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Recipe For Strong Teen Bones: Exercise, Calcium And Vitamin D

Oct 28, 2013
Originally published on November 1, 2013 7:03 pm

It's really only a sliver of time when humans build the bulk of their skeleton. At age 9, the bones start a big growth spurt. And by the time puberty ends, around 14 or 15 years old, the adult-sized skeleton is all but done, about 90 percent complete.

But doctors say a lot of children aren't getting what they need to do that. Calcium and vitamin D are essential, sure, but so is lots of time jumping and running.

"It's the magic window of time when bone is built," says Dr. Laura Tosi, an orthopedic surgeon who directs the pediatric bone health program at Children's National Health system in Washington, D.C. And when it comes to bones, "bigger is definitely better," she says. "The wider and thicker the bone, the harder it is to break or tear."

Just about everybody knows that calcium and vitamin D are essential to build strong bones. But children and teenagers are all too often shunning the foods that would help them get enough calcium and vitamin D to build those bones.

Federal health officials recommend that children between the ages of 9 and 18 get 1,300 milligrams of calcium every day. That translates into four to five glasses of milk or the equivalent. According to Dr. Neville Golden, an adolescent medicine specialist at the Stanford University School of Medicine, most teens are not drinking anywhere near that amount.

Only about 15 percent of high school students are drinking milk, according to a 2011 federal survey. And only about 9 percent of girls do. In part that's because milk drinking is viewed as "uncool," says Golden, and teens, particularly girls, often think of milk as fattening.

But that's not true, he says. One glass of skim milk contains no fat and approximately 80 calories, about the same caloric content as an apple.

Now of course there are other sources of calcium — yogurt and cheese, for example. But lots of kids think those are fattening, too, Golden says. And while vegetables can be a source of calcium, you'd have to eat an awful lot of them to reach the recommended levels — one cup of broccoli has just 42 mg of calcium. Fortunately, there are other food sources, including fortified orange juice, breakfast cereals and tofu.

Calcium supplements are often recommended for adults to meet their recommended daily requirement. But for kids, Golden says, it's far better to eat calcium-rich foods. That's because the body absorbs calcium better from food than it does from supplements.

Even if boys and girls get the recommended amount of calcium, if they're not also getting vitamin D it won't make a difference. "You can drink as much calcium as you like, but if you don't have enough vitamin D, you're not going to absorb it," Golden says. The vitamin, which is actually a hormone, interacts with the lining of the stomach and intestines to help calcium get absorbed.

In 2010, the Institute of Medicine said that children and most adults need 600 international units of vitamin D a day. They found no evidence of widespread vitamin D deficiency, though people these days spend much less time out in the sun, which stimulates the body's production of vitamin D.

Vitamin D is found in foods like fatty fish such as salmon and sardines, but teenage girls were least likely of all age groups to get enough vitamin D in food, according to a 2010 study. One interesting point, says Golden: Farmed salmon is not as vitamin D rich as wild-caught salmon. And like calcium, vitamin D is added to foods like milk and orange juice.

If a teenager still isn't getting enough vitamin D from fish, milk and other healthy foods, Golden says, a reasonable workaround is taking supplements of about 400 international units per day.

Perhaps the secret ingredient to building strong bones for a lifetime is exercise, says orthopedic surgeon Tosi. One study found that when children jumped up and down between classes, totaling about 15 minutes a day, they added mass to their leg bones.

The bounce is what's important, Tosi says. "We think the bounce probably sends an electrical or other signal right up the skeleton, saying, 'OK, time to give more, time to build more bone.' "

So, jumping, jogging, tennis and basketball are all good options. Federal health officials suggest kids get at least one hour of exercise every day.

Copyright 2013 NPR. To see more, visit



On a Monday, it's MORNING EDITION, from NPR News. I'm Steve Inskeep.


And I'm Renee Montagne.

Today in Your Health, we have a case of two much medical information. Excessive medical screening by for-profit companies may lead to needless treatment.

INSKEEP: First, building healthy bones in young children. Doctors worry that kids are not getting enough exercise, Vitamin D or calcium. Those are all building blocks for strong bones.

NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE: Its really only a sliver of time when humans build the bulk of their skeleton. From age nine to the end of puberty, around 14 or 15, is when our major growth spurt happens.

DR. LAURA TOSI: It's the magic window of time when bone is built.

NEIGHMOND: Orthopedic surgeon Laura Tosi directs the pediatric Bone Health Program at Children's National Health System in Washington, D.C. Because that magic window is so short, she says it's crucial to build as much bone as possible during that time.

TOSI: For me personally, the most important things are exercise, vitamin D and calcium.

NEIGHMOND: Think of calcium as the cement in bone. It builds density. And because it's not made by the body it has to be absorbed through food.

Dr. Neville Golden, with the American Academy of Pediatrics, says federal recommendations say kids between nine and 18 should get 1300 milligrams of calcium every day.

DR. NEVILLE GOLDEN: That translates into somewhere between four to five glasses of milk or equivalent per day. And most teens are not doing that.

NEIGHMOND: In fact, a recent study found only about 15 percent of high school students drank three or more glasses of milk a day. Only about 9 percent of girls did. In part, milk drinking is often viewed as sort of uncool, says Golden. But also its often viewed as fattening.

GOLDEN: And that's not in fact true. For example, one glass of skim milk contains no fat and approximately 80 calories. That's about the same caloric content as an apple.

NEIGHMOND: Now, of course, there are other sources of calcium: yogurt, cheese and vegetables. But Golden says you'd have to eat an awful lot of vegetables to reach the required 1300 milligrams.

GOLDEN: One cup of broccoli contains about 42 milligrams. So if you think about that; how many cups of broccoli do you need to consume in order to get enough calcium in a day. But there are other sources - orange juice that's fortified as a good source, breakfast cereals that are fortified, tofu that is fortified. These are all good sources of calcium.

NEIGHMOND: Golden says that today, 30 percent of boys and up to 70 percent of girls do not get the calcium they need. And there's some evidence that teenagers are suffering an increasing number of bone fractures. Part of the problem, Golden adds, many kids are also deficient in vitamin D.

GOLDEN: In fact, you can drink as much calcium as you like. But if you don't have enough vitamin D, you're not going to absorb the calcium.

NEIGHMOND: Sunshine helps the body make Vitamin D. It's also in certain foods, like salmon and sardines. But if you can't sit out in the sun or eat fish, Golden says supplements will do the trick.

Orthopedic surgeon Laura Tosi says exercise can also make a huge difference. She points to research from Canada that had kids jump up and down for just a few minutes when they were changing classes.

TOSI: They found that just doing that - was about 15 minutes of jumping a day - made a highly statistically significant difference in how they increased their bone mass over a couple of years.

NEIGHMOND: It's the bounce, says Tosi, that stimulates bone growth.

TOSI: The bounce sends probably an electrical or other signal right up the skeleton saying, OK, time to build more.

NEIGHMOND: So, jumping, jogging, basketball - all help build bone. Federal health officials say kids should get at least one hour of exercise every day. And they should get their calcium from food, not supplements.

Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.