Thin, fragile struts of bone, called trabeculae, are characteristic of severe osteoporosis. Image courtesy of David Gregory and Debbie Marshall, Wellcome Images.
Boning Up on Osteoporosis
Our bones are living tissues in a constant state of healthy repair and renewal. When that doesn’t happen or doesn’t happen enough, bones can become more hollow and vulnerable to sudden fractures and breaks, which can lead to even more serious health complications.
The condition is called osteoporosis, and it’s a national affliction: More than 44 million Americans currently suffer from low bone density (LDB) or osteoporosis. As our population ages, that number will likely grow. The National Osteoporosis Foundation estimates half of all Americans over the age of 50 will suffer from (LBD) or the disease itself by 2020.
Many things cause or contribute to osteoporosis. The biggest factors are age and gender. The majority of people with osteoporosis are older and female. It’s estimated that one in two women and one in four men over the age of 50 will break a bone due to osteoporosis.
A lot is known about osteoporosis, but the disease can still be pretty confusing. For example, the Institute of Medicine (IOM), which advises the federal government on health issues, has recommended that women older than 50 supplement their diets with calcium and vitamin D, but the U.S. Preventive Services Task Force (USPSTF), another health advisory group, recently said there’s no evidence that supplementation makes a measurable difference.
For some answers, we turned to Deborah Kado, MD, and Heather Hofflich, DO. Both are specialists in treating osteoporosis in the UC San Diego Health System.
Q: Where do you stand on the issue of vitamin D and calcium supplements? The IOM says women older than 50 should consume 1,200 milligrams of calcium daily to promote bone health, but the USPSTF has said low supplemental doses of calcium or vitamin D are ineffective in helping prevent fractures and the evidence for higher doses is unclear.
Kado: The USPSTF is correct in concluding that the available evidence does not support calcium or vitamin D supplementation as effective for preventing fractures. But it is clear that having adequate calcium in the diet and sufficient vitamin D are important in maintaining bone health. My recommendation (in line with current FDA regulations) is that older women and men should take about 1,200 mg of calcium daily. The average American consumes about 500 to -600 mg, so I usually advise that additional calcium supplementation of about 600mg is ideal.
With regard to vitamin D, having sufficient levels is important for optimizing the amount of calcium in the bone. This vitamin helps ensure adequate calcium absorption from the gut and also favors keeping a good balance of calcium in the bone. I generally recommend 800 to 1,000 IU daily of vitamin D3.
Q: What about findings that suggest high calcium intake may increase the risk of heart disease in women?
Kado: Even prior to recent publications suggesting that women who take calcium supplementation greater than 800 mg daily are at increased risk of heart attacks and mortality, there were some physicians who voiced belief that taking calcium could lead to calcium build-up in the arteries. However, this assumption is simply an hypothesis with no sound evidence to support it. My personal view is that patients should be aware of their daily calcium intake, try to achieve at least 600 mg and generally not take more than 800 mg daily in supplements.
