Liz B. is a 73-year-old white woman who is seeing her doctor for a regular physical. She is married and retired, but volunteers for several organizations and watches her grandchildren two mornings a week. She and her husband play golf about once a week during the spring, summer, and fall. She weighs 130 pounds and always thought she was 5’6”. However, when she was measured at this physical, she was 5’4”. Because of her age and height loss, she has a dual-energy x-ray absorptiometry (DEXA) measurement that shows that she has low bone mineral density (BMD) values of her proximal femur and lumbar vertebrae (both values are classified as osteoporotic according to World Health Organization definitions). A chest x-ray also revealed two vertebral fractures. However, she has no pain in her back or neck. The RDN and Liz discuss her diet, concluding that her diet is low in calcium and vitamin D, but high in sodium. Along with suggestions to decrease her sodium intake and increase her fruit and vegetable intake, she is advised to start taking supplements of calcium (1000 mg/day) and vitamin D (800 units/day). They discuss avoiding high-impact exercise affecting the spine because of the low bone mass and existing vertebral fractures, but increasing flexibility, balance, and posture exercises. Because of the DXA results, she also begins on a bisphosphonate drug in addition to the calcium and vitamin D supplements. She receives baseline tests of bone turnover, to be rechecked in 6 months and an appointment for another DXA in 1 year. After 1 year on the medication, supplements, diet and exercise changes, Liz has another DXA. Her BMD has improved to the osteopenia level, and she is taken off the bisphosphonate medication.
Nutrition Diagnostic Statement
Inadequate calcium and vitamin D intake related to avoidance of dairy products as evidenced by diet history revealing less than 20% of estimated requirements. Note: This may be resolved once she starts taking supplements.
Nutrition Care Questions
1. If Liz wants to increase her calcium through fortified foods rather than take a supplement, how would you counsel her?
2. Design a set (3 days minimum) of daily menus that provide approximately 800 mg of calcium from foods alone, which, coupled with a 500-mg supplement, would provide a total of 1300 mg daily, the current adequate intake for calcium. Similarly, design these same meals to include 400 units of vitamin D, with another 400 units coming from supplements.
3. If Liz’s sodium intake is high, what foods would you advise her to eat less frequently?