Proper nutrition is an integral part of maintaining healthy bones and preventing falls. Learn more about Nutrition Services at Burke: http://www.burke.org/rehab/patientinfo/nutrition-dietician-consult

1. NUTRITION
and
BONE HEALTH
November 7, 2012
Deborah McInerney, MS, RD, CDN
Clinical Nutritionist
Hospital for Special Surgery

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. Small changes in diet,
exercise and
medication can help
prevent a broken bone.

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. Calcium and
Vitamin D
Recommendations

6. Why are Calcium and
Vitamin 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. November 30, 2010
Institute of Medicine
(IOM) announced
new reference values
for calcium and
vitamin D

9. 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.

10. 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. MEETING NEEDS
FOOD AND
SUPPLEMENTS

12. Food First
 Preferred source of calcium for body
 Dairy foods are richest sources of
calcium
 Improved dietary patterns
 Nutrient density

13. Dairy Foods
Milk 1 cup (8 oz) 300 mg*
Yogurt, plain 1 cup (8 oz) 300-400 mg
Cheese 1 ounce 200 mg
Milk pudding, ½ cup (4 oz) 55 mg
ready-to-eat
Frozen yogurt ½ cup 100 mg
Ice cream ½ cup 84 mg

14. Non-Dairy Foods
Almonds 1 ounce 70 mg
Broccoli 1 cup 40-80 mg
Kale ½ cup 90 mg
Salmon, canned 3 ounces 180 mg
with bones
Sardines, in oil 3 ounces 325 mg
with bones
Soybeans, 1 cup 260 mg
cooked

15. Calcium-Fortified Foods
 Juices  Rice/soy milk
 Cereals  Waffles
 Breakfast  Hot chocolate
bars  Cottage
 Sports bars cheese
 Granola bars  Tofu

16. Dietary Challenges
 Lactose intolerance
 Dairy Allergy
 Vegetarianism

17. 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

18. Dairy Allergy or Vegetarianism
 Calcium-fortified soy/rice products
 Non-dairy, calcium-fortified
beverages
 Non-dairy, calcium-rich foods

19. Sources of Vitamin D
 Eggs
 Fortified foods
 Fatty fish
 Vitamin supplement
 Sunlight – limited benefit

20. Vitamin D Food Sources
 Eggs
 Fatty fish
 mackerel, salmon, sardines
 Fortified milk, juice, cereals

21. Vitamin D Food Content
FOOD VIT D (IU)
Cod liver oil, 1 Tbsp 1360
Swordfish, cooked, 3 oz 566
Sockeye salmon, cooked, 3 oz 447
Tuna, canned in water, 3 oz 154
Milk, 1 cup (8 oz) 115-124
Orange juice, fortified, 1 cup 100-137
Egg, 1 25-40

22. 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

23. 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

24. 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*

25. 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

26. 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.

27. Nutrients to Consider
 Protein
 Sodium
 Fiber
 Caffeine
 Oxalates
 Phytates

28. 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

29. Reading Food Labels
Calcium % based on
1000 mg
30% = 300 mg

30. Estimating Calcium Intake
PRODUCT AMT OF CALCIUM
Milk (8 oz) 300 mg
Yogurt (6-8 oz) 300 mg
Cheese (1 oz/1” cube) 200 mg
Fortified orange juice 300 mg
(1 cup)
TOTAL 1100 mg

31. Additional Resources
New York State Osteoporosis
Prevention & Education Program
(NYSOPEP)
SUNY Upstate Medical University
http://www.upstate.edu/nysopep/

32. Additional Resources
National Osteoporosis Foundation (NOF)
1232 22nd Street NW
Washington, D.C. 20037-1202
1.800.231.4222
http://www.nof.org/

33. Additional Resources
The National Institutes of Health (NIH)
Osteoporosis and Related Bone
Diseases – National Resource Center
2 AMS Circle
Bethesda, MD 20892-3676
1.800.624.BONE
http://www.niams.nih.gov/Health_Info/bone/

34. Additional Resources
Office of Dietary Supplements
National Institutes of Health
6100 Executive Blvd., Room 3B01,
MSC 7517
Bethesda, MD 20892-7517
301.435.2920
http://ods.od.nih.gov/