Calcium does not work alone. A healthy diet, weight-bearing physical activity, and vitamin D are also important for developing strong bones.

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1 Calcium and Yu As yu grw, yu need calcium t build strng bnes and a healthy bdy. Getting plenty f calcium while yu are yung als makes yur bnes strng and keeps them strng fr yur entire lifetime. In fact, yur bdy's need fr calcium is at its highest pint between the ages f 9 and 18 years. Hwever, mst yung peple in the United States dn't get enugh calcium in their diets. What is calcium? Calcium is a mineral that many parts f yur bdy need. Its main jb is t build strng bnes and teeth, which cntain 99% f yur bdy's calcium. Yur bnes are a bank fr calcium. A very small amunt f calcium is in bdy fluids such as bld. But this small amunt f calcium des imprtant things. It has a rle in helping yur muscles mve and in cntrlling yur bld pressure. If yu make the right chices, the fds yu eat r the things yu drink can prvide the calcium yu need. If yu dn't get enugh calcium, yur bnes will weaken. This is because yur bdy will take calcium frm yur bnes t meet its needs. Why shuld I bank calcium? When yu are yung, yur bdy can depsit calcium in yur "bne bank" by increasing yur bne density. Density is a measure f hw thick yur bnes are. Higher density bnes are strnger and less likely t break. As yu get lder, yu lse the ability t bank calcium. By the time yu reach yung adulthd, yur bnes reach their peak bne density. That means yur bnes are as dense (r packed with calcium) as they will get fr life. Then yur bdy mainly withdraws calcium frm yur bne bank. Peple wh d nt have enugh calcium in their bne bank can get steprsis when they get lder. Osteprsis is a disease that can make bnes s fragile that they can break frm the stress f just bending ver. Peple with steprsis may nt knw they have the disease until 1 r mre bnes fracture. By this time, it is usually t late t und the damage t their bnes. Is calcium all I need fr strng bnes? Calcium des nt wrk alne. A healthy diet, weight-bearing physical activity, and vitamin D are als imprtant fr develping strng bnes. Healthy diet Prper nutritin is very imprtant t keep bnes healthy. Physical activity Studies shw that regular, weight-bearing activities (such as walking, running, and jumping and playing tennis, basketball, r sccer) help yu build strng bnes. Vitamin D Surces f vitamin D include the fllwing: Sunlight (Yur bdy makes vitamin D when yur skin is expsed t sunlight.) Milk and ther dairy prducts frtified with vitamin D Vitamin D frtified drinks and ther fds, such as cereals (check the label) Multivitamins Hw much calcium d I need? Hw much calcium yur bdy needs varies accrding t age. Yu need the mst calcium between 9 and 18

2 years f age. The American Academy f Pediatrics recmmends the fllwing daily intake f calcium: Age Calcium Need (mg per day) Servings f Milk t Meet Need 4 8 years servings 9 18 years 1,300 4 servings years 1, servings Hw can I get calcium? The best way t get the calcium that yu need is by eating and drinking fds that naturally cntain calcium. Many fds cntain calcium. Lw-fat milk and ther dairy prducts are very gd surces f calcium. They naturally ffer the mst calcium per serving. Fr example, 1 cup f milk has abut the same amunt f calcium as 4 cups f brccli. Many fds cntain sme calcium, but the best surces include the fllwing: Lw-fat milk, ygurt, and ther milk prducts are generally super surces f calcium. Flavred milks, such as chclate r strawberry, have as much calcium as plain milk but may have mre calries. Dark green, leafy vegetables such as kale and turnip greens are lw in calries and high in calcium. Hwever, spinach is nt a gd surce f calcium. Brccli, tfu, chickpeas, lentils, split peas, and canned salmn and sardines (and ther fish with bnes) als are gd surces f calcium. Calcium-frtified juices and cereals can help bst the calcium in yur diet, but limit yurself t 8 t 12 unces (1½ cups) f juice a day. (See "Cunting Calcium" at the end f this handut.) Calcium supplements Certain medical cnditins, diets, r lifestyle chices can make it hard fr yu t get enugh calcium by eating the right fds. In sme cases, yur pediatrician may recmmend a calcium supplement, such as a daily dse f a calcium-cntaining antacid r anther type f calcium supplement. If yu take calcium supplements, dn't take mre than a ttal f 1,000 mg f them a day. Lactse intlerance Sme yung peple have significant lactse intlerance, which means they have truble digesting lactse (the sugar in milk). In mst peple, lactse intlerance is f a mild frm. These peple can digest dairy prducts in small amunts with a meal. Cheeses and ygurts in which the lactse is partially brken dwn can prvide gd surces f calcium fr them. There are preparatins f the enzyme lactase that make lactse easier t digest. Als available is milk with reduced lactse. Nndairy fds that are rich in calcium, as well as calcium-frtified fds, als can be gd chices fr peple wh have lactse intlerance. In sme cases, yur pediatrician may recmmend a calcium supplement. What decreases my calcium intake?

3 The fllwing can hurt yur bne health: Drinking a lt f sda (pp r sft drinks) Studies shw that this may make yu mre prne t bne fractures. This may be because sdas ften take the place f milk r ther calcium-rich drinks. Cla-type sdas als cntain phsphrus, which may interfere with hw yur bdy handles calcium. Certain diets Sme diets may nt prvide enugh calcium, such as a vegetarian diet that excludes dairy prducts. Befre yu start any diet, check with yur pediatrician t make sure it includes enugh calcium. Caffeine, alchl, and tbacc All f these can cause yu t lse calcium frm yur bnes. Certain medicines and diseases Sme medicines and kidney and intestinal diseases can cause yu t lse calcium frm yur bnes. Ask yur pediatrician if any f the medicine yu are taking affects yur bnes and what yu can d t prtect them. What can I d t get mre calcium? There are many ways t get mre calcium, such as Chse milk r smthies instead f sda at restaurants r schl cafeterias. Bst the calcium in salads with beans (such as garbanz r kidney), cheese, brccli, almnds, r tfu. Chse ygurt as a light meal r snack. Create special drinks with milk. Add flavrings. Make shakes r smthies. Use lw-fat ygurt n its wn r with fresh fruit. Add it t pancakes r waffles, shakes, salad dressings, dips, and sauces. Try calcium-rich fds that may be new t yu and yur family. Try calcium-frtified juice and calcium-frtified waffles r cereal fr breakfast. When pssible, chse surces f calcium that are either lw in fat r have n fat at all. Or make trade-ffs in yur fd chices. Fr example, if yu g fr a thick, chclate milk shake, skip the French fries. (Remving fat frm a fd des nt take away calcium.) Hw t read fd labels Fd labels list the amunt f calcium in a serving as "% Daily Value," nt as milligrams (mg). 100% f the Daily Value = 1,000 mg f calcium per day T find ut hw many milligrams f calcium are in a serving, place a "0" at the end f the number listed fr the daily value. Fr example, a serving f calcium-frtified range juice might list the amunt f calcium as 30% f the daily value. 30% Daily Value = 300 mg calcium In general, a fd that lists a daily value f 20% r mre fr calcium is high in calcium. Any fd that cntains less than 5% f the daily value is lw in calcium. Cunting calcium If yu are between the ages f 9 years and 18 years, yu need abut 1,300 mg f calcium each day. Keep track f what yu eat fr a few days t see if yu are getting enugh calcium. If a medical cnditin r restricted diet is keeping yu frm getting the calcium yu need, talk with yur pediatrician.

4 The fllwing tables shw the amunt f calcium in a variety f fds. Calcium amunts may vary. Check nutritin labels n prducts fr exact amunts. Milk Grup Milk*, regular r lw fat, 1 cup Ygurt, nnfat, fruit, 1 cup 260 Cheese, 1-z slice 200 Cheese, pasteurized, ¾-z slice 145 Ice cream, ½ cup 90 Ice cream, sft-serve, ½ cup 115 Frzen ygurt, ½ cup 105 Pudding, instant, ½ cup 150 Sy milk, calcium-frtified, 1 cup Prtein Grup Almnds, chpped, 1 z 65 White beans, cked, biled, 1 cup 160 Salmn, canned with bnes, 3 z 205 Tfu, firm, calcium-frtified, ½ cup 205 Vegetables/Fruits Brccli, cked, 1 cup 60 Cllards, cked, 1 cup 265 Tmates, canned, stewed, 1 cup 85 Orange juice, calcium-frtified, 1 cup 300 Orange, 1 medium 50 Grains English muffin, plain, enriched, 1 95 Pancakes (made with milk), 1 80 Crn trtilla, 1 45 Selected breakfast cereals, calcium-frtified, ¾ 1 cup 100 Instant atmeal (made with water), calcium-frtified, ½ cup 65 Prepared Fds

5 Bean and cheese burrit 110 Cheese pizza, 1 slice 120 Cheeseburger 140 Tac, 1 small 220 *Lw-fat milk has as much r mre calcium than whle milk. Surce: US Department f Agriculture Cpyright 2006 American Academy f Pediatrics The infrmatin cntained in this publicatin shuld nt be used as a substitute fr the medical care and advice f yur pediatrician. There may be variatins in treatment that yur pediatrician may recmmend based n individual facts and circumstances. Reprinted frm:

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