BONE HEALTH

From The Jerusalem Post Thursday May 10, 2001

US study: Haredi lifestyle bad for young bones
By Judy Siegel

JERUSALEM (May 10) - Dr. Dorit Nitzan-Kalusky, head of the Health Ministry's nutrition department, yesterday asked Health Minister Nissim Dahan for funding to determine whether haredi teenagers suffer from low bone mineral density (BMD) that can cause osteoporosis later in life.

Nitzan-Kalusky prepared the request immediately after receiving a New York study that found haredi teenagers in Brooklyn - especially the boys - suffer from significantly lower BMD than their non-haredi counterparts.

She said that after reading the study, published in the May issue of the American Pediatrics Association's journal Pediatrics, she correlated data on milk-product consumption among haredi adults from her recent National Nutrition Study.

She found that haredi adults consume significantly less milk products than secular or modern Orthodox adults - hinting at a serious deficit among their children as well. She is optimistic that Dahan will approve her request.

Osteoporosis expert Dr. Yossi Foldes said he also recommended that the hypothesis that a haredi childhood can lead to thin bones be studied among a similar group in Israel. "It is a very interesting finding," said Foldes of the Jerusalem Osteoporosis Center at Hadassah-University Hospital on Mount Scopus.

The article, called "Reduced Spinal Bone Mineral Density in Adolescents of an Ultra-Orthodox Jewish Community in Brooklyn" and written by Drs. Wael Taha, Daisy Chin, Arnold Silverberg, Larisa Lashiker, and Henry Anhalt, of the borough's Maimonides Medical Center, and Dr. Naila Khateeb, of Byrd Regional Hospital in Louisiana, examined 30 haredi boys and 20 haredi girls 15 to 19.

The authors, who used a device to check bone density and conducted a physical examination of each volunteer, found that BMD in the boys was "significantly decreased in ultra-Orthodox Jewish adolescents," and that the males had "profoundly lower spinal BMD" than the girls.

Since adolescence is the time of peak bone mass growth, with the maximal accrual rate occurring in early to mid-puberty and slowing in late puberty, low bone density could lead to osteoporosis decades later (the risk of this disease is generally much higher in women than men). Aside from inadequate production of sex steroids (which was not relevant in the 50 teenagers), the main causes of low bone density in teenagers are inadequate physical activity, calcium intake, and vitamin D stores (from sunlight conversion of precursors to vitamin D, and to a lesser degree from dietary intake), the researchers noted.

The haredi youngsters, especially the boys, were found to get much less exercise than other teenagers and to remain indoors studying for long hours; since their traditional dress covers most of their bodies, their skin is less exposed to sunlight when they are outside.

In addition, the researchers theorized that dietary restrictions that require observant Jews to wait six hours after eating meat and poultry before eating dairy products could mean that they consume too little calcium.

Foldes said nobody has studied this in Israel, but that it is certainly worth investigating. "The data is does not absolutely settle the matter, but haredi youngsters do have a lifestyle different from their non-haredi peers, and this could explain the differences," he said.

Large families and much higher poverty rates among haredim could explain inadequate dairy product consumption no less than rules on waiting between meat and dairy meals, he added.

Although there is intense sun most of the year, even here there are vitamin D deficits in children, whether haredi or not, Foldes added. "The common taking of vitamin-rich fish oil and liver decades ago has passed, and children are frequently kept out of the sun because the risk of developing skin cancer. In addition, few foods here are enriched with vitamin D, unlike the situation in the US. Thus this subject is definitely worth investigating in a clinical study," he said.