Bone Health

How can I keep my bones healthy and strong?

Be sure to get the recommended amount of calcium and Vitamin D. Adults 19 to 50 years old should have an intake of 1,000 mg of calcium daily (the equivalent of slightly less than 4, 8-oz. servings of milk or soy substitute). . Vitamin D helps the gastrointestinal tract absorb calcium. The recommended vitamin D intake is 400 to 800 IU per day. Although some of our vitamin D is manufactured in our skin after exposure to sunlight, we cannot rely on the sun to produce all the vitamin D we need, especially in northern areas like New England. Supplementation of vitamin D should not exceed 2,000 IU per day, due to potential toxicity.

What are the best sources of calcium in food?

Nutritionists believe that it is preferable to choose food over calcium supplements if possible since calcium rich foods contain many other nutrients that work with calcium to keep your bones healthy. Some studies have shown, however, that a mix of calcium supplements and calcium-rich foods produces better outcomes.

Milk Group (or Milk Substitute)
The milk group (or a fortified substitute) is the best source and you should try to get "4 a day." About four servings of dairy (each about 300 mg) provides slightly more than the daily goal of 1,000mg calcium. Three servings plus a 500mg calcium supplement would also give you the needed amounts. Dairy products are a particularly good source of calcium because they are also fortified with vitamin D.

All types of milk 1 cup 300 mg
Calcium-fortified soy milk 1 cup 300 mg
Low-lactose milk 1 cup 300 mg

Yogurt
All yogurts 1 cup 350-400 mg
(top off your baked potato or add fruit to make a smoothie)

Cheese and Ice Cream
Swiss cheese 1.5 oz 408 mg
American cheese 2 oz 348 mg
Cheddar cheese 1.5 oz 306 mg
Mozzarella cheese (skim) 1.5 oz 311 mg
(top off your salad)
Parmesan cheese, grated 1 oz 390 mg
(top off your pasta)
Low-fat cottage cheese 1/2 cup 78 mg
Typical ice cream 1/2 cup 88 mg

Meat/Protein Group
Sardines with bones 3 oz. 371 mg
Canned Salmon with bones 3 oz 167 mg
(good substitute for tuna)
Almonds 1/3 cup 120 mg
Tofu (calcium-fortified) 1/2 cup 258 mg

Vegetable Group
Kale 1/2 cup 90 mg
Okra 1/2 cup 88 mg
Beet greens 1/2 cup 82 mg
Broccoli 1/2 cup 47 mg
(Dark green vegetables are rich in calcium, but little is absorbed. However, they are a good source of vitamin K, which is also important for bone health.)

Fruit Group
Orange 1 52 mg
Calcium-fortified orange juice 8 oz 300 mg
(a very well absorbed source of calcium)
Figs, dried 10 289 mg

Grain Group
Enriched English muffin 1 96 mg
4-inch Pancakes made with milk 2 72 mg
Hamburger bun 1 54 mg
6-inch corn tortilla 1 42 mg
Calcium fortified cereal 1 cup 300 mg
(Start your day with cereal and milk.)

Combination Foods
Cheese pizza 1 slice 220 mg
Taco Salad 1 280 mg
Taco 1 109 mg
Caffe Latte 12 oz 412 mg
Caffe Mocha 12 oz 337 mg
Cappuccino 12 oz 262 mg

Should I take a calcium supplement?

If your typical diet does not allow you to consume enough calcium, calcium supplements should be taken.

Multivitamins with minerals do not have the amount of calcium needed as a supplement.

Calcium supplements exist in different compounds, all available over the counter. Although all of these provide calcium they have different calcium concentrations, and absorption may differ.

The best choices for calcium supplements include:

  • Calcium carbonate pills, especially those that include vitamin D
  • Calcium citrate or maleate pills, especially those with vitamin D. These are more expensive but are absorbed somewhat better.
  • Chewable forms of calcium, such as "Viactiv," or similar generic brands

If you take a multivitamin with vitamin D, you do not need vitamin D in your calcium supplement, too.

You can adjust your daily intake of a supplement, depending on your dietary intake of calcium foods for the day, to approach your goal of 1,000 mg per day.

Women and men diagnosed with osteopenia (below normal bone density) or osteoporosis (more advanced bone loss), need 1500 mg calcium per day through diet and supplements. They should also take 800 IU per day of vitamin D.

What else can I do to keep my bones healthy?

Get regular physical activity.
Physical activity, particularly weight-bearing exercise, applies tension to muscle and bone which encourages the body to compensate for the added stress by increasing bone density. Activities that involve the repeated action of your feet hitting the ground such as brisk walking, jogging, racket sports or aerobic dancing are the best options. Weight training on resistance machines or with free weights also strengthens bones. Swimming and bicycling promote fitness but they aren't bone builders.

Maintain a healthy weight.
If you cut back on food to cut calories, you may come up short on calcium, too. Too great a gap between caloric intake and energy expenditure affects estrogen levels in women. Because estrogen helps deposit calcium in the bones, you lose the natural protections that hormones provide against bone loss and increase your risk for osteoporosis. A return to normal eating and exercise patterns may lead to return of normal menstrual periods and prevent further bone loss. However, affected women may live the rest of their lives with weakened bones, leading to impaired mobility, chronic pain and deformity. This is also true for men who become significantly undernourished and underweight; changes in testosterone levels produce calcium losses that can eventually result in osteoporosis (as well as the other chronic issues described above).

Avoid smoking.
Smoking is bad for your bones as well as your heart and lungs.

Go easy on alcoholic drinks.
Excessive drinking interferes with calcium absorption.

Be moderate with caffeine intake.
Moderate caffeine intake (1 cup of coffee or 2 cups of tea per day) has a small effect on calcium absorption. It can temporarily increase calcium excretion and may modestly decrease calcium absorption.  If intake of caffeine is significantly higher, and if a person has a poor dietary intake of calcium to begin with, the effects on calcium balance would be much more significant.

Can I make an appointment at Health Services?

If you are a Brown student and you are have concerns about nutrition and bone health, Health Services offers the services of a registered dietitian. You can make an appointment to see her by calling 401.863-2794. These appointments are free for Brown students. Health Services is located at 13 Brown Street on the corner of Brown and Charlesfield Streets.

Links you can use

Health Education: Osteoporosis

Medline PLUS

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Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.