Prevention of Osteoporosis

Osteoporosis (porous bone) is a disease in which bones become weak and are more likely to break (fracture). Without prevention or treatment, osteoporosis can progress without pain or symptoms until a fracture occurs. Fractures from osteoporosis commonly occur in the hip, spine, and wrist.

Osteoporosis is not just an "old woman's disease." Although it is more common in white or Asian women older than 50 years of age, osteoporosis can occur in almost any person, male or female, at any age. Building strong bones and reaching peak bone density (maximum strength and solidness) can be the best defense against developing osteoporosis. After reaching the peak, which usually occurs by the age of 30, a healthy lifestyle can help keep bones strong.

Osteoporosis is more or less preventable for most people. Prevention is very important because, while treatments are available for osteoporosis, no cure currently exists. Prevention of osteoporosis involves several aspects, including nutrition, exercise, lifestyle, and early screening.

Eating the proper foods is essential for good nutrition and prevention of osteoporosis. Our bodies need the right vitamins, minerals, and other nutrients to stay healthy. Getting enough calcium and vitamin D is important for strong bones as well as for proper function of the heart, muscles, and nerves. The best way to get enough calcium and vitamin D is through a balanced diet.

A Diet High in Calcium

Not getting enough calcium during a lifetime significantly increases the risk of developing osteoporosis and is associated with low bone mass, rapid bone loss, and broken bones. A diet high in calcium is important (see Osteoporosis and Calcium). Good sources of calcium include low-fat dairy products, such as milk, yogurt, cheese, and ice cream; dark green leafy vegetables, such as broccoli, collard greens, and spinach; sardines and salmon with bones; tofu; almonds; and foods with added calcium, such as orange juice, cereals, soy products, and breads. Calcium supplements and vitamins are also available.

A Diet High in Vitamin D

Vitamin D is important for the body to absorb calcium from the diet. Without enough vitamin D, the body is unable to absorb calcium from the foods that are eaten, and the body has to take calcium from the bones, making them weaker. Vitamin D comes from two sources. It is made in the skin through direct exposure to sunlight, and it comes from the diet. Many people get enough vitamin D naturally. Vitamin D is also found in fortified dairy products, egg yolks, saltwater fish, and liver. However, vitamin D production decreases with age, in people who are housebound, with the use of sunscreens, and during the winter when sun exposure is decreased. In these cases, people may need vitamin D supplements to ensure a daily intake of 400-800 IU of vitamin D.

Exercise is important to prevent osteoporosis. Although bones may seem like hard and lifeless structures, bones are living tissue that respond, like muscle, to exercise by becoming stronger. Physical activity during childhood and adolescence increases bone density and strength. This means that children who get exercise are more likely to reach a higher peak bone density (maximum strength and solidness), which usually occurs by 30 years of age. People who reach higher peak bone densities are less likely to develop osteoporosis.

The best exercise to prevent osteoporosis is weight-bearing exercise that works against gravity. Weight-bearing exercises include walking, hiking, jogging, climbing stairs, playing tennis, jumping rope, and dancing. A second type of exercise is resistance exercise. Resistance exercises include activities that use muscle strength to build muscle mass, and these also help to strengthen bone. These activities include weight lifting, such as using free weights and weight machines found at gyms and health clubs. Exercise has additional benefits in older people as well because exercising increases muscle strength, coordination, and balance and leads to better overall health (see Fall Prevention and Osteoporosis).

Elderly people, people with osteoporosis, people with heart or lung disease, and people who have not exercised for most of adulthood should check with their health care professional before beginning any exercise program.

Quit Smoking

• Smoking is bad for the bones as well as for the heart and lungs.
• In women, nicotine inhibits the bone protective effect of estrogen.
• Women who smoke often go through menopause earlier, which hastens the development of osteoporosis because bone density decreases more rapidly after menopause. Women who smoke and choose hormone replacement therapy after menopause may require higher doses of hormones and have more complications.
• Smokers may absorb less calcium from their diets.
• Smokers have a higher lifetime risk of hip fracture and rheumatoid arthritis than nonsmokers.
• Men smokers are at risk of developing osteoporosis.

Limit Alcohol Intake

Regular consumption of 2-3 ounces of alcohol a day may be damaging to bones, even in young women and men. Heavy drinkers are more likely to have bone loss and fractures. This is related to both poor nutrition and increased risk of falling.

Therapeutic Medications

Currently, bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronate (Reclast) are approved by the U.S. Food and Drug Administration (FDA) for the prevention and treatment of postmenopausal osteoporosis in women. As men age, they are also susceptible to osteoporosis. Alendronate is approved to increase bone mass in men with age-related osteoporosis. Alendronate and risedronate are approved to treat men and women with steroid-induced osteoporosis. Adequate calcium and vitamin D intake is essential for bisphosphonates to be effective.

Raloxifene (Evista) is approved for the prevention of osteoporosis only in postmenopausal women who are not taking hormone replacement therapy. Teriparatide is approved for the treatment of the disease in postmenopausal women and men who are at high risk for fracture. Estrogen/hormone therapy (ET/HT) is approved for the prevention of postmenopausal osteoporosis, and calcitonin is approved for treatment. Both alendronate and risedronate are approved for use by men and women with glucocorticoid-induced osteoporosis. See Understanding Osteoporosis Medications for more information.

Estrogen/Hormone Therapy

After menopause, bone strength and density decreases rapidly in women. Studies show that estrogen therapy/hormone therapy (ET/HT) reduces bone loss, increases bone density in both the spine and hip, and reduces the risk of broken bones (especially the hip and spine). Currently, ET/HT is approved to prevent osteoporosis from developing after menopause. This therapy is most commonly available in the form of a pill or skin patch. See Hormone Replacement and Osteoporosis for more information.

When estrogen therapy (ET) is taken alone, it increases a woman's risk of developing cancer in the uterus (cancer of the uterine lining, called endometrial cancer). Therefore, for women who have not had their uterus removed (have not had a hysterectomy), doctors prescribe an additional hormone, either natural progesterone or a synthetic similar substance called progestin. Progestin or progesterone in combination with estrogen is called hormone therapy (HT), and it reduces the risk of endometrial cancer in women who have not had a hysterectomy. A large study from the National Cancer Institute (NCI) has recently indicated that long-term use of ET (estrogen alone) may also be associated with an increase in the risk of ovarian cancer.

The Women's Health Initiative (WHI) study recently demonstrated that HT is associated with increases in the risk of breast cancer, ovarian cancer, stroke, and heart attack. No studies have determined whether ET (estrogen alone) is associated with an increase in the risk of breast cancer or whether it has an effect on cardiovascular events (like heart attack).

Doctors prescribe any estrogen therapy only for the shortest period of time possible. ET/HT used to prevent osteoporosis after menopause should only be considered for women with menopausal symptoms who at significant risk of developing osteoporosis, and other nonestrogen medications are considered if osteoporosis is the primary concern.

The only reliable way to determine loss of bone mass is to have a bone mineral density (BMD) test. People with strong risk factors for osteoporosis should have a BMD test. Take a one-minute osteoporosis risk test from the International Osteoporosis Foundation. Risk factors for osteoporosis include the following:

• Estrogen deficiency
  • Early menopause (age <45 years) from naturally occurring processes or surgical removal of the ovaries
  • Absence of menstrual periods (amenorrhea for >1 year, menopause)
  • Hypogonadism (impaired gonads, which are the ovaries or testes, or impaired sex hormones, which are estrogen or testosterone)
• Long-term corticosteroid therapy (>6 months)
• Family history of hip fracture or vertebral fractures
• Low body mass index
• Eating disorders such as anorexia nervosa or bulimia
• Previous broken bones related to having weak bones
• Loss of height (widow's hump or dowager's hump)
• Female sex
• Asian or white race
• Poor diet without enough calcium
• Lack of exercise
• Excessive exercise leading to cessation of menstruation
• Smoking
• Regular use of large amounts of alcohol

Recommendations in the United States are that all women 65 years of age and older should have a bone mineral density test (BMD). Additionally, postmenopausal women younger than 65 years who have one or more risk factors (in addition to being postmenopausal and female), women who present with fractures, and women who are considering therapy for osteoporosis should have a bone mineral density test.

Examples of tests that are used to measure bone mineral density include dual energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), and quantitative ultrasound (QUS). See Bone Mineral Density Tests for more information.

By detecting low bone mass (osteopenia) or porous bones (osteoporosis) early, the patient and the doctor can take action to stop the progression of bone loss. With lifestyle changes and appropriate treatment strategies recommended by a doctor, osteoporosis can be prevented and treated and the consequences of osteoporosis (broken bones and disability) can be avoided.

National Osteoporosis Foundation
1232 22nd Street NW
Washington, DC 20037-1292
202-223-2226

International Osteoporosis Foundation
[email protected]