1. Dr.maninder Ahuja Chairperson Geriatric gynaecology committe FOGSI In co-ordination with Dr.Jaideep Malhotra & Chairperson public awareness committee (IMS) 5/10/2015Dr.MANINDERAHUJA1

2. If this is your age Then you need this much calcium each day (mg) 0 to 6 months210 7 to 12 months270 1 to 3 years500 4 to 8 years800 9 to 18 years1,300 19 to 50 years1,000 Over 50 years1,200-1500 5/10/2015Dr.MANINDERAHUJA2 Growth spurt BONE LOSS

3. Some age groups need MORE or LESS than 100% DV for calcium and vitamin D. Calcium requirements vary by age: More is needed as we grow older Need is highest during rapid growth of adolescence. 100% DV for calcium and Vitamin D are based on 1,000 mg calcium and 400 IU vitamin D.( DV –DAILY VALUES) 5/10/2015Dr.MANINDERAHUJA3

4. 5/10/2015Dr.MANINDERAHUJA4 Age Daily vitamin D needs in International Units (IU) 600 IU-800IU 200 IU 400 IU 0 100 200 300 400 500 600 up to 50 51-70 over 70

5.  FDA uses “Percent Daily Value” (% DV) to describe amount of calcium needed by general U.S. population daily  100% DV for calcium = 1,000 mg  Look for this label:  “Nutrition Facts” on foods  “Supplement Facts” on vitamin/mineral supplements 5/10/2015Dr.MANINDERAHUJA5

6.  Broccoli, raw 1 cup = 9% DV  Collards 1/2 cup = 20% DV  Turnip greens, boiled 1/2 cup = 10% DV  Orange juice and other calcium- fortified beverages 6 oz. = 20 to 30% DV, varies—check label  Yogurt- 1 cup (8 oz.) = 30% DV  Milk 1 cup = 30% DV  Cheese 1½ oz. natural/2 oz. processed = 30% DV  Milk pudding 1/2 cup = 15% DV  Frozen yogurt, vanilla, soft serve ½ cup = 10% DV  Ice cream, vanilla ½ cup = 8% DV  Soy or rice milk, calcium-fortified 1 cup = varies—check label 5/10/2015Dr.MANINDERAHUJA6

7. FOOD ITEMCa mgs/100gm %of RDI(25-50 YRS) Fenugreek470mg12% Cauliflower140mg14% Spinach60mg6% Ladies fingers90mg9% Beetroot200 mg20% Cabbage80mg 6% Grapes30 mg7% Dates70 mg 5% Orange50 mg10% Raisins100mg11% Banana10 mg1% Papaya10 mg 1% 5/10/2015Dr.MANINDERAHUJA7

8. FOOD ITEMCa mg/100 gm% of RDI(25-50 YRS) Ragi330 mg 32% Mutton (muscle) 150mg15% Crab1370 mg137% Mackerel(bangda)430mg43% Rohu650 mg65% Black gram (urad dal)200mg20% Soya bean240 mg24% Dal160 mg16% Almonds230 mg 23% Milk powder skimmed1270Mg137% Milk powder whole910 mg91% 5/10/2015Dr.MANINDERAHUJA8

9. 5/10/2015Dr.MANINDERAHUJA9 Calcium: The UL(upper limit for 1 year and older (including pregnant and lactating women) is 2,500 mg/day. It was not possible to establish an UL for infants under age 1. Vitamin D: No higher than 50 mcg (micrograms) or 2,000 IU for ages 1 and over; 25 mcg (1,000 IU) for 0 to 12 months The National Osteoporosis Foundation recommends limiting Vitamin D to 800 IU/day unless your doctor prescribes it.

10.  An easy way to meet calcium needs is consuming 3 cups (8 oz.) each day of fat-free or low-fat* milk or equivalent milk products in combination with a healthy diet. equivalents: 8 oz. milk 1 cup yogurt 1-1/2 oz. natural..or 2 oz. processed..cheese 5/10/2015Dr.MANINDERAHUJA10

11. EXCESSIVE SODIUMOXALIC ACID  Can increase urinary calcium excretion  2,300 mg daily  Oxalic acid in foods such as spinach, chard, beet greens and chocolate Binds calcium in those foods  Doesn’t seem to affect calcium in other foods, including chocolate milk  These greens still good for you; may help calcium absorption in other ways 5/10/2015Dr.MANINDERAHUJA11

12.  Baked beans 1 cup = 14% DV  Salmon, canned, with edible bones 3 oz. = 18% DV  Sardines, canned, in oil, with edible bones 3 oz. = 32% DV  Soybeans, cooked 1 cup = 26%  Tofu, firm, with calcium ½ cup = 20% DV; check label  Cereal, calcium- fortified Serving size and amount of calcium varies—check label 5/10/2015Dr.MANINDERAHUJA12

13.  Vitamin D is manufactured in your skin following direct exposure to sun.  Amount varies with time of day,season, latitude and skin pigmentation.  10–15 minutes exposure of hands, arms and face 2–3 times/week may be sufficient (depending on skin sensitivity).  Clothing, sunscreen, window glass and pollution reduce amount produced Main dietary sources of vitamin D are: Fortified milk (400 IU per quart) Some fortified cereals Cold saltwater fish (Example: salmon, halibut, herring, tuna, oysters and shrimp) Some calcium and vitamin/mineral supplements 5/10/2015Dr.MANINDERAHUJA13

14.  There may be additional substances in foods that affect the body’s absorption and use of their calcium. So try to obtain Ca requirement from food.  A balanced diet that promotes a healthy weight may provide additional benefits to protect against osteoporosis.  At one time body can absorb 500 mg so take throught day. 5/10/2015Dr.MANINDERAHUJA14

15.  Start with small portions of foods such as milk and gradually increase serving size  Eat dairy foods in combination with a meal or solid foods.  Try dairy foods other than milk:  Many hard cheeses (cheddar, Swiss, Parmesan) have less lactose than milk  Yogurt made with live, active bacteria  It may be easier to digest lactose that is pre-digested or broken down to its simple sugar components (glucose and galactose):  Lactose-hydrolyzed milk and dairy products  Commercial lactase preparations 5/10/2015Dr.MANINDERAHUJA15

16. 5/10/2015Dr.MANINDERAHUJA16 Add powdered milk to food (1 tablespoon = 50 mg calcium) Make oatmeal and cream-type soups with milk instead of water Add milk to coffee IF YOU DON’T LIKE MILK? TAKE ALTERNATIVES

17. 5/10/2015Dr.MANINDERAHUJA17 Try chocolate milk. 8-oz. has only 2 - 7 mg caffeine. Average glass provides only 60 more calories than unflavored milk. Make instant hot cocoa with milk, not water. Serve milk-based desserts (puddings, frozen yogurt, custard, ice cream,kheer). Limit fat and sugar.

18.  For support of back and hip  Would reduce pain  Less chances of fracture if used properly  Not used during night time 5/10/2015Dr.MANINDERAHUJA18

19.  Aerobic like walking, yoga, taichi, dancing for heart endurance and weight management, balance, range of movement and toning up of muscles  Weight bearing and strength building for prevention of weak muscles and weak bones 5/10/2015Dr.MANINDERAHUJA19

20.  Cobra Pose –  Lie on your belly. Place your hands besides your chest or shoulders. Inhale as you lift your head and shoulders, pressing your hips into the floor and tightening your buttock muscles. Using your hands as support, arch your back up, to a comfortable stretch. Keep your shoulders relaxed back and down without overstretching your lower back. Only come as high up as is comfortable. 5/10/2015Dr.MANINDERAHUJA20

21.  Half Wheel Pose –  On your back, grab your ankles and draw your heels to the buttocks, with the heels about 18 inches apart. Tighten your buttock muscles, raise your entire torso up off the ground, slowly as if massaging each part of your back, and arch your spine, as if pressing your navel point to the sky. Hold this position for up to 3 minutes, or move the body in synchronization with your breath, inhaling as you stretch up and exhaling as you relax your back down. This exercise helps to strengthen your lower back, and relieve tension in the ovaries. 5/10/2015Dr.MANINDERAHUJA21

22.  Knees to Chest for Lower Back Relaxation –  Lying on your back, gently draw your knees to your chest and hold them there with your hands. Relax your head, neck and shoulders. Relax your breath. You can gently rock side to side as well. This posture provides a gentle stretch for your lower back and massages your ovaries and reproductive organs. This is a rejuvenating exercise. Relax in this posture to help you tune into your body and let go of tension. 5/10/2015Dr.MANINDERAHUJA22

23. SEATED ROW FOR BACK KEEP YOUR BACK ST.DON’T BEND FORWARD LUNGES FOR THIGH 5/10/2015Dr.MANINDERAHUJA23

24. 5/10/2015Dr.MANINDERAHUJA24 ~ Support your bones. They support you!

25. 5/10/2015Dr.MANINDERAHUJA25