October 18, 2004

The incidence of osteoporosis is on the rise in Asia. Experts attribute this trend to longer life spans, as bones tend to weaken with age. Osteoporosis doesn’t just affect elderly women, it has been diagnosed in women as young as twenty five, and many men of all ages too. According to the International Osteoporosis Foundation, around the world an estimated one in five men over the age of fifty will experience osteoporosis. For this reason, World Osteoporosis Day 2004 on October 20th will be aiming to raise awareness about bone health in men.

Osteoporosis progresses without any symptoms or pain and is usually discovered when a minor fall or sudden strain causes a fracture, of the hip, wrist or spine. Researchers estimate that by 2050, half of the world's osteoporotic fractures will occur in Asia. What’s worrying is that the effects of a fracture, especially a hip fracture can be quite debilitating. A study in Singapore found that one in five persons died within a year of sustaining an osteoporotic hip fracture and one in three became wheelchair bound or bed-ridden. There is no cure for osteoporosis but the good news is, it is preventable. Life-long preventive diet and exercise measures or efforts in later life to slow the rate of bone mineral loss are highly effective. 

The Asian Food Information Centre therefore recommends three essential goals to beat osteoporosis: consume enough dietary calcium, ensure the body gets enough vitamin D from diet and/or sunlight, and fit in enough weight-bearing exercise into your daily routine.

Dietary calcium needs change over a lifetime. Including enough calcium in the daily diet during childhood, adolescence and early adulthood is especially important, as during these years the bones build calcium deposits to achieve maximum strength and size. This process continues up to about age thirty. Thereafter, adequate dietary calcium is still essential but the body’s needs are a little lower. Calcium intake needs to be increased during pregnancy and breast-feeding because of the increased demands of the baby. The aging body absorbs calcium less efficiently, so older men and women should make special efforts to ensure they are consuming enough calcium-rich foods, and for women the menopause further increases the body’s daily dietary calcium needs.

So, how much calcium is essential? Calcium recommendations range from country-to country, varying between 800mg to 1500 mg per day. A reasonable goal to aim for is five to seven servings of calcium-rich foods daily, if each serving provides about 150mg to 200mg of calcium.

Milk and milk products are rich in calcium that is easily absorbed by the body. One option to meet daily calcium goals is two cups of milk and two serving of other calcium-rich foods each day.

Up to 90 % of Asians have some form of lactose intolerance, but for many this does not mean milk products have to be avoided completely. Lactose is the sugar naturally present in milk, and many adults are lactose intolerant because their bodies only produce small amount of the digestive enzyme necessary to digest lactose. However, the majority of adults are able to consume small amounts of milk consumed with other foods, and can eat dairy products which have lower amounts of lactose than milk. For example, many individuals with some lactose intolerance find they can enjoy hard cheeses such as Swiss or Cheddar, yogurt and specially processed low-lactose products.

Other excellent sources of calcium include fish canned with bones, green leafy vegetables, broccoli, calcium-fortified soymilk, tau kwa, tau foo, tau huay and tempeh. It is a good idea to include soy foods, as they are not only a good source of calcium, but also rich in isoflavones that can reduce bone breakdown, increase bone formation and bone mineral density.

Besides these foods, a wide array of foods such as such as juices, breads, breakfast cereals, crackers, breakfast bars and malted beverage drinks are fortified with calcium. So remember to check food labels for the calcium content per serving and build in some calcium-fortified foods into the daily meal plan as well.

As many breakfast foods are rich in calcium, efforts to include a range of these foods in your morning meal can boost daily calcium levels considerably. A calcium-fortified orange juice with a bowl of soupy noodles cooked with spinach and tau foo; a cup of milk with a wholemeal cheese sandwich; calcium-fortified breakfast cereal with a cup of milk or yogurt; or calcium-fortified soy milk with a breakfast bar can provide at least 400mg of calcium.

Adequate vitamin D is also essential for bone health, as it helps the body absorb calcium efficiently. Enough vitamin D is manufactured in the skin following a ten to fifteen-minute exposure of the hands, arms and face to sunlight two to three times a week. Excellent dietary sources of vitamin D include egg yolk; oily fish, liver and vitamin D fortified milk and fortified breakfast cereals.

Older individuals may need to consider a supplement if sunlight exposure is minimal, as their body does not absorb dietary vitamin D as efficiently. Also, those who find it difficult to meet daily dietary calcium goals from food alone, might wish to consider taking a supplement, but as always with dietary supplements, it is best to check with your doctor first.

As weight-bearing exercise builds strong bones and slows bone loss, health experts recommend thirty to sixty minutes of weight-bearing exercises such as walking, jogging, running, stair climbing and skipping rope three to five times a week.

Osteoporosis can creep up on you silently, so don’t wait until the bone breaks - choose from the wide range of calcium-rich foods and include a calcium-rich food in each meal and snack, consume some vitamin D-rich food or get some sunlight, take supplements if necessary and make time for weight-bearing exercise now !

What makes a serving?

The following foods provide about 150mg to 200mg of calcium:

• ½ cup (125 ml) milk

• ½ a large carton (100g) yogurt

• 1 slice of cheddar cheese

• 1.5 oz (45g) salmon canned with bones

• 2 Chinese spoons ikan bilis

• 3 Chinese spoons kailan

• 5 Chinese spoons spinach or mustard greens

• 5 to 6 large florets of broccoli

• ½ cup (125 ml) calcium-fortified soy milk

• 1 ½  cups (375ml) soy milk

• 1 small cake taukwa

• ¼ large square tau foo

• ½ rice bowl of tau huay

• 1 cake tempeh

• 2/3 cup calcium-fortified cereal

Source: Feed your child right – Lynn Alexander & Yeong Boon Ye, Times Books International 1990; www.nih.gov ; supermarket food labels

See also:

·         International Osteoporosis Foundation http://www.osteofound.org/index.php