Q1. What dose and type of calcium and vitamin D supplementation do you recommend for patients, especially women, on long-term prednisone? Are dairy products enough or do I need extra supplementation?
One of the side effects of taking long-term prednisone is an increased risk of developing osteoporosis. This is known as steroid-induced osteoporosis. Various things can be done to reduce your risk of developing steroid-induced osteoporosis. These include lifestyle measures such as stopping smoking, reducing your alcohol intake and increasing your exercise levels. You should also make sure that you have adequate amounts of calcium and vitamin D and sometimes supplement tablets may be needed. The American College of Rheumatology Task Force on Osteoporosis guidelines recommends that all patients maintain an adequate calcium intake of 1500 mg/day and either 800 International Units (IUs)/day or 50,000 IUs 3 times per week for Vitamin D. Talk to your physician before starting any supplement.
Q2. I’m lactose intolerant. What types of food can I eat to get my daily required calcium levels to get stronger bones?
Milk, yogurt, and cheese are rich natural sources of calcium and are the major food contributors of this nutrient to people in the United States. However, other foods high in calcium are dark leafy greens such as kale, broccoli, spinach, collards and Chinese cabbage. Soy products such as tofu or soy milk are also good sources of calcium.
Q3. What kind of nutrients and how much do pregnant women need to maintain healthy bones for the woman and baby?
The National Academy of Sciences recommends that women who are pregnant or breastfeeding consume 1,000 mg of calcium each day. For pregnant teens, the recommended intake is even higher: 1,300 mg of calcium a day. Your doctor probably will prescribe a vitamin and mineral supplement to take during pregnancy and breastfeeding to ensure that you get enough of this important mineral.
Q4. What kind of foods and supplements do you recommend for people to take to reduce the risk of osteoporosis? How much of it do we need?
You can slow bone loss and possibly prevent osteoporosis by eating a diet rich in calcium and vitamin D. Foods naturally high in calcium are primarily dairy products. Other foods considered good sources of calcium include some fruits such as oranges, vegetables such as bok choy or broccoli, and legumes. For most adults ages 19 through 50, 1,000 mg covers daily calcium needs. Women starting at age 51 and men age 71 and older need no more than 1,200 mg per day. As for vitamin D, 600 International Units (IUs) daily meets the needs of almost everyone in the United States, although people 71 and older may require as much as 800 IUs per day because of potential physical and behavioral changes related to aging.
Q5. I heard vitamin D affects bone health. How much do I need and how do I consume it?
Vitamin D plays a critical role in maintaining bone health. According to the Institute of Medicine, Americans up to age 70 need no more than 600 International Units (IUs) of vitamin D per day to maintain health, and those 71 and older may need as much as 800 IUs. There are few natural sources of vitamin D in the diet. Most dietary vitamin D comes from fortified milk. Although sunlight triggers the natural production of vitamin D in skin and contributes to people’s vitamin D levels, individuals’ sun exposure varies greatly and many people are told to minimize their exposure. Talk to your doctor to see if a supplement is necessary.
Laura Gibofsky, MS, RD, CSP, CDN, is a nutritionist at Hospital for Special Surgery.