Nutrition and Bone Health


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Proper nutrition is an integral part of maintaining healthy bones and preventing falls.

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Nutrition and Bone Health

  1. 1. NUTRITION and BONE HEALTH November 7, 2012Deborah McInerney, MS, RD, CDN Clinical Nutritionist Hospital for Special Surgery
  2. 2. 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
  3. 3. Small changes in diet, exercise and medication can helpprevent a broken bone.
  4. 4. 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
  5. 5. Calcium and Vitamin DRecommendations
  6. 6. 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
  7. 7. November 30, 2010Institute of Medicine (IOM) announcednew reference values for calcium and vitamin D
  8. 8. 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.
  9. 9. 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
  11. 11. Food First Preferred source of calcium for body Dairy foods are richest sources of calcium Improved dietary patterns Nutrient density
  12. 12. Dairy Foods Milk 1 cup (8 oz) 300 mg*Yogurt, plain 1 cup (8 oz) 300-400 mg Cheese 1 ounce 200 mgMilk pudding, ½ cup (4 oz) 55 mgready-to-eatFrozen yogurt ½ cup 100 mg Ice cream ½ cup 84 mg
  13. 13. Non-Dairy Foods Almonds 1 ounce 70 mg Broccoli 1 cup 40-80 mg Kale ½ cup 90 mgSalmon, canned 3 ounces 180 mg with bonesSardines, in oil 3 ounces 325 mg with bones Soybeans, 1 cup 260 mg cooked
  14. 14. Calcium-Fortified Foods Juices  Rice/soy milk Cereals  Waffles Breakfast  Hot chocolate bars  Cottage Sports bars cheese Granola bars  Tofu
  15. 15. Dietary Challenges Lactose intolerance Dairy Allergy Vegetarianism
  16. 16. 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
  17. 17. Dairy Allergy or Vegetarianism Calcium-fortified soy/rice products Non-dairy, calcium-fortified beverages Non-dairy, calcium-rich foods
  18. 18. Sources of Vitamin D Eggs Fortified foods Fatty fish Vitamin supplement Sunlight – limited benefit
  19. 19. Vitamin D Food Sources  Eggs  Fatty fish  mackerel, salmon, sardines  Fortified milk, juice, cereals
  20. 20. Vitamin D Food ContentFOOD VIT D (IU)Cod liver oil, 1 Tbsp 1360Swordfish, cooked, 3 oz 566Sockeye salmon, cooked, 3 oz 447Tuna, canned in water, 3 oz 154Milk, 1 cup (8 oz) 115-124Orange juice, fortified, 1 cup 100-137Egg, 1 25-40
  21. 21. 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
  22. 22. 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
  23. 23. 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*
  24. 24. Choosing a Supplement Common brand namess that contain both calcium & 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
  25. 25. 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.
  26. 26. Nutrients to Consider  Protein  Sodium  Fiber  Caffeine  Oxalates  Phytates
  27. 27. 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
  28. 28. Reading Food LabelsCalcium % based on 1000 mg 30% = 300 mg
  29. 29. Estimating Calcium IntakePRODUCT AMT OF CALCIUMMilk (8 oz) 300 mgYogurt (6-8 oz) 300 mgCheese (1 oz/1” cube) 200 mgFortified orange juice 300 mg(1 cup)TOTAL 1100 mg
  30. 30. Additional ResourcesNew York State OsteoporosisPrevention & Education Program(NYSOPEP)SUNY Upstate Medical University
  31. 31. Additional ResourcesNational Osteoporosis Foundation (NOF)1232 22nd Street NWWashington, D.C. 20037-12021.800.231.4222
  32. 32. Additional ResourcesThe National Institutes of Health (NIH)Osteoporosis and Related BoneDiseases – National Resource Center2 AMS CircleBethesda, MD 20892-36761.800.624.BONE
  33. 33. Additional ResourcesOffice of Dietary SupplementsNational Institutes of Health6100 Executive Blvd., Room 3B01,MSC 7517Bethesda, MD 20892-7517301.435.2920