Upcoming 2010 Webinars

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3 Upcoming 2010 Webinars September 22 December 1 Exercise for Your Bone Health by Karen Kemmis, P.T., D.P.T., M.S. Update on Osteoporosis Treatment Options Register at or call (866)

4 Participate in Osteoporosis Support Groups NOF has support groups across the country to provide support and information for people affected by osteoporosis. NOF depends on volunteers like you to serve as support group leaders. To find out if there is a support group in your area or learn how you can start a support group, request@nof.org.

5 Join Steps for Strong Bones Walk, jog or run your way to healthier bones. Steps for Strong Bones is a fundraising and walking program. Join for free and ask your friends and family to support you in your quest for healthy bones with a donation to NOF. For more information visit or events@nof.org.

6 Join the Healthy Bones Advocacy Network NOF's Healthy Bones Advocacy Network is made up of volunteer advocates who reach out to policy makers to highlight the importance of osteoporosis and bone health and help advance NOF's public policy goals. To become an advocate or to learn more, visit

7 Attend A Gift from Mothers to Daughters On September 30, NOF will celebrate the gift of knowledge that generations pass onto future generations. This year s honorees are: Mother-Daughter Activists Marybeth and JC Bond Former First Lady of New York Matilda Cuomo Award-winning Broadcast Journalist Dr. Max Gomez For more information or to get involved, contact Kelly Austin at (202) or kelly.austin@nof.org.

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9 Mission Statement The National Osteoporosis Foundation is the leading consumer and community-focused health organization dedicated to the prevention of osteoporosis and broken bones, the promotion of strong bones for life and the reduction of human suffering through programs of public and clinician awareness, education, advocacy and research. National Osteoporosis Foundation

10 Nutrition for Your Bone Health June 29, 2010 National Osteoporosis Foundation

11 Today s Presenter Jeri W. Nieves, PhD Associate Professor of Clinical Epidemiology Columbia University Helen Hayes Hospital

12 Today We Will Discuss Part 1: How you can use the Dietary Guidelines to choose the right foods for bone health Part 2: Other vitamins and minerals for bone health Part 3: Nutrients and substances that can interfere with the amount of calcium that reaches your bones Part 4: Choosing the right supplements and other products for bone health

13 Part 1: Use the Dietary Guidelines The U.S. Dietary Guidelines can help you choose the right foods for your bone health. The Guidelines that relate to bone health are: 1. Go lean with protein 2. Focus on fruits 3. Vary your veggies 4. Get your calcium-rich foods 5. Engage in regular physical activity This topic will be addressed in the next webinar Exercise for Your Bone Health on September 22

14 Use the Dietary Guidelines The nutrition messages for skeletal health are also good for overall health The Dietary Guidelines for Americans provide science-based advice to: promote health reduce risk for major chronic diseases through diet and physical activity

15 Go Lean with Protein Use Poultry, Fish, Beans, Peas, Nuts & Seeds Get enough protein for bone health, but avoid getting too much protein from meat sources The amount of protein needed each day is about 5 ounces for women and 5½ ounces for men Avoid special diets that are extremely high in protein High intakes of saturated fats may lower bone density Dairy is a good source of protein for bones Children need protein for skeletal growth Older adults are at risk of not getting enough protein

16 Focus on Fruit and Vary Your Veggies Eating more fruits and vegetables can lead to improved bone health in people of all ages Adults need at least 2 cups of vegetables and at least 1½ cups of fruits every day Fruits and vegetables are rich in vitamins, minerals and antioxidants Fruits and vegetables may reduce calcium loss It s best to get vitamins and minerals from fruits and vegetables, rather than supplements

17 Get Your Calcium-Rich Foods Calcium helps build strong bones when you are young and helps keep them strong later in life According to NOF recommendations: Adults under age 50 need 1,000 mg of calcium every day Adults age 50 and older need 1,200 mg of calcium every day When it comes to calcium, more is not better The total amount of calcium you need each day includes the calcium you get from food and/or supplements Onlytake supplements if you don t get enough calcium from food.

18 Get Your Calcium-Rich Foods You can get calcium from dairy products Fat-free or low-fat milk, yogurt and cheese Lactose-free and lower-lactose products are available You can also get calcium from non-dairy foods Canned salmon and sardines (with bones) Dried figs Bok choy, broccoli, kale, mustard greens and turnip greens Nuts (almonds, roasted soy nuts) Foods with added calcium (juices, soy milk, rice milk, cereals and others)

19 Calcium Calculator Product Servings/Day Calcium Total Milk (8 oz.) X 300 = Yogurt (6 oz.) X 300 = Cheese (1 oz. or 1 cubic inch) Fortified Foods/Juices X 200 = X = Estimated total from other foods = 250 Total daily calcium intake, in mg =

20 Calcium Calculator Product Servings/Day Calcium Total Milk (8 oz.) 1 X 300 = 300 Yogurt (6 oz.) 0 X 300 = 0 Cheese (1 oz. or 1 cubic inch) Fortified Foods/Juices 0 X 200 = 0 1 X = 300 (fortified orange juice) Estimated total from other foods = 250 Total daily calcium intake, in mg = 850 1, = Approximately 350 mg of additional calcium needed 1, = Approximately 150 mg of additional calcium needed

21 Get Enough Vitamin D Vitamin D helps your body: Absorb calcium Build bone in youth and maintain bone in adulthood Keep bones healthy Improve muscle strength and prevents falls Vitamin D deficiency is common Vitamin D toxicity is rare

22 NOF s Vitamin D Recommendations Adults under 50 need international units (IUs) every day Adults 50 and older need 800-1,000 IUs every day Some people need more vitamin D To get enough vitamin D, many people need to take a supplement Vitamin D is available in two forms (vitamin D 2 and vitamin D 3 )

23 Part 2: Other Vitamins and Minerals In addition to calcium and vitamin D, other vitamins and minerals can affect your bones Some of these include vitamin K, B vitamins, magnesium, potassium and vitamin C We will also talk about how getting too much vitamin A may harm bones

24 Vitamin K Vitamin K may be important for bone health Recommended daily intake is micrograms (µg) Some sources are kale, brussels sprouts, spinach, mustard greens, turnip greens and vegetable oils It s available in two forms (vitamin K 1 and vitamin K 2 ) More research is needed to determine the amount and type necessary for bone health Until we know more, try to get enough from food sources

25 B Vitamins Vitamin B6, vitamin B12 and folate may be important for bone health and fracture prevention Recommended daily intakes Vitamin B6 400 mcg Vitamin B mg Folate 2.4 mcg Some sources are whole unprocessed grains, meat, potatoes, beans and lentils Older adults may require vitamin B supplements

26 Magnesium Magnesium may be important for bone health Recommended daily intake is mg Sources are legumes, vegetables, nuts, seeds, fruits, grains, fish and dairy People who may not get enough include those with malabsorption, alcoholism, type I diabetes and older adults with poor diets More research is needed before supplementation can be routinely advised

27 Vitamin C Vitamin C may be important for bone health Recommended daily intake is mg Some sources are citrus fruits and juices, peppers, tomatoes, broccoli and green leafy vegetables Supplements are not recommended unless a person has a known deficiency

28 Potassium Potassium may be important for bone health Recommended daily intake is 4,700 mg Only about one-quarter of Americans meet recommended intakes Some sources are dairy products, tomatoes, raisins, potatoes, soy beans, spinach, sweet potatoes, papaya, oranges and bananas Food sources are preferred over supplements

29 Vitamin A Too much vitamin A from retinol can harm bones Avoid cod liver oil and fish products that contain high amounts of vitamin A (retinol) Select vitamins that contain no more than 2,000 IU - 3,000 IU of retinol The body converts beta carotene from fruits, vegetables and other sources to vitamin A (beta carotene is not harmful to bones)

30 Part 3: Other Nutrients and Substances Many nutrients and substances can interfere with the amount of calcium that reaches your bones Some of these include sodium, oxalates, and phytates Drinking too much coffee, tea and certain soft drinks may impact your bone health

31 Sodium People who consume too much sodium (salt) may be at risk of losing calcium in urine which can be harmful to bones Consuming less than 2,400 mg of sodium per day should not harm bones Higher intakes of sodium may not be a problem for people who get enough calcium and/or potassium People can reduce sodium by avoiding processed foods, canned foods and other foods that contain a lot of salt

32 Foods with Oxalates Oxalates are naturally occurring substances found in certain foods Your body does not absorb calcium well from foods that are high in oxalates (oxalic acid) Spinach, rhubarb, beet greens and some beans are examples of foods that are high in oxalates These foods are nutrient-rich sources of other important vitamins and minerals, just don t count them as calcium-rich foods

33 Food with Phytates Phytates are naturally occurring substances found in certain foods Your body does not absorb calcium well from foods high in phytates like beans and wheat bran Soak beans to reduce the phytate level If you eat 100% wheat bran, take your calcium supplement at a different time and realize you may not absorb calcium in foods eaten at the same time It s stil important to eat fiber-rich foods, many of which do not interfere with calcium absorption

34 Coffee and Tea Caffeine in coffee and tea can decrease calcium absorption by a small amount Drinking more than three cups of caffeinated coffee per day is a concern You can make up for this possible calcium loss by getting enough calcium every day Adding some milk to these drinks can also help offset the calcium that is lost

35 Soft Drinks Cola drinks, but not other carbonated beverages, are associated with bone loss Colas drinks tend to contain phosphoric acid (phosphorous) and caffeine The greatest harm to bone may be that people are choosing soft drinks over calcium-rich beverages like milk and fortified juices

36 Alcohol Drinking more than two - three drinks per day may be harmful to bones Drinking heavily can lead to bone loss Drinking may afect the body s calcium supply Many people who drink do not get enough dietarycalcium, vitamin D or other nutrients Drinking may increase the risk of falls

37 Part 4: Supplements and Other Products People should only take supplements to get nutrients they cannot get from their diet Calculate your daily intake of calcium to estimate how much you need, too much from supplements may be harmful Calcium supplements may be needed to get the recommended amount Vitamin D supplements may be needed to get the recommended amount

38 Calcium Supplements Calcium supplements come in different forms no type of is best Most supplements absorb best with food You can absorb mg of calcium at one time (the rest of the calcium is lost in urine) People who take proton pump inhibitors (PPIs) for acid reflux and other conditions may better absorb calcium citrate Read NOF s Calcium handout for more tips

39 Supplements and other products Some products claim to treat or cure osteoporosis naturally Always speak with your healthcare provider and pharmacist before taking one of these products These products may contain a combination of different vitamins, minerals and other ingredients in various amounts

40 Common Ingredients in Products for Bone Health Calcium Vitamin D Magnesium Vitamin K Vitamin C Strontium B vitamins Boron Fluoride Phytoestrogens and soy isoflavones e.g. genestein Red clover Black cohosh DHEA Quercetin Omega 3 fatty acids

41 Strontium Strontium is a mineral in the prescription medicine strontium ranelate that is available in Europe and other countries In the U.S., strontium is available in supplements, such as strontium citrate and strontium carbonate These differ from the prescription medication There is not enough evidence to support the safety and effectiveness of strontium supplements to reduce the risk of broken bones

42 Phytoestrogens Naturally occurring substances that are similar in some ways to estrogens (for example soy foods and soy isoflavones) Genestein, is a soy isoflavone that is included in some brands of bone health supplements and products Some phytoestrogen compounds may be beneficial to bone health but more research is needed

43 Other Supplements and Products Just because a product claims to be natural does not mean it s safe and efective Testing for safety and effectiveness is not required Many products have limited data to support claims These products are not monitored like medications Amount of ingredients stated on the label may not be accurate Products may contain contaminants such as pesticides and metals

44 Choosing a Safe Product Get information from reliable and reputable sources Look for the United States Pharmacopia (USP) label to see if a product has been tested for purity and quality Avoid health fraud Beware of non-fda approved products that claim to cure or reverse bone loss or osteoporosis If a product s claims sound too good to be true, they probably are

45 Additional Resources National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine Web: Phone: (888) Dietary Supplements Labels Database Web: Medline Plus Web: Phone: (301) Office of Dietary Supplements (ODS) Web:

46 Additional Resources Food and Drug Administration (FDA) General information Web: Phone: (888) Reporting adverse events Web: Phone: (888)

47 Conclusions Consume a diet that contains nutrient rich forms of fruits, vegetables, whole grains and dairy products every day Consume adequate protein every day using lean sources Calcium and vitamin supplements may be needed to meet requirements for bone health Older adults may also benefit from taking B vitamins supplements

48 Conclusions The safety and effectiveness of other supplements and products are unknown These products cannot replace the need for an FDA-approved medication to treat osteoporosis and reduce the risk of broken bones in the right people

49 Contact NOF for More Information National Osteoporosis Foundation Phone: (800) Web:

50 Question and Answer Time We will now answer questions submitted by the audience during this webinar. Please note: NOF is unable to provide you with medical advice. For questions about your specific condition, please talk to your healthcare provider.

51 Upcoming Webinars in 2010 September 22 December 1 Exercise for Your Bone Health by Karen Kemmis, P.T., D.P.T., M.S. Update on Osteoporosis Treatment Options Register at or call (866)

52 Webinar Evaluation Please take a few minutes to complete the evaluation for this webinar. Simply click on the button below and you will be taken to the evaluation on your computer.

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