DAVID R. MARKS, MD: Welcome to our webcast. I'm Dr. David Marks. When I say "osteoporosis prevention," the first word that should pop into your head is "calcium." Low calcium intake has been shown to cause low bone mass. You need to get the right amounts starting early in life. But how much is enough, and can you get enough from your diet alone?
Joining me to talk about calcium, as well as some other dietary issues, is Dr. Paula Rackoff. She's Assistant Chief of Rheumatology at Beth Israel Medical Center in New York. Thanks for being here.
Now tell me, if you have bone density that's normal now, what role does that play in your chances of getting the disease later on?
PAULA RACKOFF, MD: It really depends on what age you have had the bone density test and whether it's determined to be normal relating to someone your own age.
DAVID R. MARKS, MD: So if a person is under 30, let's say, and they have normal bone density, is that a good sign?
PAULA RACKOFF, MD: That's a very good sign. It's really a problem if before the age of 30 you don't have a normal bone density.
DAVID R. MARKS, MD: Can they increase their prevention by taking more calcium?
PAULA RACKOFF, MD: Well, calcium and vitamin D can help maintain the bone density that you have, and there are some studies that show that there can even be a small increase in bone density with full calcium and vitamin D supplementation. Certainly, if you don't have enough calcium and vitamin D, then you're assured of bone loss.
DAVID R. MARKS, MD: How common is that?
PAULA RACKOFF, MD: Actually, it's quite common. The average American male or female only gets about 700 mg of calcium in their diet, so calcium deficiency is quite common. Vitamin D deficiency in young people is less common because we actually only need about 15 minutes of sun exposure for the active form of vitamin D to get into our circulation. When we're older, beyond 55 years of age, that's when vitamin D deficiency becomes more common.
DAVID R. MARKS, MD: How can this be so when we have all these calcium-enriched foods and a lot of advertising about calcium supplementation? Why is it that people aren't getting enough in their diet?
PAULA RACKOFF, MD: I think it depends where you live, and how well aware you are of the calcium-rich foods. I think much of America is still being fed fast-food diets, and there isn't a lot of calcium and vitamin D supplementation in those foods.
DAVID R. MARKS, MD: So what kind of foods should people be eating?
PAULA RACKOFF, MD: For calcium, it's really dairy products, juices that are fortified in calcium, and green, leafy vegetables. For vitamin D it's vitamin D fortified milk, egg yolks, and salt water fish.
DAVID R. MARKS, MD: What is the number of milligrams that a person should get?
PAULA RACKOFF, MD: Every premenopausal woman and every man needs approximately 1,000 mg of calcium, and every postmenopausal woman and every individual with a chronic disease, particularly those patients taking corticosteroids, needs 1,500 mg of calcium. The average recommendation for vitamin D is between 400 and 800 units of vitamin D per day.
DAVID R. MARKS, MD: So for a postmenopausal woman, you're really talking about doubling their calcium intake based upon a normal diet?
PAULA RACKOFF, MD: Right.
DAVID R. MARKS, MD: Is that a difficult thing to do without supplements?
PAULA RACKOFF, MD: It is actually more difficult than you would think to get enough calcium in your diet. You really have to be conscious of it, and that's why I really recommend that people at least figure out how much calcium they get on an average day and then supplement their calcium to maximize it to 1,500 mg -- not more than that, but 1,500 mg of calcium.
DAVID R. MARKS, MD: It's easy to say "figure out." How does a person go about figuring out how much calcium is in their food?
PAULA RACKOFF, MD: Most doctors have sheets that they can give patients to help them calculate how much calcium and vitamin D they get in their diet. There are many books out on vitamins. It's actually fairly straight-forward.
DAVID R. MARKS, MD: But people don't do it?
PAULA RACKOFF, MD: But people don't do it, right.
DAVID R. MARKS, MD: There are some other lifestyle components to preventing osteoporosis. Briefly, what are they?
PAULA RACKOFF, MD: It's really exercise -- weight-bearing exercises such as walking, jogging, tennis, soccer. Things like that where you're really using your legs increase bone density. And as we get older, the increase in bone density becomes less significant, but for older patients, weight-bearing exercises and balance training actually increase agility. Remember, what we're really worried about with osteoporosis is fracture, so particularly in our elderly patients, we really want to get them active so that they're more well-balanced and they're less likely to fall.
DAVID R. MARKS, MD: Any last comments about diet and osteoporosis?
PAULA RACKOFF, MD: Just to really pay attention to it, because it can really make a difference in the quality of your life.
DAVID R. MARKS, MD: Thank you for joining our webcast. I'm Dr. David Marks. Goodbye.
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