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Ways to Prevent Osteoporosis by Laurie B. Rosenblum, MPH

What Is Osteoporosis?

Osteoporosis is a disease of the bones in which the bones become so weak that they break easily. Bones are made up of living tissue that is constantly being renewed. This process, called remodeling, consists of two stages—bone resorption and bone formation. During resorption, old bone is broken down and removed. During bone formation, new bone is built to replace the old.

The remodeling process changes naturally throughout the life cycle. During childhood and early adulthood, new bone is formed faster than old bone is removed. Between ages 25 and 35, a peak bone mass is reached. Peak bone mass is when you have maximum bone density and strength. After this, bone loss starts to occur more than bone formation. In women, the rate of loss is greatest during the years after menopause.

Osteoporosis occurs when there is an excessive amount of bone loss and/or insufficient bone formation. The bones become thin and weak, increasing the chance of fractures. Fractures are most common in the hip, spine, wrist, and ribs, but can occur in any bone. These fractures can result in trouble walking, severe pain, loss of height, spinal deformities, and decreased function.

Because bone loss occurs without symptoms, people may not realize they have osteoporosis until a sudden bump or fall causes a fracture. Bone density tests may help predict who is at the greatest risk.

Prevention at All Ages

Since this condition occurs mainly in older people, why should you be concerned about it during earlier years? Prevention of osteoporosis can begin in childhood, when bone mass is increasing. Diet, exercise, smoking, and use of alcohol all affect bone formation throughout life. Preventive measures are also important when bone mass is decreasing, during midlife and just after menopause in women.

Calcium and Vitamin D

Good nutrition, especially an adequate supply of calcium, plays an important part in maintaining bone mass. Vitamin D is also needed to aid in calcium absorption.

Although you must work at it, it is possible to get adequate amounts of calcium from your diet. Dairy products are the best dietary sources of calcium. Other good sources include tofu, salmon (canned with edible bones), and blackstrap molasses.

If you cannot or do not regularly get enough calcium from your diet, you may need to take a calcium supplement. However, supplements should be used only to supplement the calcium in your diet, not replace it. There are several different calcium compounds on the market. They differ mainly in price and how easily they are absorbed. Be sure to discuss calcium supplementation with your doctor.

General recommendations are:

Women
- 19-50—1,000 milligrams (mg)
- 51 and older—1,200 mg
Men
- 19-50—1,000 mg
- 51-70—1,000 mg
- Over 70—1,200 mg

Vitamin D is also important.. Our usual source of vitamin D is sunlight. But, with so many of us spending abundant time indoors (and wisely using sunscreen when outdoors), few people get adequate sun exposure—especially during the wintertime.

Salmon and other types of fish (like mackeral and sardines) are good vitamin D sources. Also, adding vitamin D-fortified milk to your diet will help you meet your daily needs. . The recommendations for most adults is to get 600-1,000 international units (IU) of vitamin D each day. If you want to check on your vitamin D status, talk to your doctor, who will be able to do a blood test.

Keep in mind that your body needs vitamin D in order to absorb calcium. Evidence supports reduced fracture risk in people who have the right amount of both.

Exercise

Exercise is an important contributor to building and maintaining bone mass at all ages. It also increases the strength and coordination of muscles that support the bones. Weight-bearing exercise, such as walking, jogging, stair climbing, jumping rope, and dancing, is the best for your bones. Weight lifting has also been shown to help strengthen bones and prevent osteoporosis. If you are unaccustomed to exercising, talk to your doctor before you begin.

Other Lifestyle Factors

Smoking, and alcohol can contribute to bone loss. To reduce your risk, do not smoke, and limit your use of alcohol. Smoking is a very serious risk factor for osteoporosis and should be avoided by anyone seeking to reduce the risk of bone thinning. Also being underweight can increase your risk for osteoporosis

Medications for Prevention and Treatment

For women who are postmenopausal, there are medicines available to prevent osteoporosis. Some examples include:

Bisphosphonates
Estrogen with progestin (hormones)
Raloxifene

Your Prevention Strategy

There is general agreement that everyone can reduce their risk of developing osteoporosis by making lifestyle changes. A healthy diet and regular exercise are important throughout your life. Avoiding smoking and limiting alcohol use are two of the most important prevention strategies you can adopt.

Women from midlife on, older men, and anyone else at increased risk for osteoporosis should evaluate their risk factors in order to develop a prevention strategy. How you implement lifestyle changes and whether you take medicines are decisions that should be made by you and your doctor.

Resources:

National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov
National Osteoporosis Foundation http://www.nof.org

CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca/index_e.html
Osteoporosis Canada http://www.osteoporosis.ca

References:

Adami S, Felsenberg D, et al. Efficacy and safety of ibandronate given by intravenous injection once every 3 months. Bone. 2004;34(5):881-889.
Bisphosphonates for treatment and prevention of osteoporosis. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 9, 2013. Accessed January 28, 2013.
Calcium and vitamin D for treatment and prevention of osteoporosis. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 12, 2012. Accessed January 28, 2013.
Holick MF. Vitamin D: a D-Lightful health perspective. Nutr Rev. 2008;66:S182-S194.
Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 17, 2013. Accessed January 28, 2013.
Osteoporosis overview. NIH Osteoporosis and Related Bone Diseases National Resource Center website. Available at: http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/overview.asp. Updated January 2012. Accessed January 28, 2013.
Pyon EY.Once-monthly ibandronate for postmenopausal osteoporosis: review of a new dosing regimen. Clin Ther. 2006;28(4):475-90. Review.
Richardson JP. Vitamin D deficiency-the once and present epidemic. Am Fam Physician. 2005;71(2):241-242.

Last reviewed January 2013 by Brian Randall, MD

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