Osteoporosis - what is it and what can you do to avoid it?

It is common place for the food industry to push consumption of dairy products due to their supposed preventative properties against osteoporosis.  Osteoporosis, however, has many risk factors, with calcium intake being just one of the many avoidable risk factors and there are a number of non-avoidable risk factors also. 

So what exactly is osteoporosis? In simple terms, it is a disease of the skeleton which is recognised by low bone mass, causing bone thinning and an increased susceptibility to fractures.   The bone thinning in particular can be a chronically painful experience, and can particularly affect the back, whereas bone fractures can reduce mobility and lead to a loss of independence. 

In order to reduce the risk of developing osteoporosis in later life (from 45 onwards bones start to lose their structure) it is important to have good stores of calcium in bones.  That means consuming the recommended intake of 700mg per day of calcium from various different food sources.  But it also means recognising the other risk factors involved.  Smoking, for example, significantly affects the risk of fractures in premenopausal women and in men, and similarly, excessive alcohol consumption is a risk factor.  Body weight is positively associated with bone mass, and so maintaining a healthy BMI is important.  Intentional weight loss results in an increased rate of bone loss, particularly in cases where an eating disorder is present where it leads to low oestrogen levels. 

Vitamin D is important to help the body absorb calcium, and it can be made through exposure of the skin to sunlight.  It is also present in some food sources, such as eggs, dairy, fish and fortified cereals and orange juice.  If you don’t live in a country where you get regular sun exposure (about 10-15 minutes a day, free from sunscreen), then it might be worth considering a supplement of vitamin D.

Regardless of the above, even with the greatest intentions with diet and lifestyle, some people are at a higher risk of osteoporosis than others.  These are considered the non-avoidable risk factors, the most recognisable of which is gender.  Women simply are at a greater risk of developing osteoporosis than men.  But the risks also increase with age and can be influenced by the size of the frame of the individual, with smaller frame size tending to be at higher risk of developing the disease.  If there is a family history of osteoporosis, particularly a parent or sibling, an individual is considered to be in a higher risk category, and low levels of oestrogen at any time, but particularly during menopause increases the risk also.

So whilst it is important to be aware of adequate calcium intake, it is also good to understand the other factors that influence the risk of developing the disease.  As with all health related issues, a balanced diet and an active lifestyle, free from smoking and excessive alcohol consumption, is the best defence.  Ensuring that children and adolescents, in particular, also achieve optimum bone mass and that they maintain this during early adulthood will reduce future risk of bone loss in later life.  

How to get adequate calcium with a dairy free diet

We are continuously fed information about the “importance” of dairy products for our overall health, in particular the value of milk as a source of dietary calcium.  The truth is, for the 75% of the population with dairy intolerances, the consumption of milk and dairy is impacting on their overall wellbeing and not leading to improvements in bone health.  In fact, in countries where the least amount of dairy is consumed, the occurrence of osteoporosis is also reduced.

Calcium is certainly a very important mineral, and according to the Food Safety Authority in Ireland, we require about 800 mg/day to maintain bone health, with an increase to 1,200 mg/day for teenagers, pregnant and lactating women.  So if we cut milk and dairy products from our diets, where can we then get the necessary requirements for calcium? It’s easier than you might think.

A 200ml glass of whole milk provides approximately 236 mg of calcium.  So in order to obtain the required daily amount, you would need to take in about 680 ml of milk per day.  That’s quite a lot of milk! But using calcium rich foods as a source and can simultaneously ensure a varied diet, rich in other nutrients.  These are just a few sample menus, but do bear in mind that different brands may have more or less calcium:

Non-vegan/vegetarian:

Breakfast

1 slice calcium fortified bread – 175mg

1oz almond butter – 80mg

8oz glass calcium fortified orange juice (not from concentrate) – 300mg

Snack

2 kiwis – 100mg

Lunch

60g canned sardines in oil – 240mg

1 slice calcium fortified bread – 175mg

1 cup raw Kale – 55mg

Snack

½oz whole roasted sesame seeds/hummus containing 1tbps tahini – 140mg

Dinner

Burrito, including the following:

2 corn tortillas – 85mg

1 cup pinto beans – 75mg

1 cup brown rice – 50mg

Approximate Daily Calcium Intake = 1,475 mg

Vegan/Vegetarian:

Breakfast

30g Instant porridge oats – 125mg

200 ml calcium enriched soy milk – 240mg

Snack

1 slice calcium fortified bread – 175mg

Lunch

Salad prepared with the following:

120g raw cress – 188mg

120g raw broccoli – 112mg

10g wakame – 15mg

Snack

30g almonds – 75mg

Dinner

Stir fry, including the following:

120g tofu – 126mg

1 cup cooked spinach – 240mg

Approximate Daily Calcium Intake = 1,296mg

Also of note is that both Vitamin D and magnesium are necessary for calcium absorption.  If we were exposed to at least 30 minutes of sun per day, our bodies would make the necessary Vitamin D and we wouldn’t have to worry.  In Ireland, due to both our weather and lifestyles, this isn’t always possible.  For non-vegans, sources of Vitamin D include eggs, fatty fish and liver, and for vegan diets, fortified foods such as non-dairy milks, orange juice and cereals are good sources.  In terms of magnesium, almonds and cashews are good sources, along with dark leafy vegetables and whole grains. 

When considering you daily requirement for calcium, do give consideration to the fact that salt and caffeine can decrease calcium retention.  If you have a diet that is high in either of these, it may be worth increasing your own personal intake of calcium to ensure you have an adequate supply.