Calcium is a very important nutrient for the health, density and strength of bones. Decrease of bone density can lead to fragile bones called osteoporosis and ‘atraumatic’ fractures – fractures that occur with little or no trauma. Sometimes a small push with a foot to shut an open drawer, bending, lifting, falling from standing position or a big sneeze or a sharp turn of the wrist can cause the fragile bone to fracture. The most common fractures occur in the backbone. You would probably have seen some older women with a bent, humped back and a stooped posture.
This is most likely due to fracture of the vertebra which then gets compressed leading to loss of height which may be as much as six inches. The lifetime risk of a spine fracture in a woman is one in three and a hip fracture is one in six. Between 25-60% of women older than 60 years develop a spine fracture and about 50% will have a hip fracture. Consider not just the disability and its effects on the family and the loss of self esteem of the woman who becomes dependent on others for her needs, but costs from medications, hospitalization and that a large number of women with hip fractures do not live beyond one year. Unlike arthritis in which there is pain and inflammation of the joints, osteoporosis is a silent disease and symptoms usually appears when the disease is advanced. Since calcium is extremely important for prevention of osteoporosis, it is worthwhile to update your fact–file on calcium.
- There are specific periods in a woman’s life when she would require a good calcium intake. These are the adolescent phase when she would be maximizing her bone mass, pregnancy, breast feeding and after menopause.
- Generally speaking, the requirement for calcium per day is around 800 mg between the ages 3 – 8 years, 1000 -1300 mg for children and adolescents 9 -17 years of age and during pregnancy, 2000 mg during breast feeding and 1500 mg after menopause.
- It is presumed that around 500 mg will be sourced from the diet. The rest of the requirement of calcium will need to be met by taking calcium supplements.
- The most important dietary source of calcium is milk. One glass of milk can provide 300 – 400 mg of calcium. According to one study, girls who have low milk intake increase their risk for fracture in adulthood.
- Other calcium rich foods include shrimp, canned sardines or salmon, calcium-fortified tofu (which information is not of much use to most Indian women) and almonds. Many commercial foods, including orange juice and some cereals, are now calcium fortified. It may be worthwhile to check labels on foodstuff, for fortification and additives, when you go shopping for groceries.
- Dark green vegetables like broccoli and turnip greens are also rich in calcium. But do consider this – if you wish to take as much calcium from broccoli as from one glass of milk you will need to consume 4 cups in a day since 100 gms of broccoli contains around 85 gms of calcium, most of which is not easily absorbed. Not a very practical suggestion! So the best bet for sourcing calcium is to drink up that glass of milk.
- Add up the calcium from the milk that you drink. The rest of your requirement should be in the form of supplements. Remember to look for the amount of elemental calcium on the strip and not the total calcium mentioned.
- The concentration of elemental calcium provided by different salts varies. 40% of calcium carbonate is actually calcium whereas calcium citrate is 24% calcium and calcium gluconate provides only 9% elemental calcium. Calcium carbonate is the most preferred form of calcium prescribed.
- Different salts of calcium are absorbed in the body in different ways. Calcium citrate is better absorbed, especially in the elderly. In case you have been prescribed iron tablets too, you should choose this salt because milk and other calcium preparations decrease iron absorption.
- It is best to take your total calcium supplement in 2 doses of 500 mg each instead of both tablets together. Take them after meals to take advantage of food-induced acid secretion which enhances absorption. If taking only one tablet, take it after dinner; if two, then take one after lunch and the other after dinner.
- It is wise not to exceed total supplementary calcium beyond 1000 mg per day without your doctor’s prescription. Doing so may increase the risk of kidney stone formation.
- Calcium requires vitamin D for absorption. Even though most calcium tablets also have vitamin D, the amount in each tablet is usually not more than 200 i.u. The requirement for vitamin D is around 1000 i.u. per day, most of which is obtained by sunlight exposure.
- Dark skinned people and those using sun protection umbrellas and sunscreen do not make enough vitamin D under their skin. Dietary sources include whole milk (100 i.u. per cup) and oily fish.
- It is wise, whenever taking calcium, to take supplements of vitamin D also, especially in winter and more so, if you are more than 60 years. The best way to do this is to take one sachet of vitamin D, available cheaply with all chemists, with milk once every 2 months or every month if you are post menopausal. If unable to do so, once a year injection, 6 lakh units, is another good option.
- Those on slimming diets of yoghurt (dahi) and toned/fat free milk should remember that although these provide calcium they are poor in vitamin D, without which the calcium will not be absorbed.
- Finally, no amount of care regarding calcium and vitamin D will work unless you do weight- bearing exercises which apply tension to muscle and bone. Start your exercise programme in adolescence. Exercise moderately, more than 3 days a week for a total of 90 minutes a week. Beware of the ‘female athlete triad’, a serious and common disorder facing young female athletes, severe exercisers and dancers, which includes bone loss, absence or irregular menstruation and eating disorders. Walk briskly to improve heart performance, muscle tone and strength. Do yoga for stamina, strength, agility and stability. Make this a lifelong habit to increase bone density and to decrease your chances of falling and fracturing as you get older.
- Drinking tea regularly protects bone but caffeine, particularly from coffee, cause loss of calcium from bones. Some evidence suggests that this may be true only for elderly, thin women and not for women with normal or high weight. Carbonated drinks, especially colas and smoking are ‘calcium robbers’ and may increase the risk for fractures as you get older.
- Although 80% of people with osteoporosis are women, this is not a disease specific to women. Men start with a higher bone density and lose calcium at a lower rate than women, which is why their risk is lower. Nevertheless, after age 50, bone loss increases and according to recent studies, more rapidly than previously thought. Men, however, are a neglected segment. In one study, only 23% of the men were given some advice or treatment for osteoporosis as compared to 71% women.
- If all men were to have a daily glass of milk and combine it with some exercise they will probably not need any further treatment or supplements till they are beyond 60 in age.