Osteoporosis Prevention: Strategies for Maintaining Strong, Healthy Bones

A variety of preventive health strategies helps slow and lessen the effects of osteoporosis, the natural weakening of bones that occurs as we age and can result in debilitating injuries when coupled with accidental falls.

The Extent of the Disease

According to the National Osteoporosis Foundation (NOF), osteoporosis is a major public health threat for an estimated 44 million Americans. That is 55 percent of the 50 and over population. With the average age of Americans continuing to increase, the impact of osteoporosis is rising. Already it accounts for an estimated 1.5 million fractures a year—primarily involving the hip, vertebral and wrist bones.

About 10 million Americans already have the disease and an estimated 34 million have low bone mass, increasing their risk for osteoporosis. The NOF reports that the monetary cost of this disease was estimated between $12 and $18 billion in 2002—not counting decreased productivity.

After the age of 50, women have a 50 percent chance of suffering an osteoporosis fracture. The risk increases dramatically after the first occurrence. While less likely to suffer an osteoporosis-related fracture, men have a higher incidence of mortality within one year after a fracture than women.

Prevention and Treatment Options

The cost of osteoporosis can be high, so the benefit of preventing and treating the disease can be great. Here are some leading options:

Medications: Current osteoporosis drugs block the effect of bone-destroying cells that increase in number as we get older. The FDA is reviewing a new experimental compound—Denosumab—that, in contrast, helps prevent the formation of the harmful cells in the first place.

Time magazine in a December 8, 2009 article, “Top 10 Medical Breakthroughs,” states that two studies have shown Denosumab to be effective in preventing fractures in the two largest at-risk populations for osteoporosis, postmenopausal women and men in treatment for prostate cancer. Research, though, has yet to show how effective it is compared to osteoporosis drugs already on the market, such as Fosamax, Boniva, Actonel and Reclast.

These products belong to a group of drugs called bisphosphonates. According to the Mayo Clinic, these drugs, much like the female hormone estrogen, can inhibit bone breakdown, preserve bone mass, and even increase bone density in the spine and hip, reducing the risk of fractures.

Other drugs include Raloxifene (Evista), which also mimics estrogen’s positive effects on bone density; Calcitonin, a hormone produced by the thyroid gland that may slow bone loss; Teriparatide (Forteo), a powerful drug that stimulates new bone growth.

Talk with your physicians about these drugs, their benefits and their side effects to help determine if any may be effective and safe for you.

Hormone therapy: Estrogen therapy is generally not the first choice for maintaining bone density due to the availability of other options and the increased risk of blood clots, breast and endometrial cancer, and heart disease.

Diet: The amount of calcium our bones require from food and supplements changes as we age, according to the Institute of Medicine (IOM). It rises from 210 to 270 milligrams a day during the first year of life and peaks at 1,300 mg. from ages 9 to 18 before declining to 1,000 mg. from 19 to 50 and rising to 1,200 at age 51 and up.

Natural sources are dairy products, almonds, broccoli, spinach, cooked kale, canned salmon with the bones, sardines and soy products. Those who have trouble getting adequate calcium from their diet may consider supplements, but the IOM recommends limiting total calcium intake to 2,500 mg. a day.

Vitamin D is also essential to bone health. Many people get adequate amounts from sunlight. But that is not always possible in high latitudes or if you are housebound, regularly use sunscreen or stay out of the sun to reduce risk of skin cancer. Vitamin D is available in oily fish and egg yolks. If this does not provide enough, a good alternative is Vitamin D supplements or calcium supplements that include vitamin D.

Related to what you put in your body: do not smoke and limit alcohol consumption. Smoking increases bone loss as it may inhibit production of estrogen and reduce absorption of calcium in the intestine. Consumption of more than two alcoholic drinks a day may decrease bone formation and reduce calcium absorption.

Physical therapy and exercise: Often used in combination with medications and other therapies, physical therapy can help improve bone strength, posture, muscle strength and balance--and make falls less likely. Exercise also reduces risk of falling. A lifetime of exercise is the ideal, but you can realize benefits no matter when you start (however, see your doctor before you do begin). For the best overall benefit, combine weight-bearing exercises, such as walking, and strength training with weights.

Preventing falls: In addition to exercise, you can reduce the risk of falls and broken bones by taking steps toward making your or your loved one’s home safer (see related article, “Turn Home Sweet Home into Home Safe Home,” for greater detail on fall prevention). This can start by checking for and removing hazards such as electrical cords, area rugs and slippery surfaces that might cause trips or falls. Also, improve lighting around your home and outside areas such as pathways or sidewalks.