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Keeping bones healthy in cystic fibrosis

Bone health

Childhood is an important time for building strong, healthy bones into adulthood.

As adults get older, bones become thinner and weaker and can sometimes be more likely to fracture. In cystic fibrosis, bones are at risk of becoming weaker at an earlier age. This is called cystic fibrosis related low bone mineral density (BMD).

What increases the risk of cystic fibrosis related low BMD?

The following can increase the risk of low BMD:

 

  • being pancreatic insufficient (needing to take enzymes)
  • repeated use of long term steroids
  • reduced sunlight exposure
  • low activity levels
  • cystic fibrosis related diabetes

 

What can be done to reduce the risk of cystic fibrosis related low BMD?

A few things can be done to reduce the risk of cystic fibrosis related low BMD including:

  • having an adequate amount of calcium and vitamin D either through the diet or from supplements
  • making sure vitamins are taken at the same time as a meal and enzymes, to help the absorption of vitamins
  • weight bearing activities, including running, dancing, football, cricket and tennis

Calcium

Calcium is needed for keeping bones healthy. The body cannot make calcium so it is important that enough calcium rich foods are included in the diet to reduce the risk of developing cystic fibrosis related low BMD.

How much calcium do children with cystic fibrosis need?

Age Amount of calcium per day
1 to 3 years 500mg
4 to 8 years 800mg
9 to 18years 1300mg

What foods are good sources of calcium? 

Calcium is in dairy products for example, milk, cheese and yogurts. They are also found in baked beans, green leafy vegetables, white bread and fortified cereals. These foods are not as rich in calcium as dairy foods, so you would need a large amount of these to meet the calcium requirements.

Here is an example of a meal plan so you can see how easy it is to consume enough calcium each day:

Breakfast

Fortified cereal with full fat milk has 290mg of calcium
Orange juice has 72mg of calcium
Slice of white toast with 10g of butter has 45mg of calcium

Mid-morning snack

50g chocolate bar has 48mg of calcium

Lunch

Ham sandwich has 107mg of calcium
Mini roll has 20mg of calcium
Crisps has 10mg calcium
Grapes

Mid-afternoon snack

Cereal and milk bar has 140mg of calcium

Evening meal

2 cheese and tomato pizza slices has 400mg of calcium
Salad
2 potato waffles has 29mg of calcium
1 tablespoon of baked beans has 23mg of calcium
Twin pot yogurt has 228mg calcium 

Supper

Mug of hot chocolate made with whole milk has 225mg of calcium

Total = 1637mg

Good sources of calcium in the diet

Food (per serving) Amount of calcium
Dairy products
Thick milkshake (250mls) 340mg
Gold top milk (200mls) 268mg
Full cream milk (200mls) 243mg
Pot of yogurt (150g) 183mg
Pot of Greek style yogurt (150g) 212mg
2 infant yogurts (90g) 108mg
Twin pot yogurt (175g) 228mg
Fromage frais (100g) 86mg
ot chocolate (200mls) 225mg
Matchbox size piece of cheese (30g) 222mg
Cheese triangle 123mg
Cheese slice 186mg
Cheese strip 140 to 190mg
Cheese sandwich 300mg
Custard pot (150g) 159mg
Rice pudding (200g) 152mg
Fortified cereal with milk 290mg
Macaroni cheese (small tin) 340mg
Milk shake powder and 200mls of milk 250mg
Non-dairy foods
Children’s cereal and milk bar 140 to 170mg
Chocolate nut spread on 1 slice of bread 61mg
Bar of chocolate 60 to 120mg
1 slice of white bread 53mg
Prawns (60g) 65mg
Small piece of fish in batter 80mg
Small portion of scampi (90g) 190mg
Orange juice 72mg
Cheese and tomato pizza slice 200mg
Spinach (90g) 144mg
Broccoli (85g) 34mg
Small tin of chick peas 92mg
Small tin of kidney beans 200mg
Small can of baked beans 106mg
Oral nutritional supplements
Fortisip 180mg
Fortijuce 60mg
Scandishake made with 240ml of full cream milk 369mg
Milk alternatives
Calcium enriched soya milk (100mls) 120mg
Soya yogurt (125g pot) 150mg
Soya custard (100ml) 120mg

Vitamin D

Why is vitamin D important?

Vitamin D helps to make sure calcium is absorbed properly. This helps promote healthy bones.

Where does vitamin D come from?

Our bodies make their own vitamin D from sunlight. In cystic fibrosis, the vitamin supplements also contain vitamin D and it is important to take these at the same time as a meal and enzymes to aid their absorption.

Vitamin D can also be found in some of the foods we eat. These include:

  • oily fish
  • margarine or butter
  • fortified cereals
  • cheese
  • egg yolks
  • milk and milk products

Monitoring

At your annual review, your vitamin D level in your blood will be checked. If it is too low, the doctor will advise on how to increase this.

Other bits to remember

  • Make sure there is enough calcium in your child’s diet helps prevent cystic fibrosis related low BMD.
  • Dairy foods are the richest sources of calcium although there are many non dairy foods which contain smaller amounts of calcium.
  • Vitamin D is also very important for healthy bones.
  • Taking the vitamin supplements at the same time as a meal and enzymes helps the body to absorb them.

If you have any concerns that your child is not getting enough calcium, contact your cystic fibrosis dietitian on 0114 271 7212

Contact us

If you have any questions or concerns you can call the dietetic department on 0114 271 7212.

Is something missing from this resource that you think should be included? Please let us know

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

Resource number: CF9

Resource Type: Article

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Rachael Hobson

NHS

Western Bank
Sheffield
S10 2TH

United Kingdom

Switchboard: 0114 271 7000

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