Lifestyle Changes:

Healthy lifestyle habits, including adequate intake of calcium and vitamin D, are important for preventing osteoporosis and are also a useful accompaniment to medical treatment.

Calcium and Vitamin D

A combination of calcium and vitamin D can reduce the risk of osteoporosis. (For strong bones, people need enough of both calcium and vitamin D.) The National Osteoporosis Foundation (NOF) recommends:

• Adults under age 50 should have 1,000 mg of calcium and 400 - 800 IU of vitamin D daily.
• Adults age 50 and older should have 1,200 mg of calcium and 800 - 1,000 IU of vitamin D daily.

Dietary Sources. Good dietary sources of calcium include:

• Milk, yogurt, and other dairy products
• Dark green vegetables such as collard greens, kale, and broccoli
• Sardines and salmon with bones
• Calcium-fortified foods and beverages such as cereals, orange juice, soymilk

Certain types of foods can interfere with calcium absorption. These include foods high in oxalate (such as spinach and beet greens) or phytate (peas, pinto beans, navy beans, wheat bran). Diets high in animal protein, sodium, or caffeine may also interfere with calcium absorption.

Dietary sources of vitamin D include:

• Fatty fish such as salmon, mackerel, and tuna
• Egg yolks
• Liver
• Vitamin D-fortified milk, orange juice, soymilk, or cereals

However, many Americans do not get the vitamin D they need from diet or exposure to sunlight.

Supplements. Adults who consume adequate amounts of calcium through dietary sources may not need to take a supplement. Many require vitamin D, particularly if they do not get enough exposure to sunlight. Vitamin D is made in the skin using energy from the ultra-violet rays in sunlight. Because sun exposure increases the risk for skin cancer and premature skin aging, many Americans restrict their sunlight exposure. People's vitamin D levels decline as they age.

Calcium and vitamin D supplements can be taken as separate supplements or as a combination supplement. If taken separately, the supplements do not need to be taken at the same time.

• Calcium supplements include calcium carbonate (Caltrate, Os-Cal, Tums), calcium citrate (Citracal), calcium gluconate, and calcium lactate. Although each kind provides calcium, they all have different calcium concentrations, absorption capabilities, and other actions.
• Vitamin D is available either as D2 (ergocalciferol) or D3 (cholecalciferol). Both work equally well for bone health.

Both calcium and vitamin D supplements can increase the risks for kidney stones. If you have a history of kidney stones, discuss with your doctor whether these supplements are appropriate for you.

Calcium supplements can also have other side effects and drug interactions:

• Some people may experience gas, bloating, or constipation. These effects can usually be relieved by increasing fluid and fiber consumption.
• Calcium supplements can interfere with the actions of certain medications such as tetracycline antibiotics, thyroid hormone, and proton pump inhibitors. Iron supplements should not be taken at the same time as calcium supplements.

Exercise

Exercise is very important for slowing the progression of osteoporosis. Although mild exercise does not protect bones, moderate exercise (more than 3 days a week for more than a total of 90 minutes a week) reduces the risk for osteoporosis and fracture in both older men and women. Exercise should be regular and life-long. Before beginning any strenuous exercise program, older patients or those who have serious medical conditions should talk to their doctors.

Specific exercises may be better than others:

• Weight-bearing exercise applies tension to muscle and bone and, in young people, can increase bone density by as much as 2 - 8% a year. In premenopausal women these exercises are very protective. Careful weight training is also very beneficial for middle-aged and older people, especially women.
• Regular brisk long walks improve bone density and mobility. Most older individuals should avoid high-impact aerobic exercises (step aerobics), which increase the risk for osteoporotic fractures. Although low-impact aerobic exercises such as swimming and bicycling do not increase bone density, they are excellent for cardiovascular fitness and should be part of a regular regimen.
• Exercises specifically targeted to strengthen the back may help prevent fractures later on in life and can be beneficial in improving posture and reducing kyphosis (hunchback), even in people with existing severe conditions.
• Low-impact exercises that improve concentration, balance, and strength, particularly yoga and tai chi, may help to decrease the risk of falling.

Exercise plays an important role in the retention of bone density in the aging person. Studies show that exercises requiring muscles to pull on bones cause the bones to retain and possibly gain density.

Other Lifestyle Factors

Other lifestyle changes that can help prevent osteoporosis include:

• Limit alcohol consumption. Excessive drinking is associated with brittle bones.
• Limit caffeine consumption. Caffeine may interfere with the bodyâ ' s ability to absorb calcium.
• Quit smoking. The risk for osteoporosis from cigarette smoking appears to diminish after quitting.

Preventing Falls and Fractures

An important component in reducing the risk for fractures is preventing falls. Risk factors for falling include:

• Slow walking
• Inability to walk in a straight line
• Certain medications (such as tranquilizers and sleeping pills)
• Low blood pressure when rising in the morning
• Poor vision

Recommendations for preventing falls or fractures from falls in elderly people include:

• Exercise to maintain strength and balance if there are no conflicting medical conditions.
• Do not use loose rugs on the floors.
• Move any obstructions to walking, such as loose cords or very low pieces of furniture, away from traveled areas.
• Rooms should be well lit.
• Have regular eye checkups.
• Consider installing grab bars in bathrooms especially near shower, tub, or toilet.