MONDAY, Nov. 19, 2018 (HealthDay News) — Trying to eat a healthier diet? Don’t forget that certain foods can help protect your bones, a nutrition expert says.
“Bone disease is often preventable by getting enough calcium and vitamin D into your diet,” said Kathryn Weatherford, a registered dietitian at Beth Israel Deaconess Medical Center in Boston.
“By eating the right combination of calcium- and vitamin D-rich foods, we can boost our immune system and protect our bones,” she said. “Many foods are now fortified in calcium and vitamin D, making it easier to meet our daily recommended intake.”
Start your day with a calcium-fortified cereal that is high in fiber (more than 3 grams) and low in sugar. Whole grain cereal with a cup of milk adds up to 600 milligrams (mg) of calcium.
Fatty fish is also an excellent source of vitamin D. A 3-ounce portion of wild salmon provides more than 100 percent of daily value of vitamin D, according to Weatherford.
Eat a variety of dark, leafy greens such as spinach, kale, Swiss chard and bok choy, she added.
An 8-ounce serving of yogurt provides 400 mg of calcium. Choose non-fat yogurt or Greek yogurt, which provides additional protein.
Another suggestion is milk alternatives. Whether it is almond, soy, cashew or hemp milk, almost all milk alternatives are fortified with both vitamin D and calcium. For example, almond milk provides up to 45 percent of daily value of calcium and 25 percent of daily value of vitamin D, Weatherford said.
Your body also produces vitamin D when exposed to sunlight. Just 10 to 15 minutes of sunshine a day can produce enough vitamin D.
It’s important to monitor how much calcium and vitamin D you consume each day. If you suspect you’re not getting enough, talk to your doctor or dietitian, Weatherford suggested.
“It’s good to know if you’re vitamin D-deficient so you can take steps to fix the problem and keep building strong bones,” Weatherford said.
The U.S. National Library of Medicine has more on vitamin D.
SOURCE: Beth Israel Deaconess Medical Center, news release, Nov. 6, 2018
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THURSDAY, Oct. 4, 2018 (HealthDay News) — Vitamin D supplements have long been touted as a way to improve bone health and possibly ward off the bone-thinning disease osteoporosis in older adults.
But a new study contends that claims of benefits from supplements of the “sunshine vitamin” fall flat.
A review of previously published studies found that taking either high or low doses of vitamin D supplements didn’t prevent fractures or falls, or improve bone density.
Vitamin D is found in very few foods. One of the biggest sources of the vitamin is exposure to sunlight.
“Vitamin D supplement use is common, particularly in North America,” where up to 40 percent of older people take them, said lead researcher Dr. Alison Avenell. She is clinical chair in health services research at the University of Aberdeen in Scotland.
“Most adults don’t need to take vitamin D supplements, although they are unlikely to do harm if taken in low doses,” she added.
Vitamin D supplements do prevent rare conditions, such as rickets in children and osteomalacia (softening of bones) in adults. People at risk of vitamin D deficiency include those with little or no sun exposure, such as nursing home residents who are indoors all the time, or those who always cover their skin when outside, Avenell said.
There’s also existing evidence that vitamin D helps prevent cancer or heart disease, she added.
“Preserving bone strength involves keeping active, not smoking, not being too thin, and taking medications for osteoporosis,” Avenell said.
Based on the new findings, Avenell thinks guidelines that recommend vitamin D supplements for bone health should be changed.
For the new report, Avenell and her colleagues reviewed 81 studies, most of which dealt with vitamin D alone, not in combination with the mineral calcium.
“Calcium supplements on their own have minimal effect on bone mineral density and fracture, and may increase the risk of cardiovascular disease,” Avenell said.
The only evidence that calcium and vitamin D together prevent fractures comes from a trial of older people with very low vitamin D levels in nursing homes. But calcium and vitamin D may also increase the risk of cardiovascular disease, Avenell said.
In addition, most of the studies covered in the new review included women aged 65 and older who took more than 800 IUs (international units) of vitamin D daily.
The new study found no meaningful effect of vitamin D supplementation when it came to reducing any fracture, hip fractures or falls.
This type of study, called a meta-analysis, tries to find common elements among previously published studies. This kind or research, however, is limited by differences in the methods and conclusions of the different studies analyzed by researchers, so the findings may not be consistent across the board.
Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City, said this new study should convince doctors that vitamin D supplements don’t have a role in maintaining healthy bones, but they do have other benefits.
Previous research suggests that vitamin D, when taken in tandem with calcium, may help prevent certain cancers and protect against age-related declines in thinking and memory.
“What is important to keep in mind is that those with low vitamin D were not represented in this meta-analysis, and vitamin D supplementation — repletion, actually — is still necessary for those with low vitamin D levels, regardless of age,” Sood said.
The findings were published online Oct. 4 in The Lancet Diabetes and Endocrinology.
For more on vitamin D, visit the U.S. National Institutes of Health.
SOURCES: Alison Avenell, M.D., clinical chair, health services research, University of Aberdeen, Scotland; Minisha Sood, M.D., endocrinologist, Lenox Hill Hospital, New York City; Oct. 4, 2018, The Lancet Diabetes and Endocrinology, online
While people typically associate osteoporosis with women, men aren’t immune.
Osteoporosis commonly leads to weakening of the skeleton and fractures. According to the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases, by the age of 70, men and women are losing bone mass at about the same rate.
The institute mentions these factors that raise a man’s chances of developing osteoporosis:
- Having a chronic disease affecting the kidneys, lungs, stomach or intestines.
- Taking certain medications regularly.
- Having low testosterone.
- Smoking, drinking alcohol excessively, getting insufficient calcium or failing to get enough exercise.
- Getting older.
As if older women didn’t already worry enough about their bone health, new research suggests that anxiety may up their risk for fractures.
Based on an analysis involving almost 200 postmenopausal Italian women, the finding builds upon previous research linking anxiety to a higher risk for heart disease and gastrointestinal problems.
“Our findings are quite surprising because an association between anxiety levels and bone health was not reported before,” said study author Dr. Antonino Catalano, though the study did not prove that anxiety caused fracture risk to rise.
Catalano is an expert in internal medicine, bone metabolism and osteoporosis with the department of clinical and experimental medicine at the University Hospital of Messina in Italy.
As to what might explain the association, Catalano pointed to a number of factors.
“Our opinion is that anxious women are more likely to engage in poor health behaviors, such as smoking or a poor diet,” he said. “Moreover, the negative effects of stress hormones on bone status may be considered as also enhancing fracture risk.”
Catalano added that women who struggle with higher levels of anxiety were also found to have lower levels of vitamin D. “Poor vitamin D status has been previously associated with increased fracture risk,” he said.
The researchers noted that osteoporosis is the most common metabolic bone disease in the world. An estimated 33 percent of women and 20 percent of men will suffer from an osteoporosis-related fracture at some point in their lives.
The research team also noted that 7 percent of the world’s population suffers from anxiety disorders.
To see how the two issues might intersect, the researchers focused on patients attending one Italian osteoporosis clinic in 2017.
On average, participants were nearly 68 years old. All underwent in-depth health screenings to assess, among other things, prior fracture history, arthritis diagnoses, heart and lung health, and smoking and alcohol habits. Bone mineral density exams were also done.
A wide range of mental health concerns were also explored, including depression, tension, insomnia, memory and anxiety levels ranging from moderate to severe.
The investigators determined that women who had the most anxiety faced a noticeably higher fracture risk, compared with women with the lowest degree of anxiety.
Higher anxiety was linked to a 4 percent greater risk for a major fracture over a 10-year period, and a 3 percent greater risk for a hip fracture in the same time frame, said Dr. JoAnn Pinkerton, executive director of the North American Menopause Society.
The study was published online May 9 in the society’s journal Menopause.
Higher anxiety was also linked to lower bone mineral density scores in both the lower back area (known as the lumbar spine) and in the femoral neck area (just below the ball of the hip joint).
The findings should encourage physicians to explore anxiety levels among older women when assessing fracture risk, the researchers said.
Pinkerton highlighted a number of steps women can take to minimize fracture risk as they age.
“Women reach peak bone mass around age 35,” Pinkerton noted. “So it becomes important for perimenopausal women and menopausal women to get adequate amounts of calcium.” Experts recommend 1,200 milligrams a day, between diet and supplements, she said.
Getting sufficient magnesium and vitamin D — from either sun exposure or supplements — is also critical, she added, alongside routine strength and resistance training. That, she said, can include walking, lifting weights or using elliptical machines.
Women should also avoid smoking, drinking too much, being sedentary, taking excessive thyroid replacement medications, and/or medications such as steroids or proton pump inhibitors, Pinkerton said.
For women particularly concerned about anxiety, she suggested turning to “mindfulness, cognitive therapy, self-calming strategies, yoga, or seeking help through counseling or, if needed, medications,” she said.
As for hormone therapy, Pinkerton stressed that while it’s not a treatment for depression or anxiety, “it can sometimes be helpful in women, and is sometimes used alone or in combination, depending on whether women have menopausal symptoms or respond favorably to a trial of hormone therapy.”
There’s more on bone health at the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
SOURCES: Antonino Catalano, M.D., Ph.D., expert in internal medicine, bone metabolism, and osteroporosis, department of clinical and experimental medicine, University Hospital of Messina, Italy; JoAnn Pinkerton, M.D., executive director, North American Menopause Society, and professor, obstetrics and gynecology, University of Virginia Health System, Charlottesville; May 9, 2018, Menopause, online
With aging often comes worry about falls and the bone fractures they cause. Now, a panel of U.S. experts has new advice on what helps and what doesn’t when it comes to staying upright.
For starters, get off the sofa. And don’t rely on vitamin D to keep you from falling.
In a change from its 2012 recommendations, the U.S. Preventive Services Task Force (USPSTF) is recommending against vitamin D supplements for “community-dwelling” (those living at home) adults over 65 for preventing falls. A review of existing research showed insufficient evidence to recommend a supplement.
So what does help people prevent falls? Exercise, the task force said.
“The strongest evidence is for exercise. If you’re at risk of falling, you should think about exercise,” said the task force’s vice chair, Dr. Alex Krist, from Virginia Commonwealth University in Richmond. He added that about 20 percent of Americans over 65 have a fall each year.
The review and recommendations were published April 17 in the Journal of the American Medical Association.
An author of an editorial that accompanies the new recommendations agreed exercise can be beneficial.
“These recommendations are suggesting that we need to go beyond popping pills in order to have a major impact in preventing falls and fractures,” said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.
“Regular exercise can reduce falls with injury and it can also reduce heart disease, stroke, type 2 diabetes, dementia and some forms of cancer,” Manson said.
“Physical activity is as close to a magic bullet as there is. And it doesn’t take that much — just 30 or 40 minutes three times a week can make a difference,” she added.
Both Krist and Manson advocated for a variety of exercises. They said for someone healthy enough, the general physical activity guidelines of 30 minutes of aerobic activity most days of the week, and strength training twice a week, are a good place to start.
But not everyone over 65 can achieve that goal. Krist said to start with your doctor to get a better idea of what exercise might be right for you. For some people, the supervision that comes with physical therapy is helpful. For others, a class such as tai chi might work best. And for others, more vigorous activity may be fine.
The USPSTF is a volunteer panel of national experts. They develop recommendations for disease and injury prevention after a rigorous review of scientific evidence.
The new recommendations suggest that doctors should selectively offer multifaceted interventions to seniors at a high risk of falling.
These might include: group or individual exercise, psychological therapy, nutrition therapy, education, medication management, urinary incontinence management, environmental modification, and physical or occupational therapy. Social services and referral to specialists such as an ophthalmologist, neurologist or cardiologist are other options.
Referrals can be important because some issues may be reversible. For example, sometimes addressing problems with vision can aid in fall prevention.
“Often, older individuals assume vision loss is inevitable and a normal part of the aging process. Very often, though, problems such as cataracts or glaucoma are treatable,” Manson said.
“Falling is a major concern for older adults, and some are afraid to go outdoors because they’re afraid of falling,” she said. That leads to a double whammy as they stay inside, their muscles may atrophy, they don’t get any sunlight and may develop a vitamin D deficiency, and they’re losing out on important social interactions, Manson explained.
“I recommend at least doing strength training inside the home, or getting a treadmill to use at home. Or find a friend or family member that can go out for a walk, or start a walking club in your neighborhood,” she suggested.
The task force also recommended against daily supplementation of 400 international units of vitamin D and 1,000 milligrams (mg) or less of calcium to prevent fractures in postmenopausal women living at home.
It wasn’t clear, however, if higher doses might provide a benefit, according to the new USPSTF recommendations. There also wasn’t enough evidence for the task force to determine whether vitamin D and calcium supplements could help men or premenopausal women avoid fractures.
Learn more about preventing falls from the U.S. National Institute on Aging.
SOURCES: Alex Krist, M.D., M.P.H., U.S. Preventive Service Task Force vice chair, and professor, family medicine, Virginia Commonwealth University, Richmond; JoAnn Manson, M.D., Dr.P.H., professor, medicine, Harvard School of Medicine, and chief, preventive medicine, Brigham and Women’s Hospital, Boston; April 17, 2018, Journal of the American Medical Association