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About 10 million Americans have osteoporosis, and 44 million people who have low bone density are at risk for the condition, according to the National Osteoporosis Foundation. Osteoporosis can have serious ramifications, since it results in poor bone quality that increases the risk for fractures. Therefore, it’s important to know how to make bones strong—osteoporosis is preventable and manageable with lifestyle-based strategies and medications if needed.
What Puts You at Risk for Osteoporosis?
Age makes us susceptible to osteoporosis because as we get older bone remodeling (the constant breakdown of old bone and rebuilding of new bone) shifts out of balance, and more bone is broken down than is rebuilt. Gender is also key: in women, the drop in estrogen levels that accompanies menopause inhibits the formation of new bone. Other risk factors include:
- A family history of osteoporosis.
- Sustaining a minimal trauma fracture (for example, a fracture due to a fall) after age 50.
- Certain comorbidities, including overactive thyroid, and gastrointestinal conditions that impede the absorption of calcium, such as Crohn’s disease and ulcerative colitis (studies suggest that as many as 30 to 60 percent of people with Crohn’s and ulcertaive colitis have low bone density).
- Taking medications that can weaken bones. For example, corticosteroids such as prednisone, and proton pump inhibitors (PPIs, which are used to treat gastroesophageal reflux disease). Some studies also suggest that a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) may affect bone density, but the risk is small and needs to be set against the benefits of taking SSRIs to treat depression.
- Lifestyle factors. You’re at greater risk for osteoporosis if your diet doesn’t contain enough calcium, you drink more than two alcoholic beverages per day (alcohol impedes the absorption of calcium from food), you smoke, and/or you lead a sedentary lifestyle.
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Men Are Not Immune
“Older women are more likely to develop osteoporosis, but older men are by no means immune from the disease,” Dr. Ali notes. “They also tend to go undiagnosed, since they are less likely than women to be referred for bone density screening.” Risk factors that make men vulnerable include having female relatives with osteoporosis or parents who suffered a hip fracture, along with taking steroids or prostate cancer drugs, gastrointestinal diseases, and excessive alcohol consumption.
Calcium Helps Build Bones
Ensure that your diet supports your bones by consuming plenty of calcium. Not only does this mineral help build bones, it also helps the heart, muscles, and nerves function properly. If you don’t get enough of it, your body will take calcium from your bones to compensate.
The recommended daily calcium intake for women age 51 and older is 1,200 milligrams (mg)—men in this age range should aim to consume 1,000 mg, and increase their intake to 1,200 mg when they reach age 70. Dietary sources of calcium include milk, low-fat cheese, and yogurt. In a recent study (Osteoporosis International, May 1) of more than 4,000 adults age 60 and older, eating yogurt every day was linked to a 39 percent lower risk for osteoporosis in women and a 52 percent lower risk in men, compared with participants who never ate yogurt. “While the study doesn’t prove cause-and-effect, yogurt is a good source of calcium and vitamin D, along with other nutrients,” says Dr. Ali. “But be sure to choose brands that are low in sugar.”
Calcium also is present in fortified cereals and juices, leafy green vegetables, canned fish (particularly if you eat the soft bones), and tofu prepared with calcium sulfate. It is best to try to meet your daily calcium quota via dietary sources, since some research has linked calcium supplements to a small increase in the risk for heart attack and stroke. However, people with osteoporosis should continue to take calcium supplements if advised to do so by their doctors.
Vital Vitamin D
“You also need to get sufficient vitamin D, which helps the body absorb calcium from the food you eat,” says Dr. Ali. The recommended daily amount to prevent osteoporosis and falls is 800-1,000 international units (IUs), which you can get with 15 minutes of sun exposure (sunlight stimulates vitamin D synthesis in the body). Vitamin D also can be obtained via fatty fish (salmon, trout, mackerel, tuna), fortified milk, cereals and juices, and eggs. “If you live in an area where sunlight is scarce during the winter, a daily supplement can help boost vitamin D levels,” Dr. Ali adds. “Choose a D3 supplement—also called cholecalciferol—since D3 has a longer duration of action.”
How to Make Bones Strong With Weight-Bearing Exercise
Weight-bearing exercise (activities that force you to work against gravity, supporting your own body weight) also strengthens bones because it places them under stress, which stimulates remodeling. Examples include lifting weights, and walking. Also consider yoga—a 2016 study (Topics in Geriatric Rehabilitation, April) suggested that it may be beneficial for bone density. Among 227 participants, average age 60, those who practiced yoga at least every other day for two years had increased bone density in their spines and hips. The study participants cycled through 12 yoga poses in 12 minutes, which could be a challenge for some people, but your bones also may benefit from a slower routine. If you aren’t accustomed to yoga, your local senior center or YMCA likely offers sessions. If you’ve been diagnosed with osteoporosis, tell the instructor, since some poses may not be suitable for you.
The American College of Physicians recently updated its guidelines (Annals of Internal Medicine, May 9) for the management of osteoporosis to state that women and men who are diagnosed with the disease should be offered bisphosphonate drugs to reduce their risk for hip and vertebral fractures.
“Bisphosphonates preserve bone strength by inhibiting bone breakdown,” Dr. Ali explains. “The drugs accumulate in the bones, so many doctors suggest that you take them for five years and then stop.” In some cases, it may be advisable to continue taking bisphosphonates past five years—talk to your doctor about which approach is best for you. Also tell your doctor if you regularly take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (Advil®, Motrin®), as these can raise the risk for gastric ulcers if you take them while taking bisphosphonates.