On Nutrition

Bone health is serious business. After all, your bones are the foundation you stand on (supported by your muscles, tendons, ligaments and cartilage, of course). So it’s no laughing matter that one in two women age 50 or older, and one in four men, will break a bone due to osteoporosis.

Most people have no idea they have osteoporosis until they break their wrist, hip or vertebrae in the spine. A recently released report by the National Osteoporosis Foundation (NOF) found that only 9% of women covered by Medicare fee-for-service who suffered an osteoporosis-related fracture had previously received a bone mineral density test.

Ideally, we develop bone-healthy habits in childhood, because our best bone-building years end in our mid-20s. After that, we start to slowly lose bone mass, and in women, that loss temporarily speeds up for about five years post-menopause. Because 70% of our bone density is based on heredity, you’re at greater risk of osteoporosis if you have a family history of it — but that doesn’t mean you’re powerless. Most people fear fractures more than the osteoporosis itself; that’s why any action plan should include improving bone mass and preventing fractures, which often means preventing falls.

Building stronger bones

This may go without saying, but it’s important to get enough calcium in your diet. The NOF recommends that women get 1,000 milligrams (mg) of calcium per day up to age 50 and 1,200 mg per day after that. Men need the same amount, but their transition age is 70. Obtaining calcium from food sources is ideal, but it’s safe to use supplemental calcium to make up any dietary shortfalls. I say “safe” because reports that calcium supplements increase the risk of cardiovascular disease scared many people away from them several years ago. However, a recent, rigorous review of the evidence by the NOF and the American Society of Preventative Cardiology concluded that as long as calcium intake from food and supplements doesn’t exceed 2,000-2,500 mg per day, you should be fine.

I’m often asked if dairy is good for bones. Much has been made of studies finding that populations that consume more dairy tend to experience more fractures. Correlation doesn’t equal causation, and there are a number of variables at play. First, not every study has found the same association between dairy consumption and fractures. Second, countries that consume more dairy also tend to experience more snow and ice in the winter — a perfect setting for slipping and falling. Keep in mind that dairy foods are rich in bone-building nutrients other than calcium.

Other sources of calcium include canned sardines and salmon that still have their bones (the canning process makes the bones soft enough to eat), tofu made with calcium, tempeh, calcium-fortified soy milk and other foods, and some dark, leafy vegetables. Collard greens, broccoli rabe, turnip greens and kale are the best of the bunch. Spinach and beet greens unfortunately contain oxalic acid, which makes its calcium unavailable to us, although cooking greatly reduces that effect. In case you’re curious, eating a food with oxalic acid does not affect absorption of calcium from other foods you eat during the same meal. The same is not true for wheat bran — if you eat wheat-bran cereal with milk, you will only absorb some of the milk’s calcium.

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Since we’re talking about greens, it’s worth noting that a diet rich in fruits and vegetables is good for your bones, providing the antioxidants, potassium, magnesium, vitamin K and vitamin C that play a role in bone health. You also need vitamin D, which is essential for absorbing calcium. Most people can produce enough vitamin D through their skin, but little things like clothing and sunscreen interfere, for good reasons. Accordingly, 800-1,000 IU of supplemental vitamin D with food is recommended for osteoporosis prevention, especially here in the Northwest. Vitamin D food sources include fatty fish and fortified foods, while mushrooms contain variable amounts. Another way that fatty fish helps bones is by providing the omega-3 fatty acids EPA and DHA. Those, along with the plant-based omega-3 ALA from walnuts and flax seed can help reduce inflammation in the body — important, because inflammation can accelerate bone loss.

Preventing fractures

Fortunately, many behaviors that help you build bone mass also help you build muscle. Maintaining muscle as you age makes it more likely that you can stop a fall — and prevent a fracture — if you lose your balance. No wonder that physical activity — especially weight-bearing exercise like walking, running and resistance/strength training, which stimulate bones and muscles — are effective at preventing fractures. Exercises that help maintain balance, such as tai chi, can also help avoid falls.

Pairing that exercise with adequate protein is even better. Divide your weight in pounds in half to estimate your protein goal in grams. So, if you weight 150 pounds, aim for 75 grams (g), or about 11 ounces, of protein per day. To put that in perspective, 1 ounce equivalent (7 g) of protein equals 1 ounce of meat, poultry or fish, one egg, ¼ cup cooked beans, 1 tablespoon of peanut butter or ½ ounce of nuts or seeds.

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Salmon and White Bean Salad

This simple salad is rich in calcium (432 mg), protein (28 g), fiber (11 g) and other bone-healthy nutrients. Serves 3.

1 6-ounce can of salmon with bones, drained

1 15-ounce can of white beans, drained and rinsed

3 cups baby kale leaves

3 tablespoons sesame seeds

3 tablespoons capers, rinsed

2 tablespoons extra-virgin olive oil

2 tablespoons fresh lemon juice

Salt and pepper to taste

1. Place salmon in a medium bowl and break up with a fork. Add beans, kale, sesame seeds and capers; gently toss to combine.

2. In a small bowl, whisk olive oil and lemon juice, pour over salad and gently toss to combine.

3. Add salt and pepper to taste, stir again and serve.