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Osteoporosis

How You Can Prevent Osteoporosis

Last modified: 
23/04/2012 - 12:52

Contributing Author: Guy Slowik FRCS

Preventive measures may reduce or stop bone loss.

The earlier these measures are begun, the more effective the results. If you suspect you're at risk for osteoporosis, it's wise to address it now, before a bone fracture occurs.

Preventing osteoporosis involves making a few changes in your diet, getting enough exercise, and considering whether the available medication is right for you.

Calcium

One of the most important ways to help prevent osteoporosis is to get enough calcium in your diet. Here is the recommended daily dietary allowance of calcium for various age groups:

  • Children, age 1-10- 800 mg daily
  • Teenagers, age 11-18- 1,200 mg daily
  • Pregnant teens - 1,600 mg daily
  • Pregnant women, age 19 and older - 1,200 mg daily
  • Breast-feeding women - 1,200 mg daily
  • Adults, male, up to age 65 - 1,000 mg daily
  • Adults, male, over age 65 - 1,500 mg daily
  • Adults, women, before menopause - 1,200 mg daily
  • Adults, women, after menopause - 1,500 mg daily

Nice To Know:

Here are some examples of calcium content in foods:

Food

Amount

Calcium

Orange juice with added calcium

6 oz

200-300 mg

Dry cereal with ½ cup milk

1 oz

150-350 mg

Flour, self-rising

1 cup

300 mg

Cheese lasagna

8 oz

220 mg

Macaroni baked with cheese

1 cup

360 mg

Oatmeal with milk

1 oz

160-170 mg

Pizza, cheese

10" diameter

620 mg

Cheese, sliced American

1 oz

150-200 mg

Cheese, cheddar

1 oz

210 mg

Cheese, swiss

1 oz

270-300 mg

Cottage cheese, 1% milkfat

8 oz

140 mg

Milk, calcium fortified

8 oz

500 mg

Milk, skim, whole, 1%, or 2%

8 oz

300 mg

Milkshake, average

8 oz

450 mg

Yogurt, frozen, high-calcium

8 oz

500 mg

Yogurt, frozen (most flavors)

6 oz

150 mg

Yogurt, soft frozen

6 oz

120 mg

Yogurt, 1% milkfat

8 oz

400 mg

Puddings, instant or cooked, average

8 oz

150-250 mg

Sardines, canned with bones

8 medium

350-450 mg

Oyster stew made with milk

1 cup

280 mg

Manufacturers sometimes add extra calcium to foods such as orange juice and breakfast cereals. The Nutrition Facts label on the package will tell you how much calcium is contained in the foods you eat.

In addition, calcium supplement tablets are available over-the-counter. Products to help acid indigestion, such as Tums and Di-Gel, now have added calcium ranging from about 100 to 300 mg per tablet.

Vitamin D

One of the uses of vitamin D by the body is to help absorb calcium from the intestine. Some people with osteoporosis have a lower level of vitamin D and a less effective absorption of calcium as a result. Vitamin D is either made in the body from exposure to sunlight or is taken through foods.

The recommended daily allowance for vitamin D is 400 IU. You can increase that to 800 IU, especially if you don't get enough in your diet and don't get much sun exposure. Don't take any more than that per day, unless your physician has recommended a higher dose.

Exercise

One of the best ways to forestall osteoporosis is to do regular weight-bearing exercises.

Begin a regular exercise program and stay with it. Start light and gradually build up to 30 to 40 minutes of exercise several times a week. Of course, consult your physician before you begin any exercise program and if you feel pain after you've begun.

Although swimming is not a weight-bearing exercise, it can be excellent for strengthening the muscles in your back. The stronger the back muscles, the stronger and more dense the bones of the spine. Exercising in the water is also a good option for individuals with arthritis or others who experience pain with weight-bearing exercise.

Keep in mind that it is possible to get too much exercise. Some women athletes who train excessively and exercise strenuously may alter their hormone production so severely that their menstrual periods stop, a condition called amenorrhea. This can lead to osteoporosis and fractures.

Here are some of the many benefits of exercise:

  • Maintaining bone condition. The pull on the bones from exercising muscles helps to maintain bone density and strength.
  • Improving your posture. Exercising the back muscles helps the whole body become more upright. This can help avoid the "bent-forward position" that can develop with osteoporosis.
  • For general fitness. This is important for everybody, but especially for individuals with osteoporosis.

How-To Information:

Here are some good weight-bearing exercises you may want to consider:

  • Walking
  • Hiking
  • Jogging
  • Running
  • Jumping rope
  • Aerobic dancing
  • Ballroom dancing
  • Gymnastics
  • Tennis
  • Racquetball
  • Squash
  • Handball
  • Rowing
  • Weight training
  • Basketball
  • Volleyball
  • Cross-country skiing
  • Bicycling, to some extent

Hormone Replacement Therapy

Menopause, as well as surgical removal of the ovaries, causes estrogen production to decrease. Low estrogen levels make women more vulnerable to osteoporosis. Women can protect themselves by taking estrogen to replace what their ovaries no longer produce naturally. This is called hormone replacement therapy.

Studies have shown that osteoporosis can be prevented or delayed if estrogen treatment is begun within the first few years of menopause. Hormone replacement therapy is considered both an effective treatment and a preventive measure for osteoporosis.

Hormone replacement therapy has been shown to entirely restore the rate of post-menopause bone loss to the pre-menopausal rate. It may even replace a small amount of bone already lost.

It also controls hot flashes, vaginal dryness and other symptoms which can happen around the time of menopause.

For many years, hormone replacement therapy has been routinely given to women at menopause. In addition to osteoporosis prevention, it was thought to lower the risk of coronary heart disease and heart attack. Recent evidence shows that hormone replacement therapy may not prevent coronary heart disease or stroke and that it may increase the risk of breast cancer or ovarian cancer. The possible side effects of hypertension and the increase in risk of blood clots in some women have been known for years.

Estrogens are given either as tablets or as a skin patch that is replaced periodically. Hormone replacement therapy often includes a combination of estrogen and progesterone. Estrogen given alone is associated with an increased risk of uterine cancer, but that risk is eliminated when progesterone is added. Progesterone is not necessary for women who have had a hysterectomy (removal of the uterus).

Although hormone replacement therapy (HRT) has obvious and proven benefits, they must be weighed against possible long-term effects. It remains effective for prevention and treatment of osteoporosis and for relief of menopause symptoms. However, whether to begin hormone replacement therapy is a decision every woman must make for herself. Try to learn all you can about the facts, benefits, and risks. Your health care provider can help you determine what is right for you.

For more information about hormone replacement therapy, go to Hormone Replacement Therapy.

Medication

New medications have been approved by the U.S. Food and Drug Administration (FDA) for the prevention of osteoporosis: Fosamax (alondronate), Actonel (residronate), Evista (raloxifene) and Miacalcin (nasal calcitonin).

  • Alendronate (Fosamax) - This is the first in a new class of drugs approved by the FDA for both preventing and treating osteoporosis. It has been shown to increase healthy bone and reduce the risk of spinal fractures by 70 percent and hip fractures by over 50 percent in women with osteoporosis. The bone density increases within a few months in over 90 percent of patients and the risk of fractures improves within the first year.

    Data from clinical trials show that, over three years, Fosamax builds healthy bone at the spine and hip and other sites by as much as 10 percent compared with people not taking Fosamax.

    Fosamax can be taken weekly or daily (most patients prefer weekly). It is recommended that it be taken once you're up for the day, in the morning before breakfast with a glass of water and no other food or drink for 30 minutes. Certain individuals, such as those with digestive problems or severe kidney disease, should not take Fosamax. If you have esophageal narrowing (stricture) then you should not take Fosamax until you talk to your doctor. Fosamax is usually well tolerated, but if indigestion or heartburn occur, then check with your doctor.

    Fosamax is not a hormone and does not affect menopause symptoms. It is used in women and men with osteoporosis. It can be given along with Evista or hormone replacement therapy. This often gives a larger increase in bone density than using one of the medications alone.

  • Risedronate (Actonel) - This medication is also in the new class of drugs used to prevent and treat osteoporosis. It increases healthy bone and bone density in over 90 percent of patients. It lowers the risk of fractures in the spine by 70 percent and lowers fractures in the hip by 60 percent in women with osteoporosis. Bone density increases within a few months and the lower risk of fractures in the spine and hip happen over the first year.

    Actonel can be taken weekly or daily (most patients prefer weekly). It is recommended that Actonel be taken in the morning on arising, with a glass of water and no other food or drink for 30 minutes. If you have had narrowing (stricture) of the esophagus, check with your doctor before you take Actonel.

    Actonel can be combined with Evista or hormone replacement therapy. This treatment usually gives a large increase in bone density than either of the medications alone.

  • Raloxifene (EVISTA) - EVISTA has been approved by the FDA for the prevention of osteoporosis in postmenopausal women. Raloxifene is a member of a new class of drugs known as selective estrogen modulators (SERMs). SERMs are designed to mimic the beneficial effects of estrogen on the bone, without negative effects on the uterus and breast.

    Evista lowers the risk of fractures in the spine and has not been shown to lower the risk of hip fractures. It can be given along with Fosamax or Actonel with a greater increase in bone density usually found than with either drug alone.

    Studies have shown raloxifene to be less effective than estrogen in increasing bone mineral density, but it is not associated with increased risk of uterine cancer. Evista lowers the risk of breast cancer by 70 percent. Therefore, it is an alternative for the prevention of osteoporosis for women who are unwilling or unable to take estrogens. Side effects include hot flashes and leg cramps.

  • Calcitonin (miacalcin) -is a hormone that slows the removal of bone. It has been shown to reduce the risk of spine fractures but does not lower the risk of hip fractures. An additional advantage of calcitonin is its analgesic properties, which help relieve the bone pain that can occur with established osteoporosis.

    Until recently, calcitonin was available only in injected form, which can be inconvenient. Today, a nasal spray (Miacalcin) has been approved. The most common side effect is rhinitis. Miacalcin is used most commonly when other medications described above are not able to be taken.

How-To Information:

HRT or the newer medications?

Until recently, the only therapy known to prevent osteoporosis after menopause was to take estrogen, in the form of hormone replacement therapy (HRT).

HRT has definite health benefits for women, but it has some risks, too. Benefits and risks vary for each person, however, and must be weighed against each other. The decision to take HRT is a personal one. A woman's physician is the best source of advice on what is right for her.

Most women choose to take HRT for relief of menopause symptoms (such as hot flashes and vaginal dryness) and for protection against osteoporosis.

Women who choose not to take HRT now have the option of taking a variety of medications, for the prevention of osteoporosis. These medications do not relieve menopause symptoms or protect against heart disease, however. But if a woman is not experiencing unpleasant menopause symptoms and is not at high risk for heart disease, they may be another option for keeping her bones strong.

Nice To Know:

The following may afford protection against osteoporosis:

  • Late menopause
  • Moderate exercise
  • Adequate calcium in your diet
  • Adequate amounts of fluoride in your water
  • Normal or increased body weight
  • Use of oral contraceptives before menopause
  • Childbearing
  • Black or Afro-Caribbean ancestry
  • Hormone replacement therapy after menopause
  • Taking alendronate or raloxifene
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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.