Deborah McInerney, MS, RD, CDNClinical Nutritionist

Hospital for Special Surgery

NUTRITIONand

BONE HEALTH

November 7, 2012

Why is Nutrition Important?

Helps maintain weight and soft tissue which protects and cushions your bones, especially in the event of a fall

Ensures adequate intake of crucial nutrients

Small changes in diet,

exercise and

medication can help

prevent a broken bone.

Assessing Your Diet

24-Hour Recall

Well-balanced diet

Too much/little of certain nutrients

Overall caloric intake

Diet restrictions/intolerances

Calcium and vitamin D

Calcium and

Vitamin D

Recommendations

Why are Calcium andVitamin D Important?

Calcium – helps build and maintain strong bones

Vitamin D – plays major role in calcium absorption, therefore bone health; may increase muscle strength to help prevent falls in older adults

November 30, 2010

Institute of Medicine

(IOM) announced

new reference values

for calcium and

vitamin D

Please note that your doctor

may prescribe much more

vitamin D than the

“recommended” amounts if

you are at risk for (or

have) a low vitamin D

level.

Why So Much Vitamin D?

High risk of deficiency for those with:

Advanced age

Malabsorptive issues

Chronic renal insufficiency

Housebound individuals

Chronic illness

Limited sun exposure

MEETING NEEDS

FOOD ANDSUPPLEMENTS

Food First

Preferred source of calcium for body

Dairy foods are richest sources of calcium

Improved dietary patterns

Nutrient density

Dairy Foods

Milk 1 cup (8 oz) 300 mg*

Yogurt, plain 1 cup (8 oz) 300-400 mg

Cheese 1 ounce 200 mg

Milk pudding, ready-to-eat

½ cup (4 oz) 55 mg

Frozen yogurt ½ cup 100 mg

Ice cream ½ cup 84 mg

Non-Dairy Foods

Almonds 1 ounce 70 mg

Broccoli 1 cup 40-80 mg

Kale ½ cup 90 mg

Salmon, canned with bones

3 ounces 180 mg

Sardines, in oil with bones

3 ounces 325 mg

Soybeans, cooked

1 cup 260 mg

Calcium-Fortified Foods

Juices

Cereals

Breakfast bars

Sports bars

Granola bars

Rice/soy milk

Waffles

Hot chocolate

Cottage cheese

Tofu

Dietary Challenges

Lactose intolerance

Dairy Allergy

Vegetarianism

Lactose Intolerance

Inability to digest lactose, the milk sugar

Know degree of intolerance

Choose lactose-free/reduced, soy or rice milk

Try smaller portions or take with other foods

May tolerate cultured and aged products such as yogurt and/or hard cheese

Dairy Allergy or Vegetarianism

Calcium-fortified soy/rice products

Non-dairy, calcium-fortified beverages

Non-dairy, calcium-rich foods

Sources of Vitamin D

Eggs

Fortified foods

Fatty fish

Vitamin supplement

Sunlight – limited benefit

Vitamin D Food Sources

Eggs

Fatty fish

mackerel, salmon, sardines

Fortified milk, juice, cereals

Vitamin D Food ContentFOOD VIT D (IU)

Cod liver oil, 1 Tbsp 1360

Swordfish, cooked, 3 oz 566

Sockeye salmon, cooked, 3 oz 447

Tuna, canned in water, 3 oz 154

Milk, 1 cup (8 oz) 115-124

Orange juice, fortified, 1 cup 100-137

Egg, 1 25-40

D – The Sunshine Vitamin

Limitations of sun exposure

• Age (over 70)

• UV protection

• Suncreen/spf clothing 8 blocks

• Cloud cover/air pollution/season

• Skin pigmentation

• Amount of skin exposed

Supplements

Not monitored by the FDA

Look for calcium with vitamin D (D2 or D3)

Most common types – carbonate, citrate

Take carbonate with food; citrate on empty stomach

Calcium chews or liquid if problems swallowing

Divided doses of ≤500-600 mg each

Drink plenty of fluids

Start slowly

Excessive Supplementation

More is not necessarily better

Calcium – try not to exceed 2000 mg OR 2500 mg food and supplements

? whether >1500 mg calcium is beneficial

Excessive calcium may affect zinc, iron and magnesium absorption

Possible vitamin D toxicity >2000 IU for adults*

Choosing a Supplement

Common brand namess that contain bothcalcium & vitamin D

Citracal, Oscal, Caltrate, Nature Made

Look for a USP symbol Indicates supplement has been tested to ensure it

contains ingredients listed on label, that it is pure from lead and other metals, and that it is dissolvable in your stomach

To test dissolvability, drop supplement into a glass of clear vinegar, stirring

occasionally.

If it disintegrates within 30 minutes, it should do so in your stomach too.

Nutrients to Consider

Protein

Sodium

Fiber

Caffeine

Oxalates

Phytates

Where To Begin

Assess your diet for adequacy

Focus on calcium and vitamin D

How much do you currently get from food and/or supplements?

Find out what you need to change

Increase/decrease specific nutrients

Reading Food Labels

Calcium % based on

1000 mg

30% = 300 mg

Estimating Calcium Intake

PRODUCT AMT OF CALCIUM

Milk (8 oz) 300 mg

Yogurt (6-8 oz) 300 mg

Cheese (1 oz/1” cube) 200 mg

Fortified orange juice (1 cup)

300 mg

TOTAL 1100 mg

Additional Resources

New York State Osteoporosis

Prevention & Education Program

(NYSOPEP)

SUNY Upstate Medical University

http://www.upstate.edu/nysopep/

Additional Resources

National Osteoporosis Foundation (NOF)1232 22nd Street NWWashington, D.C. 20037-12021.800.231.4222http://www.nof.org/

Additional Resources

The National Institutes of Health (NIH)

Osteoporosis and Related Bone

Diseases – National Resource Center

2 AMS Circle

Bethesda, MD 20892-3676

1.800.624.BONE

http://www.niams.nih.gov/Health_Info/bone/

Additional Resources

Office of Dietary SupplementsNational Institutes of Health6100 Executive Blvd., Room 3B01, MSC 7517Bethesda, MD 20892-7517301.435.2920http://ods.od.nih.gov/