By Josette Keelor -- Daily Staff Writer

Eating the right foods, getting enough exercise and not staying out in the sun too long are some health concerns that many people have, especially when considering their long-term health.

Though the health of their bones might not be at the top of many people's list of health concerns, it is something that they should be thinking about, and as soon as possible.

By the age of 20, the average woman has acquired most of her skeletal mass, according to the Center for Disease Control and Prevention's Web site, www.cdc.gov.

"A large decline in bone mass occurs in older adults, increasing the risk of osteoporosis," the site says.

Osteoporosis is the consequence of poor bone health, according to Dr. Anne Bacon, a rheumatologist at Arthritis Specialists of Winchester.

"Osteoporosis is a thinning of the bones themselves," she says.

Kelli Eglinger, a physician's assistant at Bone and Joint Specialists of Winchester, explains that osteoporosis is caused by a lack of calcium and results in bone fragility problems.

Women are four times more likely than men to develop the disease, the National Osteoporosis Foundation says on its Web site, www.nof.org, though millions of Americans, including men, are at risk.

Though the disease is something that occurs as people age, Eglinger says that it can be treated and is largely preventable. There are ways to slow the process, she says. One way is to intake an adequate level of calcium and vitamin D.

"Preventing osteoporosis starts in childhood," Bacon says. Young people can help prevent osteoporosis by getting enough calcium before they reach their 30s, when people begin to stop growing bone mass, she says.

People over the age of 30 can still use calcium to benefit their bones, says Eglinger. The calcium will not add to the bones' storage of the mineral, but it will help prevent osteoporosis. Everyone should get enough calcium, she says.

Eglinger explains that teenagers should take 1,500 milligrams of calcium a day, but they should not take it all at once because the body cannot absorb the mineral that quickly. Break it up into 500 milligrams, three times a day, says Eglinger. Choosing a calcium supplement fortified with 400 milligrams of vitamin D a day is even better, she says, since bones also need the vitamin for good health.

Vitamin D aids in the body's absorption of calcium, Bacon says. It helps the body to incorporate the calcium into the bone.

Susan Lessar, a dietitian with Winchester Medical Center, recommends that adults under the age of 50 get 1,000 milligrams of calcium a day, and those over 50, 1,200.

A good way to get all the calcium you need in a day is by taking Viactiv chews. Each Viactiv chew includes 500 milligrams of calcium, says Eglinger.

"It's really easy," she says, adding that the supplements will appeal to many people because they taste like chocolate.

Pharmacies and food stores offer various brands of calcium and vitamin D, as well as combinations of the two. Often people will find that calcium is combined in a pill with magnesium.

Kitty Parker, owner of Miss Kitty's Herbs, Etc. in Winchester, explains that this is because magnesium also helps build bones. Magnesium, she says, aids in the body's absorption of calcium, and if people take calcium without enough magnesium, the calcium will deposit throughout the body and can lead to kidney stones and the hardening of arteries.

Suggested amounts of magnesium intake vary depending on age and sex, and women who are pregnant, but Lessar says that a healthy diet will likely include enough magnesium.

"Magnesium does play a role in bone structure," says Lessar. "A deficiency in magnesium is very uncommon, so it certainly is not as important as vitamin D."

Some easy ways to get magnesium through food are by eating nuts, yogurt, oatmeal, avocados, beans or spinach, according to the Web site for the National Institute of Health's Office of Dietary Supplements, www.ods.od.nih.gov.

Diet is a powerful way to help prevent or treat osteoporosis. The best way of getting enough calcium through diet is by drinking milk.

Milk is also fortified with vitamin D, though Bacon says that products made from milk, such as cheese and ice cream, are not as helpful unless they say they are fortified with vitamin D.

People who cannot have milk products can obtain calcium from fortified ready-to-eat cereals and breads, soy beverages, some fish, beans and dark greens like collards, spinach and kale.

Vitamin D is known as the "sunshine vitamin" because the sun's rays provide the body with vitamin D. Ultraviolet rays from the sun trigger vitamin D synthesis in skin, according to the National Institute of Health's Web site.

Bacon says that there has been great concern in the health community in recent years that children are not getting enough calcium or vitamin D. If children drink too much soda and not enough milk, they lessen their calcium intake, and if they do not spend enough time outside, they will not benefit from the sun's rays.

"We are a nation of couch potatoes," she says, explaining that a lot of adults also do not get sufficient amounts of vitamin D.

The sun has the potential to provide all the vitamin D that people need, says Lessar, explaining that 10 to 15 minutes of exposure twice a week is all that is needed for many people. Unfortunately the amount of vitamin D that the body can process depends on many things.

If people are wearing sunscreen, their skin is not going to absorb vitamin D from the sun. Lessar recommends that people expose their bare hands or feet to sunshine early in the morning or late in the afternoon, when the sun's rays are not as direct and will not offer as much of a risk to the skin.

According to Lessar, people with darker skin do not make vitamin D as easily as those with fairer skin do, causing them to have a greater chance of a vitamin D shortage. People who live at higher altitudes, also have a risk of vitamin D deficiency because of the angle of the sun's rays, she says.

"The people at the highest risk are the elderly who don't get outside as often," Lessar says. Those who have trouble receiving vitamin D from the sun can obtain it from fortified milk, egg yolks, salt water fish and from nutritional supplements.

Lessar advises people under the age of 50 to obtain between 265 and 530 milligrams of vitamin D a day, and those over 50 to get between 530 and 670 milligrams.

If you already have osteoporosis, Eglinger says that there are still ways that you can treat it. There are several medications that you can take, she says.

Having a Dual-Energy X-ray Absorptiometry scan to measure bone density is a way to test how healthy your bones are. Eglinger says that other people should consider screening for the disease if they have experienced a fragility fracture, a fracture sustained from a low-impact fall from a standing position, or if they have been on chronic steroids, such as those prescribed for asthma.

Doing frequent weight-bearing exercises, limiting the amount of caffeine that you ingest and quitting smoking are more ways to help prevent or slow the onset of osteoporosis.

"Basic exercise is very good for your bones," says Eglinger, because people with weak bones are more prone to fracture.

Weight-bearing exercises include weight-lifting, running, walking, tennis and gymnastics.

If you are a smoker and have had a bone fracture, Eglinger advises that, at the very least, you should stop smoking while your bone is healing. Smoking, she says, will slow the healing process.

"We are seeing osteoporosis is a major problem," says Bacon. "A lot of people just don't think about it, and then they get older [and] fracture a hip," she says.

"It's there; it's always going to be there, I think," Eglinger says of osteoporosis in American society. "Early prevention is the best treatment."

* Contact Josette Keelor at jkeelor@nvdaily.com