Most late-life maladies are not on the radar screens of America's young people. They simply do not relate to what goes on in the lives of people ages 50-70. This is a dilemma, because almost all research indicates that early awareness and lifestyle choices can prevent today's young people from becoming victims of osteoporosis, a disease affecting over 25 million Americans.

Osteoporosis is a skeletal disease in which the bones lose mass and density, the pores in bones enlarge and the bones generally become fragile. Called the "silent disease," osteoporosis often is not diagnosed until a fracture occurs, most commonly in the spine, hip or wrist. The National Osteoporosis Foundation says about 1.5 million such fractures occur each year in the United States, and the 1995 estimated cost for treating those fractures was nearly $14 billion.

There is No Cure for Osteoporosis

According to the National Osteoporosis Foundation, osteoporosis is four times more common in women than in men. Women's bones are naturally thinner and less dense than men's, and compared to men, women start losing bone mass and density at an earlier age. Menopause accelerates bone loss in women, and the disease begins to emerge around the ages of 50-60. Caucasian and Asian women are at greater risk than women of African and Hispanic descent who tend to be born with greater bone mass. For men, as levels of the male hormone, testosterone, decrease, the risk of osteoporosis increases. It is estimated that osteoporosis affects one-third of all men by age 75.

Osteoporosis can be Prevented

Research indicates that much can be done early in life to prevent this debilitating disease. Pre-teens and teenagers should make lifestyle choices which can have great influence fifty years later. Increasing bone mass between the ages of seven and twelve will mean less risk of osteoporosis years later.

Diet and nutritional intake are the first and most important choices. "Calcium intake is crucial during childhood, adolescence and early adulthood to help build the densest bones possible to carry us through life," said Mary Pat Bolton, R.D., at Baylor College of Medicine. Calcium is vital to bone growth, 45 percent of which takes place during adolescence. What many do not realize is that while bone length is established by age 20, bone density and strength can continue to be built all the way to age 30, after which bone loss begins. Prior to age 30, young women and men can build a "bone bank," that is deposit calcium in their bones, for use later in life.

Genetics Play an Important Role in Osteoporosis

Recent research in Australia, Great Britain and Switzerland found and confirmed a major link between bone mass and variations in the gene for the vitamin D receptor (VDR). Studies on identical and non-identical postmenopausal female twins in Great Britain attributed seven to ten percent of the difference in bone mass density to variant VDR genes. The Swiss study on elderly adults identified the variant gene's influence on bone mass response to calcium intake. For those with a family history of osteoporosis, genetic research may help identify an individual's risk factor and enable early intervention.

What is the Right Amount of Calcium?

The National Academy of Sciences' Dietary Reference Intake (formerly Recommended Dietary Allowance) for calcium increases from 800 milligrams per day to 1,200 milligrams per day at age 11. A 1994 National Institutes of Health consensus statement on "Optimal Calcium Intake" recommends a daily calcium intake of 1,200 to 1,500 milligrams to "obtain optimal peak bone mass..." New recommended intakes for calcium and vitamin D will be released later this year.

According to U.S. Department of Agriculture surveys, a mere 14 percent of girls and 35 percent of boys ages 12-19 are reaching the recommended 1,200 milligrams of calcium per day. Calcium requirements can be met by incorporating dairy products, broccoli, spinach and calcium fortified foods, such as juices and cereals, in the diet (see side bar).

Physical Activity is Essential

Numerous studies conclude that daily, moderate physical activity increases bone mass and density. Exercise is important at all age levels—it helps build bone mass and density during the formative years, and in older adults, it is important for balance and coordination to help prevent bone-fracturing falls. Engaging in vigorous weight-bearing exercise, such as walking, jogging, aerobics, court games, dancing and supervised weight training, for 30-60 minutes per day three to five days per week, is recommended for optimal results.

Making the right lifestyle choices early in life can prevent a debilitating disease later in life. Early awareness is considered so important to osteoporosis prevention that the Food and Drug Administration has launched a pilot program to educate girls ages 11-14. The program, "Calcium! Do You Get It?," was launched in Florida, Massachusetts, Michigan and New York during 1997. One of the program goals states: "By addressing this need at an early age, it is our hope that young girls will develop health-promoting behaviors they can carry throughout life."

Phosphorus and Osteoporosis

Phosphorus, along with calcium, is an important mineral and is essential for calcification of bones (85% of body phosphorus is located in the skeleton). It has been said for many years that the phosphorus in carbonated drinks was a contributing factor to osteoporosis. However, this theory has not held up under scientific scrutiny. The theory stated that dietary phosphorus interfered with the body's calcium-phosphorus balance. However, the National Institutes of Health concluded that the American diet contains high amounts of sodium and protein, both of which can significantly increase calcium loss, while other dietary components, including fat, phosphate and caffeine, do not significantly affect calcium loss or status. Exercising and eating foods high in calcium are still the best ways to avoid the debilitating effects of osteoporosis.

Factors that increase the likelihood of developing osteoporosis include the following:

• Female
• Thin and/or small frame
• Advanced age
• Family history of osteoporosis
• Post-menopausal
• Abnormal absence of menstrual periods (amenorrhea)
• Anorexia nervosa or bulimia
• Low-calcium diet
• Use of certain medications, such as corticosteroids and anti-convulsants
• Low testosterone levels (men)
• Inactive lifestyle
• Cigarette smoking
• Excessive alcohol use

What's A Serving?

One excellent calcium serving (20% DV)

• 1 cup skim or low-fat milk, or low-fat or nonfat yogurt
• 1 1/2 ounces cheese
• 1 cup calcium-fortified juice
• 3 ounces canned sardines with bones
• 1 slice cheese pizza

One good calcium serving (10% DV)

• 1 ounce calcium-fortified cereal
• 1 cup broccoli or kale cooked
• 3 ounces canned salmon with bones
• 4 ounces tofu (made with calcium)
• 1 cup macaroni and cheese
• 1/2 cup pudding