Adequate intake of Vitamin D and calcium
The
National Osteoporosis Foundation advises all individuals to obtain an
adequate intake of dietary calcium (at least 1200 mg per day, including
supplements if necessary) and vitamin D (400 to 800 IU per day for
individuals at risk of deficiency). An adequate intake of calcium is
necessary for the acquisition of peak bone mass and maintenance of bone
health.
The skeleton contains 99% of the body's calcium
stores. When the exogenous supply of calcium is inadequate, bone
calcium is resorbed from the skeleton to maintain serum calcium at a
constant level. Controlled clinical trials have demonstrated that the
combination of supplemental calcium and vitamin D can reduce the risk
of fracture. Providing adequate daily calcium and vitamin D is a safe
and inexpensive way to help reduce fracture risk.
Regular weight-bearing exercise
A
regular program of weight-bearing and muscle-strengthening exercises is
advised to reduce the risk of falls and fractures. Among its many
health benefits, weight-bearing and muscle-strengthening exercise can
improve agility, strength, and balance, which may reduce the risk of
falls. In addition, weight-bearing exercise has been shown to increase
bone density. Weight-bearing exercise (in which bones and muscles work
against gravity as the feet and legs bear the body's weight) includes
walking, jogging, Tai-Chi, stair climbing, dancing, and tennis. Muscle
strengthening includes weight lifting and other resistive exercises.
Before an individual with osteoporosis initiates a new vigorous
exercise program, such as osteoporosis rehabilitation or weight
lifting, an evaluation by a physician and physical therapist is
recommended.
Avoidance of tobacco use and excessive alcohol intake
All
patients at risk of osteoporosis should avoid tobacco smoking. The use
of tobacco products is detrimental to the skeleton as well as to
overall health. Moderate alcohol intake has no known negative effect on
bone and may even be associated with slightly higher bone density and
lower risk of fracture in postmenopausal women. However, excessive
alcohol intake is detrimental to bone health and requires treatment
when identified.
Pharmacologic therapy
The FDA
has approved several medications for the prevention and/or treatment of
osteoporosis. Generally speaking, pharmacologic therapy is initiated in
patients with a bone mineral density (BMD) T-score below -1.5. These
results are available from your bone densitometry (DEXA) scan.
Fosamax
and Actonel are two common medications prescribed for osteoporosis.
Fosamax reduces the incidence of spine, hip and wrist fractures by
about 50% over 3 years. Actonel reduces the incidence of spine
fractures by 41-49% and non-spine fractures by 36% over 3 years in
patients with a prior spine fracture. Clinical experience suggests that
some patients may experience upper gastrointestinal disorders such as
dysphagia, esophagitis, and esophageal or gastric ulcer with these
medications. Fosamax and Actonel must be taken on an empty stomach,
first thing in the morning, with 8 ounces of water (no other liquid),
at least 30 minutes before eating or drinking. Patients should remain
upright (sitting or standing) during this interval as well.
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