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Improving Bone Health
 “Fit for Duty. . .Fit for Life!” is a lifestyle-based column provided by USPHS Dietitians/Nutritionists.
As an officer in the Commissioned Corps of the U.S. Public Health Service, you are most likely in good physical shape. Are you taking the steps now to ensure that your good health continues into your golden years? According to the 2004 Surgeon General’s Report on Bone Health and Osteoporosis, by 2020 half of all Americans over 50 will have weak bones unless we make changes to our diet and lifestyle (1). By following these simple steps you can help to ensure bone health for life.

Step One: Eat Foods Rich in Calcium

Adults under age 50 need 1,000 mg of calcium daily while adults over age 50 need 1,200 mg of calcium daily. The 2005 Dietary Guidelines recommend three servings of low-fat or fat-free milk and milk products each day to help provide adequate calcium (3). One serving of dairy products is equal to 1 cup (8 fl oz.) of milk, 8 oz. of yogurt, 1.5 oz. of natural cheese (such as cheddar) or 2 oz. of processed cheese (such as American). 

For people who do not or cannot consume dairy products, there are other calcium-rich alternatives such as broccoli, Chinese cabbage, and almonds, in addition to foods which are fortified with calcium, such as fruit juices, tofu, and cereals (4, 5). These alternate calcium sources can be beneficial for people with lactose intolerance, an inability to digest the sugar in milk (lactose) (6). If you think you may be lactose intolerant and would like assistance in getting enough calcium in your diet, speak to a Registered Dietitian.

Step Two: Consume Adequate Amounts of Vitamin D

Vitamin D works with calcium to build and strengthen bones by allowing the bones to absorb calcium. Adults under age 50 need 400 – 800 IU of vitamin D daily and adults age 50 and over need 800 – 1000 IU of vitamin D daily.

The major dietary sources of vitamin D are vitamin D fortified milk, egg yolks, saltwater fish, liver, and dietary supplements. If you are choosing a vitamin D supplement, it is best to choose one containing vitamin D3 (cholecalciferol) instead of vitamin D2 (ergocalciferol) to best support bone health (9).

Step Three: Be Physically Active Every Day

Assess your exercise routine to ensure it includes weight-bearing physical activities such as dancing, walking, stair climbing, and strength training which stimulate bones to grow stronger. Including at least 30 minutes most days of weight bearing and strengthening physical activity for adults, and 60 minutes most days for children can help keep bone strong.

Step Four: Avoid Smoking and Limit Alcohol Intake

Now is the time to quit smoking. Smoking increases bone loss, decreases intestinal calcium absorption, and reduces blood levels of vitamin D which decreases the ability of bones to absorb calcium. As well, if you consume alcohol do so moderately. Alcohol reduces the intestinal absorption of calcium and decreases the conversion of vitamin D to its active form which also reduces calcium absorption.

Step Five: Discuss Increased Risks with Your Doctor

Ask your healthcare professional about other possible risk factors that may compromise your bone health, such as genetics, certain medical conditions such as hyperthyroidism or arthritis, or taking certain prescription medications such as thyroid medicine, and what additional actions you can take to protect your bones.

By making small lifestyle changes today, you can ensure your bone health for tomorrow.


1. U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, 2004.

2. National Osteoporosis Foundation (NOF). Five steps to bone health and osteoporosis prevention. NOF, Prevention. 2008. http://www.nof.org/prevention/index.htm .

3. U.S. Department of Agriculture (USDA), U.S. Department of Health and Human Services (HHS). Dietary Guidelines for Americans. 2005. http://www.health.gov/DietaryGuidelines/default.htm .

4. National Osteoporosis Foundation. What you should know about calcium. NOF, Prevention. 2008. http://www.nof.org/prevention/calcium2.htm .

5. Centers for Disease Control and Prevention (CDC). Nutrition for Everyone: Bone Health. CDC, Nutrition. 20007. http://www.cdc.gov/nccdphp/dnpa/nutrition/nutrition_for_everyone/bonehealth/

6. U.S. Food and Drug Administration. Consumer Health Information. Problems Digesting Dairy Products? 2008. http://www.fda.gov/consumer/updates/lactose032508.pdf .

7. National Institutes of Health. National Institutes of Child Health and Human Development. Make Calcium Easy to Get at Home. 2008. http://www.nichd.nih.gov/milk/can/easy.cfm .

8. National Institutes of Health. Office of Dietary Supplements. Dietary Supplements Fact Sheet: Vitamin D. 2008. http://ods.od.nih.gov/factsheets/vitamind.asp .

9. National Institutes of Health. Office of Dietary Supplements. Dietary Supplements Fact Sheet: Calcium. 2005. http://ods.od.nih.gov/factsheets/calcium.asp .
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