Osteoporosis prevention relies on a three-pronged approach: Exercise, proper nutrition and—when appropriate—medication, including some bisphosphonates. Although women are more likely than men to develop osteoporosis, men too should get regular exercise, eat well and minimize other risk factors.
Exercise is an important component of osteoporosis prevention. The more active you are, the stronger your bones will be. Certain types of exercise are more beneficial than others for preventing osteoporosis. For best results, your exercise routine should include weight-bearing and resistance exercises and ideally should begin well before menopause. Older people should incorporate balance exercises into their routine as well.
Although calcium is in the nutritional spotlight for its role in preventing osteoporosis, vitamin D also is essential. Other nutrients provided by a well-rounded, healthy diet also play a role in building healthy bone.
• Calcium. The National Osteoporosis Foundation (NOF) recommends that all women age 50 and older—and men age 71 and older—get 1,200 mg of calcium per day. Men under age 71 should get 1,000 mg daily.
The best sources of calcium are low-fat milk and other dairy products. For example, one cup of milk contains 300 mg of calcium, and one cup of plain, low-fat yogurt contains 415 mg. Low-fat dairy products contain slightly more calcium than their full-fat counterparts—low-fat milk actually contains slightly more than 300 mg of calcium per cup, while full-fat milk contains slightly less. But the real reason to choose low-fat products is to avoid excessive intake of saturated fat. (While milk is a good source of calcium, it is not known whether it actually reduces fracture risk.)
If you have lactose intolerance (an inability to digest the naturally occurring sugars in milk) and dairy foods give you digestive problems, you will need to include other sources of calcium in your diet such as canned salmon with bones (3 oz. contains 200 mg of calcium), leafy green vegetables, almonds and calcium-fortified foods, including cereals, orange juice, soy milk and almond milk.
Despite these dietary sources of calcium, surveys show that most people consume less than the daily recommended intake (DRI) for calcium from their diet. In fact, a dietary intake of only 400 mg of calcium per day is common. Although meeting the DRI is possible with careful dietary planning, most people need to take daily supplements that provide an additional 500 to 1,000 mg of calcium.
Various calcium supplements are available. Calcium carbonate and calcium citrate contain the highest percentage of calcium in each tablet, but calcium citrate is more readily absorbed from the intestine. You should take calcium carbonate pills with meals because this type of calcium is absorbed better in the presence of stomach acid.
Some research has suggested that calcium supplements may adversely affect the heart, but more research is needed before firm conclusions can be drawn. For now, osteoporosis experts believe that if adequate calcium cannot be obtained through diet, the benefits of supplementation outweigh the risks. Nevertheless, given the possibility of cardiovascular risks, it’s certainly reasonable to talk to your doctor about the use of calcium supplements. Also, according to the Institute of Medicine, a respected independent group of U.S. scientists, your daily calcium intake from food and supplements should not exceed 2,000 mg.
• Vitamin D. A recent study found that women with low blood levels of vitamin D were at increased risk for hip fracture. Without vitamin D, the body cannot absorb calcium properly.
Studies have confirmed that vitamin D helps prevent osteoporosis and lower the risk of fractures in older adults. Vitamin D not only helps with the absorption of calcium, but it also aids in the biochemical process by which calcium turns into bone.
Most vitamin D is synthesized by the skin in response to sunlight. Very few foods are naturally high in vitamin D, making it difficult to consume enough of the vitamin through diet alone. While some foods are fortified—especially breakfast cereals and milk products— studies have shown that the amount listed on the label does not always accurately reflect the contents.
The NOF recommends that people age 50 and over consume 800 to 1,000 IU of vitamin D per day. The recommendation from the Institute of Medicine is slightly lower—600 IU for most adults and 800 IU for those over age 70—which will achieve a vitamin D blood level of 20 ng/mL, the amount experts believe is necessary to ensure good bone health.
However, if you already have osteoporosis or osteopenia—and so are at increased risk of fractures and falling—a higher blood level of vitamin D is needed. In that case, your best bet is to follow the NOF recommendations.
It’s also important not to overdo vitamin D intake, since too much can be toxic to the kidneys, especially in doses over 10,000 IU daily. That, however, is far above the IOM’s current safe upper limit of 4,000 IU from food and/or supplements.
• Other nutrients. A healthy diet rich in fruits and vegetables will provide plenty of phosphorus, magnesium and vitamins C and K, all of which play a role in bone health.
If you take a daily multivitamin, choose one that contains no more than 900 micrograms (mcg) of vitamin A for men and 700 mcg for women. Also make sure that at least 20 percent of its vitamin A is in the form of beta-carotene. Research suggests that a high intake of vitamin A from retinol might increase the risk of hip fractures in postmenopausal women; too much vitamin A has also been associated with fractures in men.