Your bones grow and strengthen during childhood, but bone accumulation is not completed until you are in your twenties. The bone mass you attain before age 30 is perhaps the most important determinant of life-long skeletal health. Genetic factors exert a strong influence on your peak bone mass, but physiologic, environmental, and modifiable lifestyle factors can also play a significant role. Among these are adequate nutrition and body weight, exposure to sex hormones at puberty, and physical activity.

Maximizing bone mass early in life is the most crucial way to reduce the impact of bone loss related to aging. Childhood is also a critical time for the development of lifestyle habits conducive to maintaining good bone health throughout life. For example, exercising promotes strong bones. Cigarette smoking, which usually starts in adolescence, may negatively affect your ability to achieve peak bone mass.

Here are some tips on reducing your risk of osteoporosis:

• Eat a balanced diet rich in calcium and vitamin D.
• Exercise regularly.
• Do not smoke.
• Avoid excessive alcohol and caffeine.
• Talk to your healthcare provider about medications for prevention.
• Have a bone mineral density test.
• Ask your healthcare provider whether any of your regular medications might contribute to osteoporosis.

Eat a Balanced Diet Rich in Calcium and Vitamin D

Good nutrition is essential for normal growth. A balanced diet, adequate calories, and appropriate nutrients are the foundation for development of all your tissues, including bone. Inadequate intake of calcium and vitamin D is thought to contribute to the development of osteoporosis.

Calcium

Calcium is the nutrient most important for attaining peak bone mass and for preventing and treating osteoporosis. Depending on your age, recommended calcium intakes for adults fall between 1,000 and 1,300 mg per day, according to the National Academy of Sciences.

You can increase your calcium intake by eating more calcium-rich foods such as low-fat milk, yogurt, cheese, sardines, soy foods, and broccoli. Many foods such as orange juice, breakfast bars, and cereals are now fortified with calcium, as well. You can increase the calcium content of home-baked goods by adding non-fat powered dry milk to them. If you are unable to get adequate calcium in your diet, talk to your healthcare provider or a registered dietitian (RD) about a supplement.

High dietary protein, caffeine, phosphorus, and sodium can adversely affect calcium balance, but the effects may not be as important in individuals with adequate calcium intakes.

Vitamin D

Vitamin D is required for optimal calcium absorption and thus is also important for your bone health. Your skin manufactures vitamin D in response to direct exposure to sunlight. Approximately 10-15 minutes of sunlight exposure two to three times a week is enough to meet the requirements for vitamin D in most people.

Older adults and people who are exposed to little sunlight may have difficulty meeting vitamin D requirements. Most infants and young children in the US have adequate vitamin D intake because of supplementation and fortification of milk. During adolescence, when consumption of dairy products decreases, vitamin D intake may be inadequate, and this may negatively affect calcium absorption.

Experts recommend a daily intake of between 400 and 800 international units (IU) of vitamin D. You can get more vitamin D by getting at least 15 minutes of sunshine two to three times per week, drinking vitamin D-fortified milk, or taking a vitamin D supplement. Remember that excess vitamin D from supplements or cod liver oil can be toxic!

Other Nutrients

Other nutrients have been evaluated in relation to bone health. A recent study showed that Japanese postmenopausal women who took vitamin K supplements experienced a reduced rate of fractures. Due to side effects and medication interactions, talk to your doctor or dietician before you begin taking dietary supplements.*

Exercise Regularly

There is strong evidence that regular physical activity in childhood and adolescence contributes to higher peak bone mass. Exercise during later years, combined with adequate calcium and vitamin D intake, may help slow the decline in bone density associated with aging. Some evidence indicates that weight-bearing and resistance exercises are most likely to be beneficial.

To help reduce bone loss, engage in regular weight-bearing exercise. Examples include walking, running, tennis, dancing, hiking, and racquetball. Strength training can also help increase your bone density and keep your muscles strong, so that you are less likely to fall.

Do Not Smoke

A study reported in the January/February 2001 Journal of the American Academy of Orthopedics suggests that smoking puts people at higher risk for developing osteoporosis.

Avoid Excessive Alcohol and Caffeine

Alcohol has several negative affects on bones. Alcohol can interfere with vitamin D metabolism, which results in impaired calcium absorption. It also increases magnesium excretion. In addition, alcoholics tend to have diets that are lacking in many key nutrients, including calcium and vitamin D.

Heavy drinking can affect hormone production in both women and men. In premenopausal women, chronic alcohol use can result in irregular menstrual cycles. This increases the risk of osteoporosis. Testosterone production may be affected in alcoholic men. Low testosterone levels have been linked to a decrease in bone formation.

Heavy alcohol consumption is associated with an increased risk of fracture. Alcohol affects your balance and gait making you more prone to stumble, trip, or run into objects.

The relationship between caffeine use and bone health is not as clear-cut. Studies on the effect of caffeine on the bones have yielded mixed results. On the basis of the studies to date, current recommendations are for moderate caffeine consumption, which equals two or less cups of coffee per day.

Talk to Your Healthcare Provider About Medications for Prevention

Medication, such as estrogens, alendronate, risedronate, among others, have been approved by the US Food and Drug Administration for the prevention and treatment of osteoporosis. These medications slow or stop bone breakdown.

Hormone Replacement Therapy (HRT)

Estrogen replacement therapy (ERT) and combined HRT have been used for both the prevention and treatment of osteoporosis. ERT contains estrogen alone; combined HRT contains estrogen plus progestin. ERT and combined HRT have been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine and hip fractures in postmenopausal women. ERT is available as a pill or skin patch; HRT is available in pill form.

Although ERT/combined HRT may cut the risk of osteoporosis in half, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.

Alendronate Sodium (Fosamax)

Alendronate is from a class of drugs known as bisphosphonates. It is used in the prevention and treatment of osteoporosis. It should be taken with a full glass of water first thing in the morning at least a half hour before eating, drinking, or taking other medicines. Individuals should remain in an upright position for at least a half hour after taking this medication.

Risedronate Sodium (Actonel)

Risedronate is also a bisphosphonate. It slows bone loss, increases bone density, and reduces the risk of spine and nonspine fractures. It should be taken with a full glass of water first thing in the morning at least a half hour before eating, drinking, or taking other medicines. Individuals should remain in an upright position at least a half hour after taking this medication.

Zoledronic Acid (Zometa)

Zolendronic acid is the most potent bisphosphonate available—so potent, in fact, that it can only be given by injection. Partly because of its inconvenient form of administration, zolendronic acid has been largely reserved for use in patients seriously ill with cancers affecting their bones. However, a recent study suggests that once yearly injections in patients with a recent hip fracture due to minimal trauma (like those that occur with osteoporosis) can reduce the risk of a second fracture.

Researchers treated 2,127 patients who had a hip fracture surgically repaired within the previous 90 days with either annual injections of zoledronic acid (5 mg) or a placebo for up to five years. All subjects (who averaged 75 years of age) also received vitamin D and calcium supplements. Compared to those who were assigned placebo, patients who received the zoledronic acid were significantly less likely to suffer recurrent fractures of the hip and elsewhere over two to three years of follow-up. They were also more likely to survive.*

Raloxifene (Evista)

Raloxifene is one of a class of drugs called selective estrogen receptor modulators (SERMs). It helps prevent bone loss at the spine, hip, and total body and may increase bone mass. In some studies, after three years of use, raloxifene reduced the risk of spine fractures by about 50%. Raloxifene is available as a pill and should be taken once a day, with or without meals.

Side effects are not common. Those reported include hot flashes and deep vein thrombosis.

Calcitonin (Miacalcin)

Calcitonin is a naturally occurring hormone that helps slow bone loss, increase bone density, reduce the risk of spinal fractures, and may relieve the pain of bone fractures. It is given to women who are at least five years past menopause. It is taken as an injection or a nasal spray.

Have a Bone Mineral Density Test

Osteoporosis often has no symptoms and can go undetected for years. For that reason, early diagnosis is important. A bone mineral density test (BMD) can diagnose osteoporosis and determine your fracture risk. BMD is a painless and noninvasive test that measures the density (mass) of your bones. Talk to your healthcare provider about whether you are a candidate for a BMD test.

Ask Your Healthcare Provider Whether Any Of Your Regular Medications Might Contribute to Osteoporosis

• Glucocorticoids, such as prednisone
• Immunosuppressants, such as methotrexate and cyclosporine
• Chemotherapy
• Thyroid hormone replacement
• Anticonvulsants, such as phenytoin
• Loop diuretics
• Medications containing aluminum, such as some antacids
• Long-term heparin therapy

References:

National Institutes of Health website. Available at: http://www.nih.gov/.

National Osteoporosis Foundation website. Available at: http://www.nof.org/.

Updated section on Other Nutrients on 10/6/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance: Cockayne S, Adamson J, Lanham-New S, et al. Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:1256-1261.

Updated Medication section on 10/9/07 according to the following study, as cited by DynaMed's Systematic Literature Surveillance: Lyles KW, Colón-Emeric CS, Magaziner JS. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007 Sep 26. [Epub ahead of print]

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