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Osteoporosis: Unique Risk Factors In African American Women

Take care of yourself and your family. After all, healthy families build healthy communities!
Constance Brown-Riggs
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Registered dietitian, certified diabetes educator, author of The African American Guide to Living Well with Diabetes and Dannon Nutrition Advisor

Registered dietitian, certified diabetes educator, author of The African American Guide to Living Well with Diabetes and Dannon Nutrition Advisor
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Fridge filled with dairy product eggs fruits and vegetable
Fridge filled with dairy product eggs fruits and vegetable

Osteoporosis is a metabolic bone disease characterized by low bone mineral density (BMD) which makes bones fragile and susceptible to fracture. Many African American women believe that osteoporosis is only a concern for white women. This misperception can be a barrier to prevention and treatment. It's true that African American women tend to have higher BMD than white women throughout life, however, there are specific issues that African American women face when it comes to developing osteoporosis that are less well known [1]. These issues include the following:

  • Under recognized and undertreated. The NIH Osteoporosis and Related Bone Diseases National Resource Center acknowledges that "Although African American women tend to have higher bone mineral density (BMD) than white women throughout life, they are still at significant risk of developing osteoporosis. The misperception that osteoporosis is only a concern for white women can delay prevention and treatment in African American women who do not believe they are at risk for the disease." [2]

  • At risk. As African American women age, their risk for hip fracture doubles approximately every 7 years [1].

  • Sickle cell anemia and lupus. Diseases more prevalent in the African American population, such as sickle cell anemia and lupus, are linked to an increase risk of developing osteoporosis [1,3].

  • Insufficient calcium and vitamin D intake. African American women consume 50 percent less calcium than the Recommended Dietary Allowance [1]. Adequate intake of calcium and vitamin D throughout life, as part of a healthy dietary pattern, may reduce the risk of osteoporosis, by helping build and maintain good bone health. Vitamin D can be made in the skin when exposed to sunlight. However, skin pigmentation is one of several factors that can determine how much sun exposure you need. African Americans have dark pigment, which lessens the body's ability to produce vitamin D in the skin. Obesity--which is high among African American women in the United States, may also play a role in keeping vitamin D levels low. That's because obesity reduces the body's ability to use vitamin D [4].

  • Exercise Regularly. Exercising regularly throughout life, with an emphasis on weightbearing activities such as walking, jogging, dancing, and weight training can help lower risk of osteoporosis [1].

  • Lactose Intolerance. As many as 75 percent of African Americans may experience lactose intolerance. Lactose intolerance can hinder optimal calcium intake. People with lactose intolerance may avoid milk and other dairy products even though most are excellent sources of calcium because they have trouble digesting lactose, the primary sugar in milk [1].

    • Eating a well-balanced diet adequate in calcium and vitamin D throughout life is key to building bones and lowering risk for osteoporosis. Calcium and vitamin D can be found in the foods you eat. Dairy products such as milk, yogurt and cheese, are the primary sources of calcium in American diets. Dietary patterns that provide 3 servings of dairy products per day can improve bone mass [4]. Vitamin D functions in the body to maintain proper levels of calcium and phosphorous, thereby helping to build and maintain bones. Milk and yogurts that are fortified with vitamin D can be good sources of this nutrient. Other sources of vitamin D include fish such as salmon or tuna, and vitamin D-fortified ready-to-eat breakfast cereals [4].

    According to the 2015 Dietary Guidelines for Americans, older children, teens, and adults have a recommended dairy intake of 3 servings a day, while children 4 to 8 years old are recommended to consume 2.5 servings, and 2 servings per day are recommended for children 2 to 3 years old. In general, a serving of dairy is 1 cup of milk, 1 cup of yogurt, 1.5 ounces of natural cheese, or 2 ounces of processed cheese.

    For those who are lactose intolerant, smaller portions (such as 4 fluid ounces of milk) may be well tolerated. Lactose-free and lower-lactose products are available. These include lactose-reduced or lactose-free milk, yogurt, and cheese. Yogurt can be a more easily digestible alternative to milk because it contains live and active cultures that help with lactose digestion. In addition, yogurt on average contains less lactose per serving than milk so you may be able to enjoy yogurt products with fewer associated symptoms [5]. Also, enzyme preparations can be added to milk to lower the lactose content.

    The tips listed below will help you make wise dairy choices everyday:
    • Try nonfat or lowfat yogurt as a snack.
    • If you drink cappuccinos or lattes -- ask for them with non fat (skim) or low fat milk.
    • Make fruit-yogurt smoothies in the blender.
    • Add non fat or low fat milk instead of water to oatmeal and hot cereals.
    • Make a yogurt parfait with whole grain cereals, fruits and nonfat or lowfat yogurt for breakfast.
    • Use non fat or low fat milk when making condensed cream soups (such as cream of tomato).
    • Make a dip for fruits or vegetables from nonfat or lowfat yogurt.
    • Top sliced fruit with flavored nonfat or lowfat yogurt for an easy-to-make dessert.
    • For dessert, make chocolate or butterscotch pudding with non fat or low fat milk.
    • Top casseroles, soups, stews, or vegetables with shredded reduced fat or low fat cheese.
    • Include milk as a beverage at meals. Choose non fat or low fat milk.
    • Top a baked potato with nonfat or lowfat yogurt.

    Take care of yourself and your family. Adults who drink milk or eat dairy foods can demonstrate to children that dairy is important and should be a staple in their diet. Dairy foods are especially important for building the growing bones of kids and teens. Make non fat or low fat dairy foods part of everyday meals and snacks--not only as part of a strategy for preventing osteoporosis, but for everyone's nutritional benefit. After all, healthy families build healthy communities!

    References
    1. Osteoporosis and African American Women. NIH Osteoporosis and Related Bone Diseases. National Resource Center. June 2015. http://www.niams.nih.gov/health_info/Bone/Osteoporosis/Background/african_american_women.pdf
    2. Sadat-Ali M, et al. Low bone mass due to sickle cell anemia, is it becoming a real issue? West Afr J Med, 2008 Oct;27(4):218-23. http://www.ncbi.nlm.nih.gov/pubmed/19469399
    3. NIH ODS Strengthening Knowledge and Understanding of Dietary Supplements https://ods.od.nih.gov/factsheets/VitaminD-Consumer/
    4. U.S. Department of Health and Human Services and U.S. Department of Agriculture. ChooseMyPlate.Gov. Dairy. Available online: http://www.choosemyplate.gov/dairy-nutrients-health. Accessed June 15, 2016.
    5. Lomer MCE, Parkes GC, Sanderson JD. Review article: lactose intolerance in clinical practice--myths and realities. Aliment Pharmacol Ther. 2008;27:93-103.
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