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What Parents Need To Know About Children's Bone Health

From the Centers for Disease Control and Prevention

Why should girls and teenage girls be concerned about bone health?

It's never too early to start being concerned about bone health. Childhood — the peak bone producing years — is the time to start teaching your children about bone health. You can work with them to develop good diet and exercise habits, which will help them to have strong, healthy bones throughout their lives. And, a poor diet and not enough physical activity during the adolescent years (age 9 to 18) can result in weaker bones in adulthood. This increases the risk for osteoporosis, and can affect the body's ability to heal properly after an injury. By making sure they get enough calcium, as well as weight bearing physical activity, girls can develop strong bones and reduce their risk for osteoporosis later in life.

How much calcium do girls need?

Girls ages 9 to 18 need 1,300 milligrams (or 130% daily value) of calcium each day. But many girls in this age group do not get enough calcium. Some studies have shown that a typical girl gets only about 800 milligrams of calcium a day.

Should girls take a calcium supplement to make sure they get enough calcium?

Girls can get plenty of calcium from food. It's found in a variety of good tasting foods like milk, yogurt, broccoli, and low-fat cheese. Many foods also have (extra) calcium added to them like orange juice, milk, breakfast cereals, cereal and other bars, and soy drinks. Be sure to check food package labels to see if they have added calcium. While not common, some girls might have allergies or other dietary restrictions, and can ask their health care provider about supplements. But, most girls can get enough calcium by eating the right types of foods. While it is possible to get too much calcium, it is not likely for most girls. Even with all the products that have added calcium, girls consume far less calcium each day than the recommended 1,300 mg.

Which foods have calcium?

You may know that dairy foods like nonfat or low-fat milk, cheese, and yogurt, have calcium. But there are also many other foods with calcium — vegetables like broccoli, kale, and collards; almonds; and tofu made with calcium sulfate (check the ingredient list). Also, foods such as orange juice, some breakfast cereals, and cereal bars are available with added calcium. Look for foods that say they have calcium and be sure to read the label. Take a look at the calcium content in some everyday foods. Choose fat-free or low-fat versions of foods, when available.

The chart below lists the calcium content of foods and drinks that many young girls like.

Plain, fat-free yogurt 1 cup 450
Grilled cheese sandwich** 1 sandwich 371
American cheese 2 ounces 350
Ricotta cheese, part skim ½ cup 340
Fruit yogurt 1 cup 315
Cheddar cheese 1- ½ ounces 204
Milk (fat-free or low-fat) 1 cup 300
Orange juice with added calcium 1 cup 300
Soy beverage with added calcium 1 cup 250-300
Tofu (made with calcium) ½ cup (about five
1-inch cubes)
Macaroni and cheese ½ cup 180
Cheese pizza 1 slice 220
Frozen yogurt (fat-free or low-fat) ½ cup 105
Broccoli, cooked or fresh 1 cup 90
Ice cream ½ cup 84
Bok choy, cooked or fresh ½ cup 80
Almonds, dry roasted 1 ounce (About 20-25 almonds) 71
White bread 2 slices 70

* Calcium content varies depending on the ingredients of many foods.

**Using 2 slices of white bread, 1- ½ ounces of cheese, and nonstick cooking spray.

Can you get enough calcium if you are lactose intolerant?

Yes. Lactose intolerance means some girls don't feel well (stomachache, gas) after they have milk or other dairy products. The good news is that there is milk and other dairy products that are specially made for people with lactose intolerance. Look for milks, cheeses, cottage cheese and other products that have the enzyme lactase, which helps a person to digest dairy. You can also buy Lactaid pills to chew or swallow with the first bite of dairy, which contain lactase. There are also other foods that have calcium like broccoli, almonds, and foods fortified with calcium like orange juice and cereals. Remember to look for "calcium" on food labels.

What is weight-bearing activity?

Weight bearing physical activity is any activity in which your body works against gravity, so your feet and legs are supporting or carrying your weight. Examples of weight bearing physical activities that young girls like include walking, running, tennis, dancing, tae kwon do, hiking, hopscotch, and basketball. Activities that are not weight bearing include riding a bike or a scooter, swimming, and skateboarding. But, these activities do benefit overall health and can be mixed with weight bearing activities.

How do calcium and physical activity make bones strong?

To make bones strong and to keep them strong, the body needs both calcium and weight bearing physical activity. It's not enough to do one or the other to make bones strong, it takes two!

Calcium helps bones to develop properly. When the body makes new bone tissue, it first lays down a framework of a protein called collagen. Then, calcium from the blood spreads throughout the collagen framework. The hard crystals of calcium fill in all the nooks and crannies of the framework. Calcium and collagen work together to make bones strong and flexible.

Calcium is also needed for many other activities within the body such as neural communication (the way your nerves and brain send signals to each other) and heart and lung functions. If the body doesn't get enough calcium from foods and drinks, it can take it from bones, which can make bones weaker.

Physical activity just as a muscle gets stronger and bigger the more you use it, a bone becomes stronger and denser when you exercise. Bones are living tissue. Weight bearing physical activity causes new bone tissue to form, making bones even stronger. It also makes muscles stronger, and muscles push and tug against bones, making bones even stronger. And, it improves coordination, which makes falls less likely, keeping bones safer from breaks.

How can girls take part in weight-bearing physical activity while staying indoors?

There are plenty of indoor weight-bearing exercises that girls can do to help them develop strong, healthy bones. Dancing, lifting hand-held weights (or soup cans), jogging in-place, and push-ups can be done indoors, as well as outdoors.

What else can adolescents do to improve and promote their bone health?

It is important for girls to not drink alcohol or smoke, and to have a healthy overall diet. Smoking, drinking alcohol, and having eating disorders such as anorexia nervosa or bulimia can increase a girl's risk for developing weaker bones.

How does caffeine affect bone health?

Caffeine itself does not appear to have harmful effects on bone health. But young girls often choose soft drinks with caffeine over milk drinks.

Last updated April 27, 2009