Osteoporosis Osteoporosis Prevention

Prevention Of Osteoporosis: Maximizing Peak Bone Mass

I often see women in their early forties who bring in the results of a "baseline" bone density measurement test and are shocked to find that they have osteopenia (mild low bone mass) or even osteoporosis (more severe low bone mass). They ask me why they are losing bone so rapidly. In the vast majority of cases, these women are not rapidly losing bone and in fact, have perfectly healthy, normal bone tissue, just less of it. They wonder why, then, if their bones are healthy, they have less bone than the "average" woman's. I explain to them that, ten to twenty years ago, they probably achieved a lower peak bone mass than the "average" woman, probably due to genetic factors. Some women just have smaller and thinner bones than other women.

To understand peak bone mass in another way, think of your skeleton as a retirement bank account. From birth until age 30 or so, you continually make deposits into your account. When you retire at age 30, the deposits stop and you have to start making withdrawals for the rest of your life. Thus, the size of your bank account at age-30-retirement is analogous to your peak bone mass. This is the bone you will have to work with for the rest of your life.

Maximizing Peak Bone Mass

Obviously, we would all like to have the strongest skeletons possible (or the biggest bank accounts!) by the time we reach our thirties. To some extent, this is predetermined by genetics, as mentioned above. Some of us inherit a good skeleton from our families and some of us don't. We can't change our families or our inheritances. What we can change are our lifestyles that account for up to 20% of peak skeletal mass. By "lifestyle" I mean diet, exercise, and habits. A final critical factor is the role of sex hormones.

Diet
Good bone health begins in childhood with the two most important building blocks of the skeleton: calcium and vitamin D. Children need the calcium from milk and other dairy products and green vegetables, such as broccoli and kale, to achieve the strongest bones possible.

To get adequate amounts of calcium, you will need at least 3-5 servings of dairy or other foods high in calcium each day. A typical serving of milk (1 cup) or yogurt (1 cup) contains about 300-400 mg of calcium. Half a cup of ice cream contains 100 mg of calcium. Green vegetables are also good sources of dietary calcium. If your dietary calcium does not add up to what you need, calcium supplements may be used.

So, for children and young adults, it is critical to encourage diets rich in dairy products and to avoid excess amounts of soda and caffeine. The table below shows how your need for calcium varies according to your age and gender. These are the recommended daily allowances for calcium, adapted from the National Academy of Sciences (1997):

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