Prevention and Treatment of Osteoporosis

Osteoporosis is a common cause of fractures (broken bones), especially in women who are beyond menopause. However, by strengthening your bones, slowing bone loss, and avoiding falls, you can help prevent or treat the condition and avoid fractures.

Diet
Prevention and treatment of osteoporosis begin with proper diet. Ensuring that you get enough calcium and vitamin D each day is a great start (Table). Calcium helps your body build bone, and vitamin D helps your body absorb calcium. Calcium can be found in dairy products (e.g., milk, cheese, yogurt, and ice cream); in salmon and sardines with bones; in dark green, leafy vegetables (e.g., kale and broccoli); and in foods with added calcium (e.g., orange juice). For example, a one-cup serving of milk contains about 300 mg of calcium, and a one-cup serving of broccoli contains about 135 mg.

Supplements also provide needed calcium. If you need to take a supplement, choose it carefully. Avoid bone meal and dolomite supplements because they may contain lead.

You need at least 400 IU of vitamin D each day. You can get your daily requirement by taking a multivitamin; getting 30 to 60 minutes of sun exposure (wear sunscreen and protective clothing); or consuming foods, such as fortified milk (a one-cup serving contains 100 IU) or salmon (a three-ounce serving contains 425 IU). Although vitamin D in adequate amounts helps your body absorb calcium, it is harmful if taken in excessive amounts. Most people should avoid taking more than 800 IU each day.

Exercise
You can help reduce the risk of developing osteoporosis by exercising regularly. Your regular exercise program should include weightbearing and resistance exercises that strengthen bones and muscles. Participate in this program three to five times each week. Weightbearing exercises include activities such as walking, dancing, hiking, and housework. Resistance exercises include weight training and pushups. Remember to talk with your doctor before starting any exercise program. He or she can help you create a program that fits your needs and abilities.

Medication
Your doctor may prescribe various medications that help slow the loss of bone mass so your body can build new bone as fast as old bone is lost. Hormone replacement therapy (i.e., replacement of estrogen) is one of the most valuable options for women who are candidates for such medication. In addition to the treatment of bone loss, the benefits of this therapy include a reduction in the risk of heart disease and in the symptoms of menopause. Unfortunately, some women cannot or will not take hormone replacement therapy because of side effects (e.g., breast tenderness, slight bloating, and vaginal bleeding), certain risk factors (e.g., endometrial, breast, or uterine cancer), or other associated problems (e.g., uncontrolled hypertension, impaired liver function, or porphyria). Some women may not be able to take estrogen therapy if they have problematic diabetes, gallbladder disease, migraines, pancreatitis, high triglyceride levels, or endometriosis. However, these women may be able to take other medications, such as alendronate (Fosamax), calcitonin, or calcium plus vitamin D. Talk with your doctor to find out about the best choice for you.

Home safety
Falls often lead to fractures in people with osteoporosis. To prevent falls, create a safe home. Remove or anchor rugs and furniture that may cause you to trip. Install nightlights and grip bars in your bathroom and use a rubber mat in the floor of your tub. Keep regularly used items at a height you can reach easily without a stool. Make sure that the rooms in your home are well lit.

Screenings and lifestyle changes
By age 30, you and your doctor should discuss your risk of developing osteoporosis. Regular osteoporosis screenings that may include bone density tests should begin for women by age 65 and for men by age 75. Younger men and women should have these regular screenings if they have alcoholism, use tobacco heavily, or have an associated disease (e.g., hyperparathyroidism, disease treated with steroids, glandular disease, or advanced kidney or liver disease). The use of DEXA (dual-energy x-ray absorptiometry) scan bone density tests has greatly increased the accuracy of diagnosis and has allowed better monitoring of the disease and its treatment (see "Screening Tests for Osteoporosis,").

In addition to checkups, you can help prevent osteoporosis by making some lifestyle changes. Stop smoking and decrease your alcohol intake. Increase your physical activity level and improve your diet.

All women, and even some men, should be concerned about osteoporosis. For women, waiting until your postmenopausal years to consider the risks and to make lifestyle changes may not be prudent. Education, wise lifestyle choices, and regular screenings can reduce the likelihood that this disease will affect your quality of life.

Clark H. Cobb, M.D.
Columbus, Georgia