How Can You Prevent Osteoporosis?

Last Editorial Review: 7/5/2017

Ask the experts

I'm a 35-year-old woman of average build and have a family history of osteoporosis. I exercise, don't smoke, and try to eat a calcium-rich balanced diet. What other steps can I take to prevent osteoporosis?

Doctor's response

It sounds as though you are taking very good steps to prevent osteoporosis. Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density. The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased. Research has not yet determined what type of exercise is best for osteoporosis or for how long. Until research has answered these questions, most doctors recommend weight-bearing exercise, such as walking, preferably daily.

You are also right in not smoking. Smoking cigarettes decreases estrogen levels and can lead to bone loss in women before menopause. Smoking cigarettes can also lead to earlier menopause.

In regard to calcium, it is recommended that premenopausal women take 1,000 mg of calcium in their diet each day. Unfortunately, surveys have shown that average women in the United States are consuming less than 500 mg of calcium per day in their diet, less than the recommended amounts. Additional calcium can be obtained by drinking more milk and consuming more yogurt, cottage cheese, and calcium-fortified foods, such as orange juice, or by taking calcium supplement tablets. Before taking calcium supplements, check with your doctor. Calcium supplements are generally avoided if one has had kidney stones.

An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength. Vitamin D helps the absorption of calcium from the intestines. Vitamin D comes from the diet and the skin. Vitamin D production by the skin is dependent on exposure to sunlight. Active people living in sunny regions (Southern California, Hawaii, countries around the equator, etc.) can produce most of the vitamin D they need from their skin. Conversely, lack of exposure to sunlight, due to residence in northern latitudes or physical incapacitation, causes vitamin D deficiency. In less temperate regions such as Minnesota, Michigan, and New York, skin production of vitamin D is markedly diminished in the winter months, especially among the elderly. In that population, dietary vitamin D becomes important. The Food and Nutrition Board of the Institute of Medicine has recommended 200 IU of vitamin D daily for men and women 19 to 50 years old.

When a women becomes menopausal, estrogen supplementation is considered. Menopausal hormone therapy (previously referred to as hormone replacement therapy or HRT) has been shown to prevent bone loss, increase bone density, and prevent bone fractures. It is useful in preventing osteoporosis in postmenopausal women.

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

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