Preventing Osteoporosis

Protecting Your Bones for Life

Preventing osteoporosis is far easier than treating it. While you can’t control certain risk factors (age, gender, genetics), many powerful strategies are within your control. The actions you take now—whether you’re in perimenopause, early postmenopause, or many years beyond—directly affect your bone health and fracture risk for the rest of your life.

Calcium: The Building Block

Why Calcium Matters: 99% of your body’s calcium is stored in bones and teeth. Adequate calcium is essential for building and maintaining strong bones. If you don’t consume enough, your body takes calcium from bones (making them weaker) to maintain blood calcium levels needed for heart, muscles, and nerves.

How Much You Need

Age 40-50 (Premenopausal): 1000mg daily

Age 50+ (Postmenopausal): 1200mg daily

Why More After 50:

• Calcium absorption decreases with age
• Estrogen loss affects calcium metabolism
• Need more to maintain bone health

Best Food Sources (Preferred Over Supplements)

Dairy Products (Highest Amount, Best Absorbed):

• Milk: 300mg per cup (8 oz)
• Yogurt: 250-400mg per cup (Greek yogurt often has more)
• Cheese: 200-300mg per 1.5 oz (cheddar, mozzarella, Swiss)
• Cottage cheese: 125mg per ½ cup

Non-Dairy Sources:

• Fortified plant milk (almond, soy, oat): 300-450mg per cup (check label)
• Fortified orange juice: 300mg per cup
• Tofu (calcium-set): 250-750mg per ½ cup
• Canned salmon/sardines (with bones): 180-325mg per 3 oz
• Leafy greens:
  • Collard greens: 360mg per cup cooked
  • Turnip greens: 250mg per cup cooked
  • Kale: 180mg per cup cooked
  • Bok choy: 160mg per cup cooked
• Almonds: 75mg per ¼ cup
• White beans: 160mg per cup
• Figs (dried): 120mg per ½ cup

Why Food Is Better:

• Contains other nutrients that support bone health (protein, potassium, magnesium, vitamin K)
• Better absorbed than supplements
• Doesn’t increase kidney stone risk like high-dose supplements

Calcium Supplements (If Needed)

When to Supplement: If you can’t get 1200mg daily from food (many women can’t), supplement the difference.

Calculate Your Needs: Track food intake for typical day. If getting 600mg from food, supplement with 600mg.

Types:

Calcium Carbonate:

• Contains most elemental calcium (40%)
• Least expensive
• Best absorbed with food (needs stomach acid)
• May cause gas, bloating, constipation
• Brands: Tums, Os-Cal, Caltrate

Calcium Citrate:

• Contains less elemental calcium (21%)
• More expensive
• Absorbed with or without food
• Better tolerated (less GI side effects)
• Better for people over 50, those on acid-reducing medications
• Brands: Citracal

Which to Choose: Calcium citrate is generally preferred for postmenopausal women (better absorbed, fewer side effects), but carbonate is fine if well-tolerated and taken with food.

How to Take Calcium Supplements

Divide Doses:

• Your body can only absorb about 500mg at once
• If taking 1000mg supplement, split into 500mg twice daily
• Take smaller doses throughout day for best absorption

Timing:

• Carbonate: With meals
• Citrate: Any time

Don’t Take With:

• Iron supplements (each interferes with the other’s absorption—take several hours apart)
• High-fiber foods (fiber reduces absorption—take between meals if high fiber diet)

Take With:

• Vitamin D (helps calcium absorption)
• Food (if calcium carbonate)

Don’t Overdo It

Maximum: 2000-2500mg daily from all sources (food + supplements)

Risks of Too Much:

• Kidney stones (especially with high-dose supplements)
• Constipation
• Possible increased cardiovascular risk (controversial—primarily concern with high-dose supplements, not food sources)
• Interferes with absorption of other minerals

Balance Is Key: Get as much as possible from food (up to 1200mg), supplement moderately if needed. More isn’t better beyond 1200mg.

Vitamin D: The Calcium Helper

Why Vitamin D Matters: Without adequate vitamin D, you only absorb 10-15% of calcium you consume. With sufficient vitamin D, absorption increases to 30-40%. Vitamin D is essential for bone health.

How Much You Need

Age 40-70: 600 IU daily (minimum)

Age 70+: 800 IU daily (minimum)

Many Experts Recommend More: 800-1000 IU daily for all adults, especially those at risk for deficiency.

Upper Limit: 4000 IU daily (don’t exceed without medical supervision)

Sources

Sunlight:

• Skin produces vitamin D when exposed to UVB rays
• 10-30 minutes midday sun exposure several times weekly (without sunscreen, exposing arms and legs)
• Problem: Many factors reduce production (age, dark skin, northern latitudes, winter, sunscreen use, indoor lifestyle)
• Postmenopausal women produce less vitamin D from sun than younger people
• Can’t rely on sun alone, especially in winter

Food Sources (Limited):

• Fatty fish: Salmon (450 IU per 3 oz), mackerel, sardines
• Fortified milk: 100 IU per cup (not enough alone)
• Fortified orange juice, plant milks, yogurt: 100-150 IU per serving
• Egg yolks: 40 IU per egg
• Fortified cereal: varies, check label
• Mushrooms (UV-treated): varies widely

Difficult to Get Enough from Food: Would need to eat salmon daily to meet needs from food alone.

Vitamin D Supplements

Most Women Need Supplements: Especially postmenopausal women, those in northern climates, darker skin, limited sun exposure.

Forms:

• Vitamin D3 (cholecalciferol): Preferred—better absorbed, raises blood levels more effectively
• Vitamin D2 (ergocalciferol): Plant-derived, less effective

How to Take:

• Take with meal containing fat (fat-soluble vitamin—absorbed better with dietary fat)
• Can take daily dose all at once
• Often combined with calcium in single supplement

Check Your Level

Blood Test: 25-hydroxyvitamin D level

Optimal Range:

• Sufficient: 30-50 ng/mL (75-125 nmol/L)
• Insufficient: 20-30 ng/mL
• Deficient: Below 20 ng/mL

Who Should Be Tested:

• All postmenopausal women (high deficiency rates)
• Anyone with osteoporosis or osteopenia
• Limited sun exposure
• Dark skin
• Malabsorption disorders

If Deficient: May need high-dose supplementation initially (50,000 IU weekly for 8-12 weeks) then maintenance dose.

Weight-Bearing and Muscle-Strengthening Exercise

Most Important Modifiable Factor: Exercise is one of the most powerful tools for maintaining bone density and preventing fractures.

Why Exercise Matters

Builds and Maintains Bone: Bones respond to physical stress by becoming stronger (like muscles). Weight-bearing stress stimulates bone formation.

Improves Balance and Coordination: Reduces fall risk—preventing falls prevents fractures.

Builds Muscle Strength: Strong muscles support and protect bones, improve balance.

Slows Bone Loss: Exercise reduces rate of bone loss after menopause.

Weight-Bearing Exercise

What It Is: Activities where your bones support your body weight against gravity.

High-Impact (Best for Bones):

• Jogging, running
• Jumping rope
• Dancing
• High-impact aerobics
• Hiking
• Stair climbing
• Tennis, racquetball
• Basketball, volleyball

Low-Impact (Still Beneficial, Safer for Some):

• Brisk walking
• Low-impact aerobics
• Elliptical machine
• Stair-step machine

NOT Weight-Bearing (Good for Heart/Health But Don’t Build Bone):

• Swimming
• Cycling
• Water aerobics

How Much:

• 30-60 minutes most days of the week
• Variety is good
• If you can only do low-impact, that’s better than nothing

Getting Started:

• Start slowly if sedentary
• Walking is accessible for most people
• Gradually increase intensity and duration
• Make it enjoyable so you’ll stick with it

Muscle-Strengthening (Resistance) Exercise

What It Is: Activities that make muscles work against resistance—weights, resistance bands, or body weight.

Why It Matters:

• Builds muscle mass (which declines with age)
• Increases bone density, especially in spine and hips
• Improves posture
• Increases metabolism

Types:

• Free weights (dumbbells)
• Weight machines
• Resistance bands
• Body weight exercises (push-ups, squats, lunges, planks)
• Functional activities (lifting, carrying, climbing)

How Much:

• 2-3 days per week (minimum)
• Major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms)
• 8-12 repetitions, 2-3 sets
• Allow rest day between sessions for muscle recovery

Getting Started:

• Consider working with trainer or physical therapist initially to learn proper form
• Start with light weights, master technique, gradually increase weight
• Many exercises can be done at home with inexpensive equipment

Balance and Flexibility Exercises

Why Important: Improve balance and prevent falls—critical for fracture prevention.

Types:

• Tai chi (excellent for balance)
• Yoga
• Standing on one foot
• Heel-to-toe walk
• Balance exercises (stand on unstable surface like foam pad)
• Stretching

How Much:

• Several times per week
• 10-15 minutes daily if possible

Exercise Safety

If You Have Osteoporosis:

• Avoid high-impact activities (may cause fracture)
• Avoid forward bending or twisting at waist (spine fracture risk)
• Avoid activities with fall risk
• Focus on low-impact weight-bearing, strength training, and balance exercises
• Consult physical therapist for safe exercise program

If You Haven’t Exercised Recently:

• Start slowly
• Get provider clearance if health concerns
• Gradually increase intensity and duration
• Listen to your body

Don’t Smoke

Smoking Is Terrible for Bones:

• Decreases estrogen levels
• Interferes with calcium absorption
• Decreases blood flow to bones
• Toxic to bone-forming cells
• Increases fracture risk by 30-40%

Benefits of Quitting:

• Bone health begins improving immediately
• Within 10 years, fracture risk approaches that of never-smokers
• It’s never too late to quit

Resources to Quit:

• Medications (varenicline, bupropion, nicotine replacement)
• Counseling
• Quitlines (1-800-QUIT-NOW in US)
• Support groups
• Talk to your provider

Limit Alcohol

Moderate Alcohol (1 Drink Daily): May not harm bones and might even have small benefit.

Excessive Alcohol (More Than 2 Drinks Daily):

• Interferes with calcium absorption and vitamin D metabolism
• Toxic to bone-forming cells
• Increases fracture risk (from bone weakness plus increased falls)
• Disrupts hormone balance

Recommendation:

• Maximum 1 drink daily for women
• If you don’t drink, don’t start for bone health

What’s a “Drink”:

• 12 oz beer (5% alcohol)
• 5 oz wine
• 1.5 oz liquor (80 proof)

Maintain Healthy Weight

Underweight Is a Risk Factor:

• BMI under 19
• Body weight under 127 lbs
• Less mechanical stress on bones
• Often associated with inadequate nutrition
• Lower estrogen production (fat tissue produces estrogen after menopause)

Excessive Weight Loss:

• Rapid weight loss causes bone loss
• Eating disorders (anorexia) severely damage bones

Obesity:

• While higher body weight protects bones somewhat, obesity has many health risks
• Goal: healthy weight range (BMI 18.5-24.9)

Bottom Line:

• Don’t be underweight
• If need to lose weight, do so gradually with adequate calcium/vitamin D and resistance exercise to minimize bone loss

Medications That Affect Bones

Medications That Weaken Bones

Corticosteroids (Prednisone, Others):

• Most significant medication risk
• Even low doses (5-7.5mg daily) for 3+ months cause bone loss
• If must take long-term: extra attention to calcium/vitamin D, bone density monitoring, possible preventive medication

Other Medications:

• Some anti-seizure medications (phenytoin, phenobarbital)
• Some cancer treatments (aromatase inhibitors, chemotherapy)
• Proton pump inhibitors/PPIs (long-term use may reduce calcium absorption—controversial)
• Excess thyroid hormone replacement
• Depo-Provera (birth control injection)
• Some antipsychotic medications

If Taking These:

• Don’t stop without discussing with provider
• Discuss bone health with provider
• Optimize calcium/vitamin D
• Consider bone density testing
• May need medication to protect bones

Hormone Replacement Therapy (HRT)

HRT Protects Bones:

• Prevents postmenopausal bone loss
• Reduces fracture risk by 30-40%

Consider HRT If:

• Moderate to severe menopause symptoms
• Early menopause (before 45)
• High fracture risk

Not Recommended for Osteoporosis Treatment Alone: Other medications more appropriate for treating established osteoporosis (but HRT prevents bone loss if using for symptoms).

When Stopped: Bone loss resumes at menopause rate. Protective effect ends.

Fall Prevention

Why Critical: Most fractures occur from falls. Preventing falls prevents fractures.

Home Safety

Reduce Hazards:

• Remove throw rugs or secure with non-slip backing
• Improve lighting (especially stairs, hallways, bathrooms)
• Install handrails on both sides of stairs
• Add grab bars in bathroom (shower, tub, near toilet)
• Keep floors clear of clutter, cords, pets
• Secure loose carpeting
• Use non-slip mats in tub/shower
• Keep frequently used items at waist level (avoid reaching or bending)
• Consider raised toilet seat

Personal Factors

Vision:

• Annual eye exams
• Update glasses prescription
• Treat cataracts, glaucoma
• Adequate lighting

Footwear:

• Supportive, low-heeled shoes with non-slip soles
• Avoid walking in socks or slippery shoes
• Replace worn shoes

Assistive Devices:

• Use cane or walker if balance issues
• Ensure properly fitted and used correctly

Medications:

• Some medications increase fall risk (sedatives, blood pressure meds causing dizziness, sleep aids)
• Review medications with provider
• Don’t stop on your own, but discuss alternatives

Chronic Conditions:

• Treat conditions affecting balance (arthritis, Parkinson’s, neuropathy, low blood pressure)

Balance and Strength

• Balance exercises (see exercise section)
• Tai chi (highly effective for fall prevention)
• Strength training (strong muscles protect against falls)

Dietary Considerations

Protein:

• Important for bone health and muscle strength
• 1-1.2 g per kg body weight daily (about 70-90g for average woman)
• Include protein at each meal

Vitamin K:

• Supports bone health
• Found in leafy greens, broccoli, Brussels sprouts
• Eat variety of vegetables

Magnesium:

• Supports bone health and vitamin D metabolism
• Found in nuts, seeds, whole grains, leafy greens, beans
• Most people get enough from diet

Phosphorus:

• Essential for bones
• Found in many foods (meat, dairy, nuts, whole grains)
• Deficiency rare; excess (from cola sodas) may be harmful

Sodium:

• Excess salt increases calcium loss in urine
• Limit processed foods high in sodium

Caffeine:

• Modest intake (2-3 cups coffee daily) okay
• Excessive caffeine may increase calcium loss slightly

Alcohol:

• Limit to 1 drink daily (see above)

Avoid Extreme Diets:

• Very low-calorie diets cause bone loss
• Diets excluding entire food groups risk nutrient deficiencies

Special Situations

Celiac Disease, Inflammatory Bowel Disease: Malabsorption affects calcium/vitamin D absorption. Need higher doses, close monitoring.

Lactose Intolerance: Use lactose-free milk, calcium-fortified alternatives, non-dairy calcium sources, supplements.

Vegan Diet: Extra attention to calcium (fortified foods, supplements), vitamin D, protein. Very achievable but requires planning.

Chronic Kidney Disease: Special considerations for calcium, vitamin D, phosphorus. Follow nephrologist’s recommendations.

Putting It All Together: Your Bone Protection Plan

Daily:

• 1200mg calcium (food preferred, supplement if needed)
• 800-1000 IU vitamin D (supplement likely needed)
• Weight-bearing exercise (30-60 minutes)

2-3 Times Weekly:

• Strength/resistance training
• Balance exercises

Lifestyle:

• Don’t smoke (quit if you smoke)
• Limit alcohol (max 1 drink daily)
• Maintain healthy weight
• Fall-proof your home

Medical:

• Bone density screening at 65 (earlier if risk factors)
• Discuss medications affecting bones with provider
• Consider HRT if appropriate

Track Progress:

• Food diary to ensure adequate calcium/vitamin D
• Exercise log to stay consistent
• Follow-up DEXA scans to monitor bone density

The Bottom Line

Prevention Is Powerful: Actions you take now directly affect your bone health for rest of your life. It’s never too late to start protecting your bones.

Key Strategies:

• Calcium 1200mg daily (food preferred)
• Vitamin D 800-1000 IU daily (supplement likely needed)
• Weight-bearing and strength training exercise (most important modifiable factor)
• Don’t smoke, limit alcohol
• Prevent falls (home safety, balance exercises)

Start Today: Every day you implement these strategies is a day you’re protecting your bones and reducing fracture risk.

Be Consistent: Bone health is lifelong commitment. One glass of milk or one walk doesn’t matter—consistent daily habits make the difference.

You Have Control: While you can’t control age or genetics, you control calcium intake, vitamin D, exercise, smoking, alcohol—all powerful tools for bone health.

Invest in Your Future: Strong bones mean independence, mobility, and quality of life in your 70s, 80s, and beyond. The effort you invest now pays dividends for decades.