When it comes to preventing and managing osteoporosis, most of us need to improve
By Natasha Persaud
Many people dismiss osteoporosis as a natural consequence of aging. In fact, this degenerative disease, which can lead to devastating injuries such as hip fractures, can be prevented and managed effectively—if you take the necessary steps.
While building strong bones begins in childhood, it’s important to continue with a healthy diet, exercise and, if your doctor determines that you will benefit, medication to keep your bones strong.
Here, we share insights and tips from the National Osteoporosis Foundation’s (NOF) 8th International Symposium on Osteoporosis.
Supplement Savvy: Calcium and Vitamin D
"Trying to build bone without calcium is like trying to build a brick wall without bricks. It’s that essential to your health," says Deborah T. Gold, Ph.D., associate professor of Medical Sociology at Duke University Medical Center in Durham, North Carolina and chair of the 2009 NOF symposium. "And vitamin D is the mortar that enables calcium to work effectively. When you’re getting enough calcium and vitamin D, you’re building up your bone bank. It’s easier to make these deposits throughout your life than to have to deal with brittle bones later on."
If you’re like most men and women, you’re probably not getting enough of either calcium or vitamin D. "Most people overestimate what they’re getting from foods such as milk, cheese, fortified orange juice and cereal," says Gold. Adults age 50 and older typically consume about 600 to 700 milligrams (mg) of calcium from foods.
Daily Recommendations for Calcium and Vitamin D
- Adults under age 50 need 1,000 mg of calcium and 400 to 800 IU of vitamin D daily.
- Women 50 and over (and men over 71) need 1,200 mg of calcium and 800 to 1,000 IU of vitamin D daily.
Most people in the United States get far less than the recommended amount of vitamin D.
Types of Calcium Supplements
The NOF suggests taking a calcium supplement to bridge the gap. Calcium supplements come in two forms:
- calcium citrate
- calcium carbonate*
*You can take calcium citrate at any time, but calcium carbonate should be taken with food.
Get the Right Dose at the Right Time
"Calcium needs to be taken no more than 500 milligrams at a time to be properly absorbed," says Gold. "That means you can’t just take a supplement once a day."
And find an easy way to remind yourself to take your calcium. "I place my supplement bottles next to my toothbrush to remind myself to take calcium twice a day; other people may put their supplements on the kitchen counter or in the car as a reminder to take calcium with meals or with a bottle of water," says Gold.
The NOF also recommends that adults take a daily vitamin D supplement, if an adequate amount isn’t included with your calcium supplement or your daily multivitamin. Few foods naturally contain vitamin D, although egg yolks, salt-water fish and liver have some. "Cod liver oil, which your mother probably gave you when you were a child, is a surprisingly good source of D," says Gold.
"Our bodies also have some ability to produce D from sunlight but most of us in the United States live at latitudes that offer insufficient levels of sunlight. Plus, many of us shun the sun to avoid skin cancer. For all those reasons, men and women under age 50 should take 400 to 800 International Units (IU) of vitamin D daily, and those 50 and over, 800 to 1,000 IU. Someone who is vitamin D deficient may require more."
But don’t overdo these supplements, cautions Gold. Daily calcium intake generally shouldn’t exceed 2,000 to 2,500 mg because of the risk of kidney stones. Very high amounts of vitamin D can contribute to kidney stones and cardiovascular disease.
Exercise can go a long way toward keeping bones healthy and preventing a devastating fracture—but "you need to do the right mix of exercise to maintain muscle and bone strength, flexibility, coordination and balance," says Karen Kemmis, a physical therapist at SUNY Upstate Medical University in Syracuse, New York.
The following workout is based on the latest research, and it can help reduce your risk of osteoporosis and a debilitating fracture, according to Kemmis. Check with your health-care provider before starting the program.
- Weight-bearing activities: Get 150 minutes per week of moderate activity or 75 minutes a week of vigorous activity. How do you know that you’re exercising at the right intensity? During moderate-level activities, such as walking briskly, you’re breathing more heavily than normal, but you can still comfortably carry on a conversation with a person next to you. Your activity qualifies as vigorous if, while exercising, it’s difficult for you to sing a tune or carry on a conversation because you’re a bit short of breath.
- Resistance training: To maintain your bone strength, add in exercises that provide some type of resistance, such as the wall push up, biceps curl, overhead press, chest press, upright row and grip strength. You can use free weights, an exercise band or your own body weight as an opposing force. Do one to three sets of 8 to 12 repetitions each. For example, to do a biceps curl, hold a weight in your hand, then gently, with a controlled motion, lift the weight from your side up to your shoulder; next, lower the weight back down to the starting position. That’s one repetition. To maintain your bone strength, progress to heavier weights over time.
- Balance training: Most people over the age of 50 need to incorporate balance exercises into their workouts. Balance training helps you stay steady on your feet, reducing the risk of falling and incurring a fracture. To maintain your balance, perform these simple routines in your spare time—at least two to five minutes every day:
- Stand on one leg: Stand in front of a sturdy chair or a steady counter, hold on to it with one hand for support; lift one leg up behind you, and hold the position for 10 to 30 seconds. Release the pose, then repeat the exercise with the other leg.
- Walk the tightrope: Walk down a hallway in your home as if you were walking a tightrope. Hold your arms out to the side and step heel to toe down the entire length of the hallway, keeping your chin up and your eyes straight ahead.
Strengthen Your Heart and Your Bones
"You may be surprised to learn that popular activities that are great for your heart are less effective at preserving bone health," says Kemmis. "These include swimming, bicycling, using the elliptical machine or stationary bike or pushing pedals on a stair climber."
To improve both your heart health and your bone strength, perform activities where you’re truly bearing your weight. Try
- step aerobics
- jumping rope
At home, you can walk up and down stairs, march in place, dance or follow along with an exercise video that incorporates dancing or bounding.
If you enjoy taking classes, sign up for a well-rounded program that includes dancing or step aerobics, weight-training sessions and tai chi. Yoga and Pilates can help with strength, flexibility and balance, but if you have osteoporosis or if you’ve experienced a fracture, you would need to avoid certain poses that require you to twist or flex your spine in ways that can promote injury.
Keep Up With Your Osteoporosis Meds
"If you have osteoporosis and you’re on medication, it’s vital to continue taking it for as long as your doctor recommends," says Gold. There are more dosing options than ever, including oral medications you take daily, weekly or monthly; an injection you get every three months at your doctor’s office; or even an infusion that you get at an infusion center once a year. Still, one in two women fails to derive maximum benefits from their prescription medication because they don’t follow their treatment programs. This can lead to fracture, while following through with taking medicines can decrease fracture risk substantially.
There are many reasons people fail to continue treatment, says Gold. Since osteoporosis causes no symptoms until a fracture occurs, it’s easy for someone to ignore the disease. Other people may experience unpleasant side effects or have difficulty adhering to the complex dosing regimen and stop taking the medication. "If you’re experiencing gastrointestinal problems with oral bisphosphonates, ask your doctor if a longer dosing interval, the newer injectable, or the annual infusion might work for you."
It can be really motivating to see how complying with your treatment is protecting your bones. "Your doctor can order a biochemical marker test 90 days after you begin treatment to determine whether your medicine is working," says Gold. "The tests either measure bone formation or bone resorption, the rate at which bone is broken down. Your doctor should also order a bone mineral density test at least every two years."
Improve Your Posture
Take this simple test to make sure your posture is correct: Stand straight in a relaxed pose. Ask someone to look at you from the side: Your ear should be aligned with your shoulder, with your hip and with your knee in one long straight line.
"One in two women and one in four men age 50 and older experience an osteoporosis-related fracture in their lifetime, potentially resulting in disability and a poor quality of life," says Gold. "That’s more than the number of strokes, heart attacks or new cases of breast cancer that occur in the U.S. each year."
Make Your Home Accident-Proof
To reduce your risks of falls, stay active and get enough calcium and vitamin D from food and supplements. "The key is to stop the first fracture," says Kemmis. "Once you fracture, subsequent fractures are more likely to occur."
To make your home as safe as possible...
- Coil or tape cords and wires next to the wall so you can’t trip over them. Have an electrician put in another outlet if you’re stretching wires.
- Remove all loose rugs or use nonslip backing so the rugs won’t slip.
- Keep objects off the stairs and floor.
- Fix loose or uneven steps.
- Get a steady step stool with a bar to hold on to. Never use a chair as a step stool.
- Place a lamp close to the bed where it is easy to reach.
- Put a nonslip rubber mat or self-stick strips on the floor of the tub or shower.
- Have a handyman or a carpenter put in grab bars next to and inside the tub and next to the toilet.
- Improve the lighting in your home with brighter bulbs. You may want to buy compact fluorescent light bulbs; these cost less to use over their lifetime than traditional bulbs.
Adapted from Check for Safety by the Centers for Disease Control and Prevention.