make vitamin D through sunlight exposure, but the amount depends on factors such as time of day, season and skin color.
Protein, the building block of life, is essential for building and keeping strong bones. It works with calcium and phosphorus to make bones stronger. Some foods that have a lot of protein include lean meats, fish, dairy products, beans, peas, lentils, nuts, seeds, quinoa and soy products.
Besides eating the right foods, there are other ways to keep your bones healthy. Weight-bearing activities like brisk walking, jogging, racket sports and dancing are all effective ways to promote bone density.
Regular bone density testing like DEXA scans is also important. A DEXA scan is a quick, painless imaging test. During the scan, you will lie on a table while a low-dose X-ray machine measures your bone strength. It mainly focuses on the spine and hips. The scan takes about 10-20 minutes and is safe, with minimal radiation exposure. Women should begin screening at age 65 (or earlier if there are risk factors) and continue every two years after that.
Bone health is an important part of our quality of life and overall well-being. There are many helpful resources with tips to make sure you get enough nutrients every day. The Mediterranean diet is good for bone health. It’s full of fruits and vegetables, which are high in vitamin C, and includes lean meats that provide protein. Another great option is the DASH diet. It also has lots of fruits, vegetables and lean meats, plus dairy products, which add more calcium. MyPlate is a useful tool because it offers advice based on your lifestyle and health goals. Many other diets and resources can also help keep your bones strong, and they all focus on eating foods that are rich in calcium and protein.
Choosing the diet that best fits you and staying active and getting regular bone density tests can keep your bones strong and reduce the risk of osteoporosis and other bone-related issues.
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