Introduction and Disease State Background
Some medical conditions develop silently, often without noticeable symptoms, until a serious complication occurs. One notable example is osteoporosis, a bone disease resulting from decreased bone mass, low bone density, and structural bone changes that can lead to an increased risk of fractures.
According to Osteoporosis Canada, around 2.3 million Canadians are currently living with osteoporosis, and it is estimated that at least 1 in 3 women and 1 in 5 men will break a bone due to osteoporosis in their lifetime.1 The ramifications of a fracture can be devastating to patients and can lead to chronic pain, disability, loss of independence, and even death.
Due to its subtle nature, osteoporosis has been dubbed the “silent thief” since it can progress without any major warning until a fracture occurs.
Although bisphosphonates are an essential tool in osteoporosis treatment, certain dietary and lifestyle modifications, when used in conjunction with bisphosphonates, can help to preserve bone mineral density.2 Low or inadequate vitamin D and calcium levels are one modifiable risk factor putting patients at risk of osteoporosis and its complications. Research has shown that across all age groups, adequate calcium and vitamin D intake has a modest effect on the preservation or enhancement of bone mass.3
Pharmacists, as one of the most accessible healthcare providers, are well-positioned to empower patients with the knowledge and tools they require to take proactive steps to protect their bone health.
The Role of Calcium, Vitamin D, and Dairy in Osteoporosis
Calcium, a vital mineral found abundantly in dairy products, plays a critical role in maintaining bone density and mass. However, many Canadians aren’t getting enough calcium. A study published in the Journal of Nutrition found that calcium intake from food and supplemental sources decreased in the Canadian population from 2005 to 2014 and that many Canadians are at risk of inadequate calcium intake.4
Osteoporosis Canada recommends consuming between 1,000 and 1,200 mg of calcium daily through food or supplements, with the preference that calcium is obtained from food sources. The recommendations differ based on age and gender:
- Women >50 years of age: 1,200 mg of calcium daily5
- Men >70 years of age: 1,200 mg of calcium daily5
- Men 51 to 70 years of age: 1,000 mg of calcium daily5
Dairy products are considered one of the best sources of calcium due to their high elemental calcium content, and high absorptive rate.4 According to Osteoporosis Canada, individuals over 50 years of age should aim to consume three servings of dairy milk and dairy products (e.g., yogurt, and cheese) per day. The calcium content for a serving of commonly used dairy products can be found on Osteoporosis Canada’s website:
Calcium-Rich Foods6
| Dairy Product | Serving Size | Calcium |
|---|---|---|
| Milk (Whole, 2%, 1%, Skim) | 1 cup (250 mL) | 300 mg |
| Yogurt (Plain, 1-2% milk fat) | ¾ cup (175 mL) | 332 mg |
| Cheese | 1 ¼ inch (3 cm cube) | 200 mg to 245 mg |
Other nutrients in dairy products, such as vitamin D, are also essential to bone health. Vitamin D is needed for efficient calcium absorption and helps to improve the function of muscles. Although vitamin D can be obtained through exposure to sunlight, many Canadians will not achieve sufficient vitamin D intake through this method alone.7,8 Therefore, Osteoporosis Canada recommends routine vitamin D supplementation through fortified foods or the use of over-the-counter products for Canadian adults year-round.
Since vitamin D occurs naturally in very few foods, certain food products such as dairy milk, margarine and egg products are required to be fortified with vitamin D in Canada. Milk is a good dietary source of vitamin D, with approximately 100 international units (IU) per cup (240 mL).7
Health Canada’s current recommended dietary allowances for vitamin D in healthy males and females are:
- Ages 9-70: 600 IU of Vitamin D daily9
- Ages >70: 800 IU of Vitamin D daily9
In addition, Osteoporosis Canada maintains that individuals with osteoporosis, or who have other medical conditions increasing the risk of fractures, may benefit from ensuring adequate vitamin D of 800-2,000 IU/day.7
Conclusion
Osteoporosis remains a significant, yet often silent, threat to bone health and can result in severe complications such as fractures, chronic pain, and impact a patient’s quality of life. While bisphosphonates play a crucial role in treatment, incorporating dietary and lifestyle modifications, particularly ensuring adequate intake of calcium and vitamin D, are a critical part of osteoporosis treatment planning. Dairy products are one of the foods that can help meet these nutritional needs. Pharmacists are in a unique position to act as bone health advocates and can help empower patients to be proactive about their bone health through medication and lifestyle counselling.
This blog post is developed by the Ontario Pharmacists Association (OPA) and supported through an education grant from the Dairy Farmers of Ontario.
References
- Osteoporosis Canada. (2024). Retrieved May 31st, 2024: https://osteoporosis.ca/facts-and-stats/
- Sunyecz JA. The use of calcium and vitamin D in the management of osteoporosis. Ther Clin Risk Manag. 2008;4(4):827-836. doi:10.2147/tcrm.s3552
- Heaney RP. The importance of calcium intake for lifelong skeletal health. Calcif Tissue Int. 2002;70(2):70-73. doi:10.1007/s00223-001-0032-3
- Vatanparast H, Islam N, Patil RP, Shafiee M, Whiting SJ. Calcium Intake from Food and Supplemental Sources Decreased in the Canadian Population from 2004 to 2015. J Nutr. 2020;150(4):833-841. doi:10.1093/jn/nxz3185. Osteoporosis Canada. (2024). Retrieved May 31st, 2024: https://osteoporosis.ca/calcium/
- Osteoporosis Canada. (2024). Retrieved May 31st, 2024: https://osteoporosis.ca/calcium/
- Osteoporosis Canada. (2024). Retrieved May 31st, 2024: https://osteoporosis.ca/calcium-rich-foods/
- Osteoporosis Canada. (2024). Retrieved May 31st, 2024: https://osteoporosis.ca/vitamin-d/
- StatsCAN (2013). Retrieved June 26th, 2024: https://www.statcan.gc.ca/o1/en/plus/5095-shedding-light-canadas-vitamin-d-levels-we-approach-shortest-day-year
- Health Canada (2023) Dietary reference intakes: Reference values for elements: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-vitamins.html
