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Bone and Joint Health
men maintain bone health

Bones are made of living cells and contain primarily collagen and calcium phosphate. Under normal circumstances, bones are as strong as cast iron. They provide support for your body so you can stand upright and walk; they protect vital organs such as your brain, heart, and lungs, and produce white blood cells for your immune system. While osteoporosis is often thought of as a woman’s issue, two million American men currently have osteoporosis, and one in four men will experience a fracture due to thinning bones. In this article, we discuss bone loss and osteoporosis risk in men.  Then, we discuss how men can maintain healthy bones as they age.

Bone Loss and Osteoporosis

In most people, bone mass peaks in your 30s, and your bones will start to thin thereafter. When your bones start to thin, it makes them more fragile and prone to fractures. Loss of bone usually happens slowly over time, and fractures or falls may be the first sign that you have weak bones, or have developed osteoporosis. In addition to being very painful, fractures later in life can become a significant threat to your mobility, independence, and quality of life. Once you have osteoporosis, even minor falls can result in fractures.

By 2020 approximately over 12 million Americans over the age of 50 will develop osteoporosis. According to the International Osteoporosis Foundation, 25% of hip fractures occur in men over the age of 50. Hip fractures, in particular, can be debilitating, and men have a harder time recovering from hip fractures than women. For men over the age of 50, the risk of developing a fracture is 16% higher than the risk of developing prostate cancer.

Osteoporosis Risk Factors in Men

Although many believe osteoporosis primarily affects postmenopausal women, many men are also at risk. According to the National Institutes of Health, risk factors for men include:

  • Race: White men are at increased risk, but all men can develop osteoporosis.
  • Age: The older you are, the higher the risk.
  • Genetics: A family history of fractures puts you at higher risk.
  • Unhealthy lifestyle: Smoking, excessive alcohol use, low calcium intake, and sedentary way of life all increase the risk of osteoporosis.
  • Medications: Regular prolonged use of steroid medications to treat asthma or rheumatoid arthritis called glucocorticoids increase the risk of osteoporosis.
  • Low testosterone levels: Certain prostate cancer treatments designed to lower testosterone levels, and undiagnosed low testosterone levels for other reasons increase the risk of osteoporosis.
  • Chronic disease: Certain chronic diseases of the lungs, kidneys, stomach, and intestines can limit absorption of calcium or change hormone levels. These issues may result in a higher risk of osteoporosis.

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What Can Men Do To Maintain Healthy Bones?

If you have any number of the risk factors outlined above or had a fall or fracture, your bone mineral density can be determined via a DEXA or DXA scan. If the scan shows that you have low bone mineral density, or you are diagnosed with osteoporosis, increasing calcium and vitamin D intake is often recommended to help maintain bone mass.

Calcium for Bone Health

The National Academy of Medicine recommends an intake of 1000 mg calcium daily for men aged 19-70 years, while men over 70 need 1200 mg calcium daily. Table 1 lists foods rich in calcium. When grocery shopping, it’s helpful to read food labels. A good practice is to choose foods that have 10 percent or more of the Daily Value for calcium.

Your body absorbs calcium food sources more efficiently if you eat them at different times throughout the day. Here are some suggestions on how to spread out your calcium intake:

  • Make your breakfast oatmeal with milk instead of water
  • Have yogurt as a mid-day snack
  • Top your baked potato at dinner with steamed broccoli and shredded cheese
  • Enjoy calcium-fortified tofu as a plant-based option for dinner

Eating a healthy diet provides many nutrients needed to maintain healthy bones, such as potassium, magnesium, phosphorus, and phytochemicals.

Table 1. Calcium Food Sources. Adapted from U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 24. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl.

Food SourceAmount of Calcium, mg
Dairy
Milk, 8 oz
Soy Milk, Calcium-Fortified, 8 oz
Yogurt, Low-Fat, 8 oz
Mozzarella Cheese, Part Skim, 1.5 oz
Cheddar Cheese, 1.5 oz
Cottage Cheese, 1% Fat, 1 Cup
Frozen Yogurt, Vanilla, Soft Serve, ½ Cup
Ice Cream, Vanilla, ½ Cup
276-293
299
313-415
333
307
138
103
84
Fruit & Vegetables
Orange Juice, Calcium-Fortified, 6 oz
Turnip Greens, Cooked/Raw, ½ Cup
Kale, Cooked/Raw, 1 Cup
Bok Choi, Raw, 1 Cup
261
99
94
74
Cereals
Ready-to-Eat Cereals, Calcium-Fortified, 1 Cup
Bread, 1 slice
100-1,000
30-73
Fish, Seafood, Plant-Based Protein
Sardines, Canned, with Bones, 3 oz
Salmon, Canned, with Bones
Tofu, Calcium-Fortified, 1/2 Cup
325
181
138-253

There is not complete agreement regarding how much calcium you need to prevent the bone from thinning, and whether a supplement is needed. According to the Dietary Guidelines Advisory Committee, many Americans do not meet recommendations for calcium intake and require a calcium supplement. The amount of calcium you need from a supplement depends on how much you usually get from the foods you eat. Studies suggest calcium-rich foods should be increased first, and a calcium supplement should be used if someone does not meet the recommended intakes.

Vitamin D for Bone Health

There is not complete agreement on the optimal daily dose of vitamin D. The current Recommended Dietary Allowance (RDA) is 600-800 IU per day, depending on age, and the upper limit for daily intake is 4,000 IU. Vitamin D experts, however, typically recommend higher doses, particularly for those who have low vitamin D levels.

The Endocrine Society advises adults with vitamin D deficiency (below 20 ng/mL) to take 6,000 IU of vitamin D each day to achieve a normal blood level (above 30 ng/mL). Once you achieve optimal blood levels, they advise a maintenance dose of 1,500-2,000 IU of vitamin D each day.

The amount of vitamin D you need depends on your age, current vitamin D level, and health status. It is best to consult with your healthcare provider to determine what dose is best for you.

It is difficult to get enough vitamin D from your diet alone because vitamin D does not occur naturally in many foods.  Fatty fish (such as salmon) and certain oils naturally contain some vitamin D. Some breakfast cereals, as well as milk, are often fortified with vitamin D. Drinking one cup of milk gives you about 100 IU of vitamin D.


Ultimately, a multipronged approach is recommended for prevention of bone loss, including participating in regular weight-bearing and resistance exercise, such as walking or running, and weight lifting, eating a well-rounded, balanced, healthy diet, taking supplements as needed, limiting alcohol intake, and avoiding smoking.

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