Osteoporosis: Is your diet giving your bones what they need?

In the e-alert 'Brittle bones may lead to heart disease' (13/12/05) I told you about an important association between bone health and heart health, along with two tips on how to avoid low bone mineral density (BMD).

Continuing on the topic of healthy bones, I have this question for women over the age of 50: Are you getting enough of two key nutrients that nourish and protect your bones?

If I were a betting woman, I'd wager that most women would have to answer 'no.' And I'm not on betting a hunch here; the numbers are in, and they're not encouraging. I recently came across four news items about bone health, all written within six weeks of each other, but their headlines read as if one person had written all four in one sitting.

Today I'll take a quick look at each of these articles, with tips on how to avoid deficiencies of calcium and vitamin D.

Are you getting enough nutrition for healthy bones?

Headline number one: 'Women Need More Calcium'

If you think this one goes without saying, you're right. And yet, according to the Osteoporosis Research Center (ORC) in Omaha, US, older women generally realise the importance of calcium intake, but most still don't get enough.

Dr. Robert P. Heaney told WebMD that he'd like to send American women to the blackboard to write 1,000 times: 'I will take my calcium.' That was his response to an ORC study that assessed calcium intake in more than 11,000 women. Results showed that only 15 percent of postmenopausal women get more than 727 mg of calcium daily. The recommended intake for women over age 50 is 1,200 mg per day.

That said, there's good news in headline number two: 'Adequate Vitamin D Could Lower Calcium Requirement'

This isn't news, really. Nutritionists have known for some time that calcium is better metabolised when vitamin D is abundant. And that's confirmed by a new study published last month in the Journal of the American Medical Association. The methodology used by researchers at a university hospital in Reykjavik, Iceland, is a little complicated, so we'll just cut to the chase. An analysis of food frequency questionnaires and blood samples of 944 subjects showed that sufficient amounts of vitamin D may be more important than high doses of calcium.

The key word here, of course, is 'sufficient.'

Many postmenopausal women deficient in vitamin D

Headline number three - 'Vitamin D Deficiency Widespread' - refers to a study that appeared in the October 2005 issue of the Journal of Nutrition.

When Boston University Medical Center researchers analysed dietary and supplement use data from more than 8,200 subjects across the US, they found that less than five percent of adults over the age of 50 were getting an adequate amount of vitamin D. Which brings us to headline four: 'Most Older Women Deficient in Vitamin D.'

According to Cancer Research UK, some groups of the UK population are more at risk for vitamin D deficiency than others. They include:

* Elderly people - especially if or home bound
* Dark skinned people
* Women with darker skin who dress to cover most of their skin

Researchers at an Amsterdam medical center compared blood samples, hormone levels and questionnaires submitted by nearly 2,600 postmenopausal women with osteoporosis in 18 different countries. On average, more than 60 percent of the subjects were vitamin D deficient. And this number rose by several percentage points among women who were tested during winter months.

This last detail reveals the best source of vitamin D: sun exposure. Dietary sources include eggs, liver, fish liver oils and oily fish such as salmon, sardines, trout and tuna. In the e-alert 'The heart-protective benefits of Vitamin D' (28/7/03), I told you about Dr. Jonathan Wright's recommendations for vitamin D intake: Between 1,600 and 2,000 IUs daily, and as much as 4,000 IUs for those over 40. Cod liver oil provides more than 1,300 IUs of vitamin D per tablespoon.

And if you are lucky enough to be flying off to a sunny destination for a holiday, remember that only a small amount of sunlight is needed for adequate vitamin D levels. Dont over do it.

Which form of calcium is best?

And finally, we return to calcium. The thing is, when you go shopping for a calcium supplement you'll find there are several different forms.

In the e-alert 'The best form of calcium to take for bone health' (26/4/04), US HSI Panellist Allan Spreen reviewed the pros and cons of different calcium forms. He noted that calcium orotate, calcium aspartate and calcium amino acid chelates provide excellent calcium absorption, but all three forms are expensive and may be hard to find. For the best compromise of price, percentage of elemental calcium and absorption, Dr. Spreen recommends calcium citrate.

Dr. Spreen adds: 'Calcium is not found in nature (in edible form) without magnesium, and they therefore should always be given together. Plus, phosphorous is also needed with calcium.'

Talk to your doctor or a health care professional before adding any of these supplements to your daily regimen.

They lurk in the neon-lit depths of office parks and hospitals. Some are nearly as elusive as the Loch Ness Monster. Sometimes they're distracted, sometimes superior and overbearing, sometimes they're simply inept. They're the Nightmare Doctors. And once you've experienced one, you'll never look at an G.P quite the same way again.

Last week I came across a New York Times article that contained several choice Nightmare Doctor stories. My favourite was that of a woman whose doctor said she needed a myelogram; a scan of the spine that requires a spinal tap. She reminded him that she'd recently had one on his recommendation. The problem was, the film from her previous test wasn't in her file and couldn't be found. When he continued to urge her to take the test, she refused.

In the end, the film was located in only half an hour.

Amazing. Her doctor was actually comfortable sending her to get a spinal tap so that he and his office staff wouldn't be inconvenienced. That's one for the Nightmare Doctor Hall of Fame.

Im sure youll agree this is a universal problem and you may have a couple of doctor-visit horror stories of your own. Many doctors these days have huge workloads and although they try to give you all the attention you deserve, sometimes this just isnt possible.

But there is something you can do about it. If you feel your doctor is rushing your consultation, keep asking questions until you get the answers you need.

If youre still in doubt about your diagnosis get a second opinion.