Question

Mrs. Brown states that she has frequent backaches. Spinal films are ordered. Later you see the report stating that the films appear normal with no significant findings 5. Prepare a list of appropriate supportive measures for Ms. Bowles to relieve the non- injury-related low back pain in the absence of fracture. In your discussions with the patient she tells you that she does not like milk or milk products and rarely includes them in her diet 6. Explain how you would encourage the patient to increase her dietary calcium intake. The physician tells Ms. Brown that her blood calcium was normal. The patient 1. Explain how you would answer this question to the patient. Ms. Bowels explains that she rarely exercises questions, "If I have enough calcium in my blood, I cannot have osteoporosis, could I?" 7. Discuss the advice that should be given to this patient as it relates to exercise.

case study - Osteoporosis

Answer 1

What structures make up the back?
The lower back where most back pain occurs includes the five vertebrae (referred to as L1-L5) in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.
What causes lower back pain?
The vast majority of low back pain is mechanical in nature. In many cases, low back pain is associated with spondylosis, a term that refers to the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older. Some examples of mechanical causes of low back pain include:

Low Back Pain Exercises Cat and camel Standing hamstring stretch Pelvic tilt Partial curl Extension exercise Quadruped arm/leg raise Gluteal stretch Side plank

Sprains and strains account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
Intervertebral disc degeneration is one of the most common mechanical causes of low back pain, and it occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
Sciatica is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
Spondylolisthesis is a condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column

Spinal stenosis is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
Skeletal irregularities include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.
Low back pain is rarely related to serious underlying conditions, but when these conditions do occur, they require immediate medical attention. Serious underlying conditions include:

Infections are not a common cause of back pain. However, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis; the intervertebral discs, called discitis; or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis.
Tumors are a relatively rare cause of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.
Cauda equina syndrome is a serious but rare complication of a ruptured disc. It occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots, causing loss of bladder and bowel control. Permanent neurological damage may result if this syndrome is left untreated.
Abdominal aortic aneurysms occur when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally enlarged. Back pain can be a sign that the aneurysm is becoming larger and that the risk of rupture should be assessed.
Kidney stones can cause sharp pain in the lower back, usually on one side.
Other underlying conditions that predispose people to low back pain include:

Inflammatory diseases of the joints such as arthritis, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae, can also cause low back pain. Spondylitis is also called spondyloarthritis or spondyloarthropathy.
Osteoporosis is a metabolic bone disease marked by a progressive decrease in bone density and strength, which can lead to painful fractures of the vertebrae.
Endometriosis is the buildup of uterine tissue in places outside the uterus.
Fibromyalgia, a chronic pain syndrome involving widespread muscle pain and fatigue.

What are the risk factors for developing low back pain?
Beyond underlying diseases, certain other risk factors may elevate one’s risk for low back pain, including:

Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. As people grow older, loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.

Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise is beneficial for the maintaining the integrity of intervertebral discs.

Pregnancy is commonly accompanied by low back pain, which results from pelvic changes and alterations in weight loading. Back symptoms almost always resolve postpartum.

Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.

Genetics: Some causes of back pain, such as ankylosing spondylitis, a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine, have a genetic component.

Occupational risk factors: Having a job that requires heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain. An inactive job or a desk job may also lead to or contribute to pain, especially if you have poor posture or sit all day in a chair with inadequate back support.

Mental health factors: Pre-existing mental health issues such as anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.

Backpack overload in children: Low back pain unrelated to injury or other known cause is unusual in pre-teen children. However, a backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue. The American Academy of Orthopaedic Surgeons recommends that a child’s backpack should weigh no more than 15 to 20 percent of the child’s body weight.

How is low back pain diagnosed?
A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. During the exam, a health care provider will ask about the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. Along with a thorough back examination, neurologic tests are conducted to determine the cause of pain and appropriate treatment. The cause of chronic lower back pain is often difficult to determine even after a thorough examination.

Imaging tests are not warranted in most cases. Under certain circumstances, however, imaging may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Imaging and other types of tests include:

X-ray is often the first imaging technique used to look for broken bones or an injured vertebra. X-rays show the bony structures and any vertebral misalignment or fractures. Soft tissues such as muscles, ligaments, or bulging discs are not visible on conventional x-rays.

Computerized tomography (CT) is used to see spinal structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumors. Using a computer, the CT scan creates a three-dimensional image from a series of two dimensional pictures.

Myelograms enhance the diagnostic imaging of x-rays and CT scans. In this procedure, a contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray or CT scans.

Discography may be used when other diagnostic procedures fail to identify the cause of pain. This procedure involves the injection of a contrast dye into a spinal disc thought to be causing low back pain. The fluid’s pressure in the disc will reproduce the person’s symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection. Discography may provide useful information in cases where people are considering lumbar surgery or when their pain has not responded to conventional treatments.

Magnetic resonance imaging (MRI) uses a magnetic force instead of radiation to create a computer-generated image. Unlike x-ray, which shows only bony structures, MRI scans also produce images of soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI may be ordered if a problem such as infection, tumor, inflammation, disc herniation or rupture, or pressure on a nerve is suspected. MRI is a noninvasive way to identify a condition requiring prompt surgical treatment. However, in most instances, unless there are “red flags” in the history or physical exam, an MRI scan is not necessary during the early phases of low back pain.

Electrodiagnostics are procedures that, in the setting of low back pain, are primarily used to confirm whether a person has lumbar radiculopathy. The procedures include electromyography (EMG), nerve conduction studies (NCS), and evoked potential (EP) studies. EMG assesses the electrical activity in a muscle and can detect if muscle weakness results from a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body. NCSs are often performed along with EMG to exclude conditions that can mimic radiculopathy. In NCSs, two sets of electrodes are placed on the skin over the muscles. The first set provides a mild shock to stimulate the nerve that runs to a particular muscle. The second set records the nerve’s electrical signals, and from this information nerve damage that slows conduction of the nerve signal can be detected. EP tests also involve two sets of electrodes—one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal transmissions to the brain.

Bone scans are used to detect and monitor infection, fracture, or disorders in the bone. A small amount of radioactive material is injected into the bloodstream and will collect in the bones, particularly in areas with some abnormality. Scanner-generated images can be used to identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.

Ultrasound imaging, also called ultrasound scanning or sonography, uses high-frequency sound waves to obtain images inside the body. The sound wave echoes are recorded and displayed as a real-time visual image. Ultrasound imaging can show tears in ligaments, muscles, tendons, and other soft tissue masses in the back.

Blood tests are not routinely used to diagnose the cause of back pain; however in some cases they may be ordered to look for indications of inflammation, infection, and/or the presence of arthritis. Potential tests include complete blood count, erythrocyte sedimentation rate, and C-reactive protein. Blood tests may also detect HLA-B27, a genetic marker in the blood that is more common in people with ankylosing spondylitis or reactive arthritis (a form of arthritis that occurs following infection in another part of the body, usually the genitourinary tract).

Treatment for low back pain generally depends on whether the pain is acute or chronic. In general, surgery is recommended only if there is evidence of worsening nerve damage and when diagnostic tests indicate structural changes for which corrective surgical procedures have been developed.

Conventionally used treatments and their level of supportive evidence include:

Hot or cold packs have never been proven to quickly resolve low back injury; however, they may help ease pain and reduce inflammation for people with acute, subacute, or chronic pain, allowing for greater mobility among some individuals.

Activity: Bed rest should be limited. Individuals should begin stretching exercises and resume normal daily activities as soon as possible, while avoiding movements that aggravate pain. Strong evidence shows that persons who continue their activities without bed rest following onset of low back pain appeared to have better back flexibility than those who rested in bed for a week. Other studies suggest that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs.

Strengthening exercises, beyond general daily activities, are not advised for acute low back pain, but may be an effective way to speed recovery from chronic or subacute low back pain. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Health care providers can provide a list of beneficial exercises that will help improve coordination and develop proper posture and muscle balance. Evidence supports short- and long-term benefits of yoga to ease chronic low back pain.

Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combinations with other interventions.

Medications: A wide range of medications are used to treat acute and chronic low back pain. Some are available over the counter (OTC); others require a physician’s prescription. Certain drugs, even those available OTC, may be unsafe during pregnancy, may interact with other medications, cause side effects, or lead to serious adverse effects such as liver damage or gastrointestinal ulcers and bleeding. Consultation with a health care provider is advised before use. The following are the main types of medications used for low back pain:

Analgesic medications are those specifically designed to relieve pain. They include OTC acetaminophen and aspirin, as well as prescription opioids such as codeine, oxycodone, hydrocodone, and morphine. Opioids should be used only for a short period of time and under a physician’s supervision. People can develop a tolerance to opioids and require increasingly higher dosages to achieve the same effect. Opioids can also be addictive. Their side effects can include drowsiness, constipation, decreased reaction time, and impaired judgment. Some specialists are concerned that chronic use of opioids is detrimental to people with back pain because they can aggravate depression, leading to a worsening of the pain.
Nonsteroidal anti-inflammatory drugs (NSAIDS) relieve pain and inflammation and include OTC formulations (ibuprofen, ketoprofen, and naproxen sodium). Several others, including a type of NSAID called COX-2 inhibitors, are available only by prescription. Long-term use of NSAIDs has been associated with stomach irritation, ulcers, heartburn, diarrhea, fluid retention, and in rare cases, kidney dysfunction and cardiovascular disease. The longer a person uses NSAIDs the more likely they are to develop side effects. Many other drugs cannot be taken at the same time a person is treated with NSAIDs because they alter the way the body processes or eliminates other medications.
Anticonvulsants—drugs primarily used to treat seizures—may be useful in treating people with radiculopathy and radicular pain.
Antidepressants such as tricyclics and serotonin and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain, but their benefit for nonspecific low back pain is unproven, according to a review of studies assessing their benefit.
Counter-irritants such as creams or sprays applied topically stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Topical analgesics reduce inflammation and stimulate blood flow.
Spinal manipulation and spinal mobilization are approaches in which professionally licensed specialists (doctors of chiropractic care) use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques have been shown to provide small to moderate short-term benefits in people with chronic low back pain. Evidence supporting their use for acute or subacute low back pain is generally of low quality. Neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis.

Traction involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released the back pain tends to return. There is no evidence that traction provides any longterm benefits for people with low back pain.

Acupuncture is moderately effective for chronic low back pain. It involves the insertion of thin needles into precise points throughout the body. Some practitioners believe this process helps clear away blockages in the body’s life force known as Qi (pronounced chee). Others who may not believe in the concept of Qi theorize that when the needles are inserted and then stimulated (by twisting or passing a low-voltage electrical current through them) naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine are released. Evidence of acupuncture’s benefit for acute low back pain is conflicting and clinical studies continue to investigate its benefits.

Biofeedback is used to treat many acute pain problems, most notably back pain and headache. The therapy involves the attachment of electrodes to the skin and the use of an electromyography machine that allows people to become aware of and selfregulate their breathing, muscle tension, heart rate, and skin temperature. People regulate their response to pain by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. Evidence is lacking that biofeedback provides a clear benefit for low back pain.

Nerve block therapies aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment.

Epidural steroid injections are a commonly used short-term option for treating low back pain and sciatica associated with inflammation. Pain relief associated with the injections, however, tends to be temporary and the injections are not advised for long-term use. An NIH-funded randomized controlled trial assessing the benefit of epidural steroid injections for the treatment of chronic low back pain associated with spinal stenosis showed that long-term outcomes were worse among those people who received the injections compared with those who did not.

Transcutaneous electrical nerve stimulation (TENS) involves wearing a battery-powered device consisting of electrodes placed on the skin over the painful area that generate electrical impulses designed to block incoming pain signals from the peripheral nerves. The theory is that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested that it elevated levels of endorphins, the body’s natural pain-numbing chemicals. More recent studies, however, have produced mixed results on its effectiveness for providing relief from low back pain.

Recommendations for keeping one’s back healthy
Following any period of prolonged inactivity, a regimen of low-impact exercises is advised. Speed walking, swimming, or stationary bike riding 30 minutes daily can increase muscle strength and flexibility. Yoga also can help stretch and strengthen muscles and improve posture. Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles.

Always stretch before exercise or other strenuous physical activity.
Don’t slouch when standing or sitting. The lower back can support a person’s weight most easily when the curvature is reduced. When standing, keep your weight balanced on your feet.
At home or work, make sure work surfaces are at a comfortable height.
Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. During prolonged periods of sitting, elevate feet on a low stool or a stack of books.
Wear comfortable, low-heeled shoes.
Sleeping on one’s side with the knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.
Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. When lifting, keep objects close to the body. Do not twist when lifting.
Maintain proper nutrition and diet to reduce and prevent excessive weight gain, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.

6.seeds are tiny nutritional powerhouses. Some are high in calcium, including poppy, sesame, celery and chia seeds.

For instance, 1 tablespoon (9 grams) of poppy seeds pack 126 mg of calcium, or 13% of the RDI .

Seeds also deliver protein and healthy fats. For example, chia seeds are rich in plant-based omega-3 fatty acids .

Sesame seeds have 9% of the RDI for calcium in 1 tablespoon (9 grams), plus other minerals, including copper, iron and manganese .

Most cheeses are excellent sources of calcium. Parmesan cheese has the most, with 331 mg — or 33% of the RDI — per ounce (28 grams) .

Softer cheeses tend to have less — one ounce of brie only delivers 52 mg, or 5% of the RDI. Many other varieties fall in the middle, providing about 20% of the RDI .

As an added bonus, your body absorbs the calcium in dairy products more easily than that from plant sources.

Many types of cheese are also packed with protein, such as cottage cheese.

What’s more, aged, hard cheeses are naturally low in lactose, making them easier to digest for people with lactose intolerance.

Dairy may have additional health benefits.

A recent study suggests it may lower the risk of heart disease .

Another study found that eating cheese daily was linked to a lower risk of metabolic syndrome, which raises your risk of heart disease, stroke and type 2 diabetes .

However, keep in mind that full-fat cheese is also high in fat and calories. Most cheeses also contain a lot of sodium, to which some people are sensitive.

3. Yogurt
Yogurt is an excellent source of calcium.

Many types of yogurt are also rich in live probiotic bacteria, which have various health benefits.

One cup (245 grams) of plain yogurt contains 30% of the RDI for calcium, as well as phosphorus, potassium and vitamins B2 and B12.

Low-fat yogurt may be even higher in calcium, with 45% of the RDI in one cup (245 grams).

While Greek yogurt is a great way to get extra protein in your diet, it delivers less calcium than regular yogurt .

One study linked eating yogurt to better overall diet quality and improved metabolic health. People who ate yogurt had lower risks of metabolic diseases, such as type 2 diabetes and heart disease (13).

4. Sardines and Canned Salmon
Sardines and canned salmon are loaded with calcium, thanks to their edible bones.

A 3.75-ounce (92-gram) can of sardines packs 35% of the RDI, and 3 ounces (85 grams) of canned salmon with bones have 21% .

These oily fish also provide high-quality protein and omega-3 fatty acids, which are good for your heart, brain and skin.

While seafood can contain mercury, smaller fish such as sardines have low levels. In addition, both sardines and salmon have high levels of selenium, a mineral that can prevent and reverse mercury toxicity (18).

5. Beans and Lentils
Beans and lentils are high in fiber, protein and micronutrients.

They also boast lots of iron, zinc, folate, magnesium and potassium.

Some varieties also have decent amounts of calcium.

However, winged beans top the chart — a single cup (172 grams) of cooked wing beans has 244 mg, or 24% of the RDI for calcium .

White beans are also a good source, with one cup (179 grams) of cooked white beans providing 13% of the RDI. Other varieties of beans and lentils have less, ranging from around 4–6% of the RDI per cup.

Interestingly, beans are credited with being one of the reasons why plant-rich diets are so healthy. Research suggests that beans may help lower “bad” LDL cholesterol levels and reduce your risk of type 2 diabetes .

6. Almonds
Of all nuts, almonds are among the highest in calcium — one ounce of almonds, or about 22 nuts, delivers 8% of the RDI .

Almonds also provide 3 grams of fiber per ounce (28 grams), as well as healthy fats and protein. In addition, they’re an excellent source of magnesium, manganese and vitamin E.

Eating nuts may help lower blood pressure, body fat and other risk factors for metabolic disease .

7. Whey Protein
Whey protein is found in milk and has been extensively studied for its health benefits.

It's an excellent protein source and full of quickly digested amino acids .

Several studies have linked whey-rich diets to weight loss and improved blood sugar control .

Whey is also exceptionally rich in calcium — a 1-ounce (28-gram) scoop of whey protein powder isolate contains 200 mg, or 20% of the RDI .

If you'd like to try whey protein, Amazon has a large selection available.
8. Some Leafy Greens
Dark, leafy greens are incredibly healthy, and some of them are high in calcium.

Greens that have good amounts of this mineral include collard greens, spinach and kale.

For instance, one cup (190 grams) of cooked collard greens has 266 mg — a quarter of the amount you need in a day .

Note that some varieties are high in oxalates, which are naturally occurring compounds that bind to calcium, making some of it unavailable to your body.

Spinach is one of them. So although it has a lot of calcium, it's less available than the calcium in low-oxalate greens, such as kale and collard greens.

9. Rhubarb
Rhubarb has a lot of fiber, vitamin K, calcium and smaller amounts of other vitamins and minerals.

It contains prebiotic fiber, which can promote healthy bacteria in your gut .

Like spinach, rhubarb is high in oxalates, so much of the calcium is not absorbed. In fact, one study found that your body can only absorb about a quarter of the calcium in rhubarb .

On the other hand, the calcium numbers for rhubarb are quite high. So even if you're only absorbing 25%, you still get 87 mg per cup (240 grams) of cooked rhubarb
10. Fortified Foods
Another way to obtain calcium is from fortified foods.

Some types of cereal can deliver up to 1,000 mg (100% of the RDI) per serving — and that's before adding milk.

However, keep in mind that your body can't absorb all that calcium at once, and it's best to spread your intake throughout the day
11. Amaranth
Amaranth is a highly nutritious pseudocereal.

It's a good source of folate and very high in certain minerals, including manganese, magnesium, phosphorus and iron.

One cup (246 grams) of cooked amaranth grain delivers 116 mg of calcium, or 12% of the RDI .

Amaranth leaves contain even more — 28% of the RDI per cooked cup (132 grams). The leaves are also very high in vitamins A
14. Figs
Dried figs are rich in antioxidants and fiber.

They also have more calcium than other dried fruits. In fact, dried figs provide 5% of the RDI for calcium in one ounce (28 grams).

Osteoporosis, or bone loss, affects people of all different ages and backgrounds. But there are certain risk factors that may make you more susceptible to developing osteoporosis.

Some of the most common osteoporosis risk factors are often unavoidable; that is, you can't control their occurrence.

These factors include:

being female: Osteoporosis is more common in women than in men—about 80% of cases affect women.
being older: As we age, our bones naturally lose some density and become weaker. That doesn't mean that every older person gets osteoporosis, but it does mean your chances of developing the disease increase with age.
having a family history of osteoporosis: Studies show that if either of your parents had osteoporosis, then you are more likely to get it, too.
having a history of broken bones: Even if you've only had one broken bone, it will increase your risk of developing osteoporosis.
having a small, thin frame: People with lighter, thinner bones are more prone to osteoporosis. However, having a larger frame is not a defense against the disease.
being white or of Asian or Latino heritage: Osteoporosis affects all races and ethnicities, but if you are white or of Asian or Latino descent, you have a higher risk.
menopause: Menopause is marked by a steep drop in estrogen, which is a female sex hormone that protects bones. When estrogen levels decrease, bones may lose density and become prone to fractures.
While there are many uncontrollable factors that may contribute to your osteoporosis risk, there are certain lifestyle behaviors that you can control that will also impact your chances of developing the disease.

Eating a diet low in calcium and vitamin D: It's important to eat a diet rich in calcium and vitamin D because these nutrients work together to promote healthy bone growth and maintenance. Calcium promotes healthy bones, and vitamin D helps your body effectively absorb calcium.
Being inactive: Exercise helps ward off osteoporosis by strengthening your bones, just as it strengthens your muscles. Strong bones are less likely to fracture.
Smoking: If you smoke, your risk for osteoporosis increases for a number of reasons. First, the chemicals found in cigarettes interfere with the normal functioning of your bone cells. Also, smoking may inhibit proper calcium absorption. And finally, smoking prevents estrogen in women from protecting their bones as it should.
Consuming large amounts of alcohol: Heavy alcohol consumption inhibits normal bone formation by impacting your body's calcium supply. If you consume alcohol, do so in moderation (less than 2 drinks a day).

Moreover, figs provide decent amounts of potassium and vitamin K.