In addition to the potential benefits of physical activity on bone health, diet is another modifiable factor. Adequate calcium intake is vital — both for achieving peak bone mass and for maintaining bone health (12). To maintain blood calcium levels, proper dietary intake is needed to prevent calcium being taken from the skeleton where 99% of the body’s calcium is stored (12). The recommendations from the NOF for dietary intake of calcium for older adults are in line with those of the Institutes of Medicine: 1,000 mg/d for men aged 50 to 70 years and 1,200 mg/d for women age 51 and older and men 71 years and older (12). For calcium recommendations throughout the life span, see Table 3.
Sources of calcium include dairy products (with low-fat or nonfat dairy products being recommended because they have the full amount of calcium but avoid excess fat), fortified food (e.g., calcium-fortified orange juice), and some fruits and vegetables (14). Obtaining nutrients from food typically is recommended; however, fortified food and supplements may be helpful for individuals whose dietary intake falls short (14). The tolerable upper intake levels for calcium vary with age (8):
Getting too much calcium is rare when relying on food alone; excess intakes are more likely for those taking supplements (8). Kidney stone formation is associated with a high intake of calcium from supplements, and some studies link a high calcium intake with an increased risk of cardiovascular disease (8).
Vitamin D is needed for calcium absorption and bone health (12). Recommendations for vitamin D intake from NOF include 800 to 1,000 IU of vitamin D per day for adults age 50 years and older (12). The 2012 Surgeon General’s Report on “Bone Health and Osteoporosis: What It Means to You” points out the increasing vitamin D needed with advancing age: 400 IU from age 0 to 12 months, 600 IU from age 1 to 70, and 800 IU for those older than 70 years (15). Vitamin D can come from sunlight (exposure to sunlight results in conversion of precursors in the skin to active vitamin D), as well as dietary sources of vitamin D like fortified milk and fish (e.g., herring, salmon, tuna, sardines). Often, vitamin D is included with calcium supplements, but avoid consuming more than 2,000 IU per day (tolerable upper level) (14).
In summary, physical activity and diet are lifestyle factors that have the potential to promote bone health throughout the life span. As stated in the Surgeon General’s Report (14): “Physical activity and adequate calcium and vitamin D intake are now known to be major contributors to bone health for individuals of all ages. Even though bone disease often strikes late in life, the importance of beginning prevention at a very young age and continuing it throughout life is now well understood.”
1. American College of Sports Medicine. ACSM’s Complete Guide to Fitness & Health. Bushman BA, editor. Champaign: Human Kinetics; 2011, 396 p.
2. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 9th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2014, 456 p.
3. American College of Sports Medicine. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescripton. 7th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2014, 862 p.
4. Borer KT. Physical activity in the prevention and amelioration of osteoporosis in women: Interaction of mechanical, hormonal and dietary factors. Sports Med. 2005; 35 (9): 779–830.
5. Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JAL. Exercise and bone mass in adults. Sports Med. 2009; 39 (6): 439–68.
6. Heaney RP, Abrams S, Dawson-Hughes B, Looker A, Marcus R, Matkovic V, Weaver C. Peak bone mass. Osteoporosis Int. 2000; 11: 985–1009.
7. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR. Position stand: Physical activity and bone health. Med Sci Sports Exerc. 2004; 36 (11): 1985–96.
9. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Check Up on Your Bones. Bethesda (MD): Osteoporosis and Related Diseases National Resource Center; [cited 2013 May 15]. Available from: http://www.niams.nih.gov/Health_Info/Bone/Optool/index.asp
11. National Osteoporosis Foundation. [Internet]. Bone Basics. Washington (DC): National Osteoporosis Foundation; [cited 2013 June 8]. Available from: http://www.nof.org/learn/bonebasics
12. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington (DC): National Osteoporosis Foundation; 2013; [cited 2013 May 15] Available from: http://nof.org/hcp/resources/913
13. National Osteoporosis Foundation. [Internet]. NOF Releases New Data Detailing the Prevalence of Osteoporosis. Washington (DC): April 18, 2013 [cited 2013 May 15]. Available from: http://www.nof.org/news/1009
14. 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.
15. U.S. Department of Health and Human Services. The Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You. Rockville (MD): U.S. Department of Health and Human Services, Office of the Surgeon General; 2012.