Bone Health – Women's Mid-Life Health Program

Your questions, answered.

We have gathered a list of the most common questions women ask regarding topics that affect your overall health and well-being.

Vitamin D is an essential nutrient that helps the body to absorb calcium in order to maintain and protect healthy bones.(1) According to Osteoporosis Canada taking vitamin D3 increases calcium absorption as much as 30-80 percent!(2) Some studies have suggested vitamin D also plays a role in improving muscle strength, reducing fracture rates as well as the rate of falls.(3,4,5)

Once vitamin D has entered the body it sends out a signal to three areas:

1. It tells the gastrointestinal (GI) tract to absorb calcium
2. The bones to release some stored calcium
3. The signal also tells the kidneys to retain more calcium.

These actions maintain calcium balance in the body and support new bone formation.(6)

The body can naturally produce vitamin D once it has been exposed to the UVB rays from sunlight.9 Factors to keep in mind which can affect how much vitamin D is produced depend on:

Diet: It may be difficult to obtain and maintain adequate amounts of vitamin D from diet alone, since few dietary products contain natural vitamin D.(10) According to Osteoporosis Canada small amounts of vitamin D can be obtained from dietary sources such as: “eggs, chicken liver, salmon, sardines, herring, mackerel, swordfish, and fish oils (halibut and cod liver oils)”.(2) Other food sources have vitamin D added to them such as: margarine, goat’s milk, cow’s milk, and plant based beverages (such as soy products).(11, 12) Orange juice may be fortified with calcium, but may not have added vitamin D.(11) Be sure to read the Nutrient Values on the packaging.

Supplement Form: A supplement may be required to meet the individual’s daily intake needs that can not be met through sunlight or diet. According to Health Canada the daily recommended amount is 400 IU per day.(7) The need for vitamin D increases after the age of 50.(11) A supplemental vitamin D tablet or liquid vitamin D drops are also recommended for individuals that do not receive their calcium requirements from fortified milk or soy beverages.(6,8)

Canada’s Food Guide recommends that all Canadians over the age of two consume 500 mL (two cups) of milk every day or fortified beverage which provides 200 IU of vitamin D. In addition to following the Food Guide; everyone over the age of 50 should take a daily supplement of 400 IU of vitamin D.(7)

Osteoporosis Canada new guidelines, July 2010, recommend for daily intake of vitamin D:

Adults under the age of 50 without osteoporosis or conditions affecting Vitamin D absorption require between 400-1000 IU per day.

Adults over the age of 50 require between 800 – 2000 IU per day.(2)

Vitamin D Deficiency: Vitamin D Deficiency There have been several bone diseases that have been link with having low levels of vitamin D in the body. Ricketts is a disease that affects children who do not receive enough calcium and vitamin D in their diet. This results in poor calcification and weakness of bones leading to growth abnormalities. Osteomalacia is the softening of bones seen in women with low calcium diets and minimal sun exposure. Osteoporosis results from the loss of calcium from the bones and can lead to fractures.(6)

Created by Mia Kubrak for The Women’s Midlife Health Program
Nursing Education Program of Saskatchewan
January 2010 updated August 2010

1 Health Canada (2007). Vitamin D for people over 50: Background Retrieved January 7, 2010 from www.hc-sc.gc.ca/fn-an/food-guide- aliment/context/evid-fond/vita_d-eng.php

2 Osteoporosis Canada (2010). Vitamin D: A key factor in good calcium absorption. Retrieved July 15, 2010 from http://www.osteoporosis.ca

3 Hegsted, D.M. (2001). Fractures, calcium, and the modern diet. American Journal of Clinical Nutrition, 74(5), p. 571-573.

4 Feskanich, D., Willett, W.C., Colditz, G.A. (2003). Calcium, vitamin d, milk consumption, and hip fractures: A prospective study among postmenopausal women. American Journal of Clinical Nutrition, 77 (2), p. 504-511.

5 Pfeifer, M., Begerow, B., Minne, H.W., Suppan, K., Fahrleitner-Pammer, A., Dobnig, H.(2009). Effects of a long-term vitamin d and cal- cium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporosis International, 20(2), p.315-322.

6 Whitney E., Rolfes S.R. (2005). Understanding Nutrition (10th ed.). Wadsworth, Thomson.

7 Eating Well with Canada’s Food Guide, 2011 from http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

8 National Osteoporosis Foundation (2008).Vitamin D Recommendations. Retrieved January 6, 2010 from http://www.nof.org/prevention/vitaminD.htm

9 Calcium and Vitamin D: Important at Every Age. Retrieved January 8, 2010 from www.niams.nih.gov/Health_Info/Bone/Bone_ Health/Nutrition/default.asp

10 Pfeifer, M., Begerow, B., Minne, H.W., Suppan, K., Fahrleitner-Pammer, A., Dobnig, H.(2009). Effects of a long-term vitamin d and cal- cium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporosis International, 20(2), p.315-322.

11 Health Canada (2007). Vitamin D for people over 50: Background Retrieved January 7, 2010 from www.hc-sc.gc.ca/fn-an/food-guide- aliment/context/evid-fond/vita_d-eng.php

12 National Osteoporosis Foundation (2008). Calcium Recommendation. Retrieved January 6, 2010 from http://www.nof.org/preven- tion/calcium2.htm

“Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue. This leads to increased bone fragility and risk of fracture (broken bones), particularly of the hip, spine and wrist. Osteoporosis is often known as “the silent thief” because bone loss occurs without symptoms. Osteoporosis is sometimes confused with osteoarthritis, because the names are similar. Osteoporosis is a bone disease; osteoarthritis is a disease of the joints and surrounding tissue”.

Sadly, for many people, the first sign they have osteoporosis is when they break a bone. By this time the disease is fairly advanced. Eighty percent (80%) of all fractures in people over the age of 60 are osteoporosis related. If you have had a fracture from a minor mishap, ask your doctor to assess your risk factors for osteoporosis. Preventing second and subsequent fractures is extremely important for your quality of life.

There is no one cause of osteoporosis. Risk factors increase your chances of developing the disease. The most important risk factor is age (65 years and over) and family history of osteoporosis. However, younger people can have bone loss as well. Other significant risk factors include: a fracture with minimal trauma after the age of 40; spine compression fracture; family history of fracture, especially mother with hip fracture.

You can live well with osteoporosis.

Up-to-date information and support is very important to help you to keep the bone you have and improve it. Preventing broken bones is the key to a good quality of life. One excellent source of current information is the Canadian Osteoporosis Patient Network (COPN) is a web-based network of people living with osteoporosis. Membership in this group provides a wealth of practical information through bi-weekly e-newsletters. Several times each year an on-line public forum features a relevant topic. Speakers from across Canada provide evidence-based current information. It is like going to a public presentation but you don’t have to leave the house!

To sign-up for COPN, check out the Osteoporosis Canada website www.osteoprosis.ca , phone them at 1-800-463-6842, or contact them through your local Chapter office.

Osteoporosis Canada’s website www.osteoprosis.ca is an excellent web resource of information about prevention and management of osteoporosis.

National Osteoporosis Foundation www.nof.org

International Osteoporosis Foundation www.iofbonehealth.org

Adding a calcium supplement into your diet helps ensure that you are meeting your daily intake requirements. There are so many different options and formulations of calcium available on the market; choosing the right one may be difficult. Osteoporosis Canada has developed some helpful suggestions on what to look for when choosing a calcium supplement.

Check the product label to find out how much elemental calcium is in each tablet. Elemental calcium tells you how much calcium is available for your body to absorb
Add up the amount of elemental calcium to know if you are meeting your daily requirement
Elemental calcium dose is often identified in brackets on a product description label (ex: calcium carbonate 1250 mg; (500 mg of elemental calcium)

Avoid supplements made from ingredients such as unrefined oyster shell, dolomite, or bone meal. These ingredients have contaminants such as toxic metals and high levels of lead
Instead choose calcium formulations such as calcium carbonate, calcium citrate, calcium lactate or calcium gluconate
Choose a product that has met specific Canadian or American safety standards regarding lead content, quality, and disintegration
The product will be stamped with either the initials D.I.N (Drug Identification Number); or G.P (General Product). American products will have the initials U.S.P (United States Pharmacopoeia) as a safety regulation

Calcium supplement tablets can be very large and hard to swallow
Some possible solutions include trying liquid, chewable, or dissolving forms of calcium. – 1200 mg of calcium is the recommended daily need of a person age 50 and over
Depending on the multi-vitamin tablet it may contain very little calcium
Vitamin D helps the body to absorb calcium. It is recommended to take between 800IU-1000IU of vitamin D daily
Not all calcium supplements are formulated with added vitamin D; be sure to check the label

Keep in mind that calcium supplements may interfere with some of the prescription medications which you may be taking. Be sure to talk to your healthcare provider or pharmacist about any possible interactions with your medication.

Calcium supplements should not be taken with iron supplements or iron-rich meals; calcium can interfere with iron absorption
Calcium supplements can also reduce the absorption of antibiotics such as tetracycline
Interaction can occur between your thyroid medication and calcium supplements; it is best to wait four hours between medications
Calcium carbonate is best absorbed when there is food in the stomach; take calcium supplements with food or after a meal. Calcium citrate, calcium lactate, and calcium gluconate are well absorbed at anytime
Medications which need to be taken on an empty stomach should not be taken at the same time as a calcium supplement
The body can only absorb 500 mg of elemental calcium at a time; be sure that your supplement does not exceed this amount per dose. Elemental calcium tells you how much calcium is in the product
Elemental calcium dose is often identified in brackets on a product description label (ex: calcium carbonate 1250 mg; (500 mg of elemental calcium)
Take calcium with plenty of water
Antacids can be used as a source of calcium. These products contain calcium carbonate; which is best taken with a meal to promote absorption. Common types include: Tums, Rolaids, or Maalox tablets. For helpful suggestions on what to look for when choosing a calcium supplement please refer to www.osteoporosis.ca (located under the ‘calcium’ section of the left hand menu)

Osteoporosis Canada
www.osteoporosis.ca
Filled with information on physical activity, calcium and vitamin D, calcium rich recipes, as well as links to quizzes, newsletters, and the Canadian Osteoporosis Patient Network (COPN).

National Osteoporosis Foundation
www.nof.org
Provides information on various aspects of living with osteoporosis, promoting bone health, and links to other accredited resources.

Dietitians of Canada
www.dietitians.ca
Provides links to an online calcium calculator, helpful tips to add more calcium into your diet, and lists of calcium rich foods.

In Motion
www.in-motion.ca
Provides helpful resources linking you to activities happening in your community. The complete In Motion guide is available online filled with samples of exercises, tips on healthy eating, and keeping active.

Health Canada
www.hc-sc.gc.ca
Focuses on providing information on how to minimize your risk for osteoporosis, examines health effects, and general overview of osteoporosis.

For more information on osteoporosis, be sure to visit your local Osteoporosis Canada chapter!

Before Starting a New Exercise Program Make Sure to:

• Check with your healthcare provider before starting any osteoporosis exercise program.

• Physical therapists are a great resource for evaluating if an exercise program is safe and meets the needs of individuals.

• Don’t do exercises that cause pain.

• Stretch before and after exercise.

• Choose a facility, leader or trainer who knows the exercise restrictions associated with osteoporosis.

National Institute of Health Osteoporosis and Related Bone Diseases’ National Resource Center (2009)
Calcium Supplements: What to look for.

Retrieved January 11, 2010 from https://www.niams.nih.gov/health-topics/bone-health-and-osteoporosis#c

National Osteoporosis Foundation (2008). Calcium Recommendation.

Retrieved January 6, 2010 from http://www.nof.org/prevention/calcium2.htm
Osteoporosis Canada (2009). How to choose a supplement.

Retrieved January 11, 2010 from http://www.osteoporosis.ca

Physical activity at any age has many proven benefits such as building strong bones, muscles, and increasing bone mass. Regular exercise can help reduce risk of developing osteoporosis, prevent further bone loss, and reduce the risk of a fracture. Several studies have shown that regular exercise can improve bone mineral density, balance and co-ordination, and reduce the risk of falls.(3,4,5)

People at risk for or those who have been diagnosed with osteoporosis should focus on exercise routines which increase strength, co- ordination, balance, and flexibility.(6,7)

The greatest impact on bone mineral density can be achieved by performing weight bearing and resistance exercises:

Weight bearing exercise focuses on having our body weight carried by the legs and feet; this in turn challenges the bones and helps to build bone mineral density.(1,8) There are two forms of weight bearing exercises (high and low impact).

High impact weight bearing is considered appropriate for someone who does not have low bone mass or osteoporosis.(2)

Examples of high impact weight bearing exercises include walking, jogging, high impact aerobics, dancing, stair climbing, jumping rope, and skating.(2, 9)

Low impact weight bearing exercises are advisable for people who can not do high impact exercises and need to build up their bone mass.2 Examples of low impact weight bearing exercises include: walking, low impact aerobics, and stair-stepping machines.(2)

Resistance exercise aims at strengthening muscles by forcing the individual to move an object or their body against gravity to create resistance. When muscles work, they pull on the bone, stimulating them to grow denser. Examples of resistance exercises include the “use of free weights, weight training machines, or exercise bands”.(9)

Other exercises you can try at home would be to stand and rise up on your toes.(2)

Incorporating balance and co-ordination exercises into your workout regimen can help reduce risk of falls and fractures. These exercises are designed to strengthen your legs and challenge your balance. Examples of routines that incorporate the use of balance include Tai Chi and dancing.(2)

Posture exercises are designed to improve the posture to help reduce the risk of fractures (especially in the spine). Fractures in the spine can result in “loss of height, rounding of the back and shoulder pain”.9 The National Osteoporosis Foundation has recommended exer- cises such as yoga or Pilates to strengthen and improve posture.(2) *Please Note: people with osteoporosis or low bone density should avoid certain positions which place the spine in a flexed position increasing the risk for a fracture. These include forward-bending exercises. A physical therapist should be able to help you learn which exercises are safe and appropriate for you.(1, 2, 5,)

Check with your healthcare provider before starting any osteoporosis exercise program
Physical therapists are a great resource for evaluating if an exercise program is safe and meets the needs of individuals
Don’t do exercises that cause pain
Stretch before and after exercise
Choose a facility, leader or trainer who knows the exercise restrictions associated with osteoporosis

Created by Mia Kubrak for The Women’s Midlife Health Program
Nursing Education Program of Saskatchewan
January 2010

1 Osteoporosis Society of Canada (2003). Osteoporosis update a practical guide for Canadian physicians. Retrieved January 13, 2010 from www.osteoporosis.ca

2 National Osteoporosis Foundation (2008). Exercise for healthy bones. Retrieved January 11, 2010 from http://www.nof.org/preven- tion/exercise.htm

3 Berry, D., Kiel, D.P., Donaldson, M.G., Cummings, S.R., Kanis, J.A., Johansson, H., Samelson, E.J. (2010). Application of the national osteoporosis foundation guidelines to postmenopausal women and men: the Framingham osteoporosis study. Osteoporosis International, 21(1), p.53-60.

4 Iwamoto, J., Yoshihiro, S., Tsuyoshi, T., Matsumoto, H. (2009). Role of sport and exercise in the maintenance of female bone health. Journal of Bone Mineral Metabolism, 27 (5), p.530-537.

5 Warburton, D. E. R., Nicol, C. W., Bredin, S.D. (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal, 174 (6), p. 801-809.

6 Brown, J.P., Josse, R.G. (2002). 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Cana- dian Medical Association Journal, 167 (10), p. S1-S34.

7 National Institute of Health Osteoporosis and Related Bone Diseases’ National Resource Center (2009). Once Is Enough: A Guide to Preventing Future Fractures. Retrieved January 13, 2010 from
www.niams.nih.gov

8 Ozgurbuz, C. (2003). Osteoporosis and physical activity. Turkish Journal of Endocrinology and Metabolism, 3, p.101-105. 9 Osteoporosis Canada (2009). Physical activity and osteoporosis. Retrieved January 13, 2010 from http://www.osteoporosis.ca/index. php/ci_id/7037/la_id/1.htm-osteo

Osteoporosis is a condition that causes “bones to become thin and porous, decreasing bone strength and leading to increased risk of breaking a bone” Osteoporosis has been named the “silent” disease because it shows no symptoms until a fracture occurs.(2) According to Osteoporosis Canada almost 2 million Canadians are living with osteoporosis; and at least 1 in 8 men over the age of 50 is affected by it.(3) Once thought of as primarily a ‘woman’s disease’; certain risk factors and lifestyle habits are known to put men at risk for developing osteoporosis.(3)

Osteoporosis develops less often in men compared to women because:

Men have larger bones and greater bone mass
Bone strength is dependent on bone mass and bone size
Once bones have reached their peak mass they begin to decline at a steady rate; for men this occurs around age 30; compared to women when it occurs in their 20s. Therefore men have gained more bone mass compared to women.(4,5,6)

There are two main types of osteoporosis: primary and secondary.

Primary Osteoporosis Risk Factors

Secondary Osteoporosis Risk Factors

Gastrointestinal disorders – conditions that prevent absorption of nutrients such as:

Regular use of certain medications including:

References used: (2,4,5,6,7,8,)

Osteoporosis often shows no symptoms until a fracture has occurred; before that happens be sure to talk to your healthcare provider if you notice any of the following:

Osteoporosis is diagnosed through the use of a Bone Mineral Density test. The test involves taking a scan of your body particularly the spine and hips to measure how dense your bones are. The test will tell you if you have osteoporosis, are at risk for a fracture, and how well you respond to treatment. (2,8)

Osteoporosis Canada Recommendations for Bone Mineral Density testing if:

You are 65 or older
You and your physician have done a risk factor assessment and have determined that you are a high-risk individual
You have lost four or more cm in height (1.6 inches) overall; which is approximately (six cm (2.4 inches) or more in those 60 years or older) or two or more cm (0.8 inches) in less than three years
You have kyphosis (excessive curvature of the spine resulting in either a hump or a more gradually rounded back)
You are taking glucocorticoid medication (ex: oral prednisone or cortisone), and want to determine if you are losing bone mass and whether treatment for osteoporosis is required
You have recently had a fracture in which osteoporosis is suspected
You already have osteoporosis and you and your physician are monitoring the effectiveness of the treatment

For further information about Bone Mineral Density testing please go to www.osteoporosis.ca

The treatment for osteoporosis does not differ between men and women. Men are advised to make lifestyle changes such as:

Created by Mia Kubrak for The Women’s Midlife Health Program Nursing Education Program of Saskatchewan January 2010 updated August 2010

1 Osteoporosis Society of Canada (2007). Osteoporosis update a practical guide for Canadian physicians. Retrieved January 13, 2010 from http://www.osteoporosis.ca

2 National Institute of Health Osteoporosis and Related Bone Diseases’ National Resource Center (2009).Men and osteoporosis. Retrieved January 12, 2010 from www.niams.nih.gov

3 Osteoporosis Canada (2008). Facts and statistics. Retrieved January 13, 2010 from http://www.osteoporosis.ca/index.php/ ci_id/8867/la_id/1.htm

4 Bilezikian, J.P. (1999). Osteoporosis in men. The Journal of Clinical Endocrinology & Metabolism, 84 (10), p. 3431-3435.

5 Campion, J.M.m Maricic, M.J. (2003). Osteoporosis in men. American Family Physician, 67 (7), p.1521-1527.

6 Khosla, S., Amin, S., Orwoll, E. (2008). Osteoporosis in men. The Endocrine Society, 39 (4), p. 441-464.

7 Pande, I., Francis, R.M. (2001). Osteoporosis in men. Best Practice and Research Clinical Rheumatology, 15 (3), p. 415-427.

8 Osteoporosis Canada (2009). Men and osteoporosis. Retrieved January 12, 2010 from http://www.osteoporosis.ca/index.php/ ci_id/7037/la_id/1.htm

Your questions, answered.

We have gathered a list of the most common questions women ask regarding topics that affect your overall health and well-being.

Women's Mid-Life Health Program

Referrals

For doctors, nurse practitioners, pelvic floor physiotherapists & naturopathic doctors use.
Download our referral form PDF here.
If you have any questions, please contact us.

Website created by Colin Richet

© 2025 Women's Mid-Life Health Program.

Your questions, answered.

We have gathered a list of the most common questions women ask regarding topics that affect your overall health and well-being.

Women's Mid-Life Health Program

Referrals

For doctors, nurse practitioners, pelvic floor physiotherapists & naturopathic doctors use. Download our referral form PDF here. If you have any questions, please contact us.

Website created by Colin Richet

© 2025 Women's Mid-Life Health Program.

For doctors, nurse practitioners, pelvic floor physiotherapists & naturopathic doctors use.
Download our referral form PDF here.
If you have any questions, please contact us.