Developing and maintaining healthy bones is a lifelong process. Since 90 percent of bone mass is developed by age 18 in women and age 20 in men, proper nutrition and sufficient calcium intake is extremely important in the early years of life. Maintaining calcium intake and vitamin D intake combined with an active lifestyle throughout the adult years also helps to prevent osteoporosis. Knowledge of osteoporosis’s risk factors and when to begin screening in later years allows for early detection and management of the disease with appropriate drug therapies.

Prevention

The most effective treatment for osteoporosis is preventing the disease’s development in the first place. Completely preventing this disease is not possible due to genetic risk factors, but a great deal can be done in terms of nutrition, exercise, and other health behaviors to reduce the risk of osteoporosis.

Prevention: Nutrition

Sufficient intake of calcium, protein, vitamin D, and various other nutrients in the younger years of life, especially during adolescence, is imperative for developing strong and healthy bones. This can be achieved in a variety of ways. The obvious solution is a balanced diet which includes dairy products, various greens, and fortified wheat products like whole grain breads and cereals.¹ Studies suggest that among children whose diets are otherwise nutritionally sound, protein may be the key factor in ensuring healthy bones later in life.²

One population at particular risk for insufficient bone development is adolescent female athletes. These young women, due to the demands of training for peak athletic performance, may suffer from Athletic Energy Deficit (AED). AED generally occurs when energy expenditure is not matched with sufficient nutritional intake, which may be the case in athletes. According to American Bone Health, this is of particular concern among female athletes because the body may compensate for reduced energy intake by shutting down certain systems associated with bone and reproductive health. Reduced estrogen levels associated with AED negatively impact bone health, as does a diet with restricted calcium and vitamin D intake. To learn more, please visit American Bone Health’s website at http://www.americanbonehealth.org/young-adults/about-aed.

As people enter adulthood and old age, the nutritional requirements for maintaining bone health increase. The National Osteoporosis Foundation recommends adults under 50 receive 1,000 milligrams of calcium and between 400-800 international units of vitamin D daily. Adults over 50 should increase this to 1,200 milligrams of calcium and 800-1,000 international units of vitamin D daily. Supplements may be necessary to meet these goals, especially for vitamin D, though care must be taken not to take in too much of these nutrients, as excessive calcium and vitamin D intake can cause health problems. More information on nutrition can be found at the National Osteoporosis Foundation’s website, http://www.nof.org/aboutosteoporosis/prevention/calcium. Studies show that even in populations who have passed the point of peak bone mass development, such as postmenopausal women, nutritional interventions to increase calcium and vitamin D intake can still improve bone mass density.³

Prevention: Exercise

Regular physical activity is another key component of osteoporosis prevention. According to a 2004 Surgeon General report on osteoporosis, increased levels of physical activity are associated with reduced fracture risk. Even moderate physical activity, such as walking, can reduce fracture risk by as much as 41 percent.⁴ Exercise is important at all ages and can make an appreciable difference even in those who have not been active in the past.

Childhood and adolescence are prime opportunities to develop bone health through physical activity. Studies show that regular exercise in this period of life improves the body’s ability to absorb calcium. Studies also show that exercise during puberty, when 20 to 30 percent of bone mass is developed, can make the body more receptive to hormones produced during this period of development, which in turn means stronger bones. This exercise and activity does not need to be anything complicated, and can involve everyday play activities such as running and jumping.⁵

In adulthood, exercise works to maintain the bone mass developed in youth. Studies in the Surgeon General report indicate that after age 30, the body loses up to five percent of its bone mass per year.⁶ Proper exercise can slow or stop this decline. The National Osteoporosis Foundation recommends an exercise routine that includes both weight-bearing and muscle-strengthening exercises to maintain bone density in adulthood. Weight-bearing exercises include jogging, stair-climbing, and tennis. Examples of muscle-strengthening exercises include lifting weights, using weight machines, or using your own body as a source of resistance by doing push-ups and sit-ups. Anyone who has multiple risk factors for osteoporosis should consult with a physical trainer to ensure an exercise routine does not involve any potentially harmful exercises. For more information on exercises to promote bone health, please visit the National Osteoporosis Foundation’s website at http://www.nof.org/aboutosteoporosis/prevention/exercise.

Seniors and the elderly can also benefit from exercise, even though people in this age demographic are at particularly high risk of osteoporosis. Low-impact weight-bearing exercises and light to moderate strength training can do a great deal to prevent fractures. Physical activity can also help mitigate a condition known as sarcopenia, or the involuntary loss of skeletal muscle mass. Although all people will experience sarcopenia to some degree as they age, the severity of the condition can be managed with an active lifestyle. The greater degree of mobility granted by this active lifestyle can also reduce the risk of falls, which are a major contributor to osteoporotic fractures, especially serious fractures of the hip.⁷

Treatment

Even if all of the above preventive measures are taken, the risk of osteoporosis cannot be totally eliminated. The fact remains that osteoporosis will affect one in two women and one in four men if current trends continue. This means people need to know about the treatments involved in managing osteoporosis.

It is important to note that treating osteoporosis involves more than treating the fractures that result from it. The weak, low-density bones which comprise the root cause of these fractures are the real target for treatment. The most common treatment for osteoporosis involves drug therapy, usually biphosphonates, calcitonin, estrogen, or some combination of the three, though other drugs may also be used.

Visit the National Osteoporosis Foundation or American Bone Health to learn more about the different drug options to treat osteoporosis.

One issue of significant concern in treating osteoporosis is ensuring that patients adhere to their medicine regimen. Medication to treat osteoporosis will not be effective if it is not used correctly and consistently. Studies estimate that between 20 and 30 percent of patients receiving the three most common osteoporosis medications (biphosphonates, raloxifene, or hormone replacement therapy) will cease taking their medicine within their first year of drug therapy, and between 25 and 50 percent of patients take their medications incorrectly. A variety of factors can explain this, including lack of patient knowledge about the importance of adherence, lack of follow-up by a healthcare professional to monitor adherence, difficulty in managing dosing requirements and instructions, side effects associated with osteoporosis medications, cost issues, or an overall lack of patient belief in the necessity of the treatment, to name a few.⁸

Osteoporosis can’t be treated if it’s not detected. Please visit the Screening section of the Policy Resource Center to learn more about screening for osteoporosis.

Sources:
1. Peters BSE, Martini LA. “Nutritional aspects of the prevention and treatment of osteoporosis.” Arquivos Brasileiros de Endocrinologia & Metabologia 54 No. 2 (2010): 179-185.
2. Libuda L, Wudy SA, Schoenau E, Remer T. “Comparison of the effects of dietary protein, androstenediol and forearm muscle area on radial bone variables in healthy prepubertal children.” British Journal of Nutrition 105 (2011): 428-435.
3. Moschonis G, Katsaroli I, Lyritis GP, Manios Y. “The effects of a 30-month dietary intervention on bone mineral density: The Postmenopausal Health Study.” British Journal of Nutrition 104 (2010): 100-107.
4. US Department of Health and Human Services. “Bone Health and Osteoporosis: A Report of the Surgeon General.” (2004): 126.
5. Ibid, 126-127.
6. Ibid, 127-128.
7. Ibid, 129.
8. Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD. “Patient Adherence to Osteoporosis Medications: Problems, Consequences and Management Strategies.” Drugs & Aging 24 Issue 1 (2007): 37-55.