Once you know you have osteoporosis, you have many options for treating the condition and strengthening your bones to prevent fractures. Talk to your doctor about what’s most likely to help you. You may try a few different approaches at once, including medications, changing your diet and exercise habits, and other lifestyle choices.
How Is Osteoporosis Diagnosed?
If your doctor thinks you might have osteoporosis, she may start by measuring your height to see if you’ve gotten shorter. The bones of the spine are often the first ones affected by the condition, which can change how tall you are.
Your doctor may also recommend a test to measure your bone density. One test called a DEXA scan is the most common tool used to measure bone density and diagnose bone loss and osteoporosis at an early stage. Quantitative computed tomography is another method, but it uses higher levels of radiation than other bone density tests. Ultrasound, which typically tests the heel of your foot, can also detect early signs of osteoporosis.
In addition to these bone density tests, your doctor might take blood or urine samples and test them to see if you have another disease that’s causing bone loss.
Although osteoporosis is sometimes diagnosed by accident after you’ve had an X-ray for a fracture or an illness, it’s not a very useful tool for early screening.
Medications for Osteoporosis
The goal of most osteoporosis medicines is to help your bones stay as strong as possible. But each of them works in different ways:
Raloxifene (Evista) is an osteoporosis treatment that acts like the hormone estrogen and can help maintain bone mass. But studies have shown that it doesn't have some of the downsides of estrogen, like increasing the risk of breast or uterine cancers. Evista often causes hot flashes and makes you slightly more likely to have blood clots.
Bisphosphonates, like risedronic acid (Actonel), alendronate (Binosto), ibandronic acid (Boniva), and alendronic acid (Fosamax), treat osteoporosis by keeping the body from breaking down bone. You take Actonel, Binosto, and Fosamax once a week while Boniva is taken once a month. If you take these medicines incorrectly, they can lead to ulcers in your esophagus, so it’s important to follow the instructions exactly.
Zoledronic acid (Reclast) is a once-yearly 15-minute infusion you get through a vein. It works similar to the way bisphosphonate drugs do, and is said to increase bone strength and reduce fractures in the hip, spine, wrist, arm, leg, or rib. The most common side effects include bone pain, nausea, and vomiting. People whose kidneys don’t work very well should avoid it or use it with caution.
Teriparatide (Forteo) treats osteoporosis in postmenopausal women and men who are more likely to get fractures. It’s a man-made form of the parathyroid hormone that your body produces, and is the first drug shown to make the body form new bone and increase bone mineral density. You take it as a daily injection for up to 2 years. Side effects include nausea, leg cramps, and dizziness.
Calcitonin is a naturally occurring hormone that stops bone loss. Its man-made form is available as a nasal spray or injection. It doesn’t work as well to prevent fractures as other available treatments. Side effects include nausea, runny nose from the nasal spray form, and skin irritation for the injection form.
Denosumab (Prolia) treats osteoporosis by interfering with the body's bone-breakdown process. It's the first biologic therapy to be approved for the condition. It's for women with a higher chance of fracture who’ve tried other osteoporosis drugs that have not worked. Side effects include pain in the back, arms, and legs.
Osteoporosis and Hormone Replacement Therapy (HRT)
The Women’s Health Initiative study found that while estrogen lowers women’s chances for fractures, it may make them more likely to have other health problems. Prempro, one type of combination hormone replacement therapy, was shown to increase some women’s chances of breast cancer, heart disease, and stroke. However, Premarin alone did not increase breast cancer risk.
So while HRT may help preserve bone and prevent fractures in postmenopausal women, your doctor may want you to use other medications first. Talk with your doctor about HRT and its benefits and risks.
Nutrition for Strong Bones
Your diet is an important part of treating and preventing osteoporosis, especially getting enough calcium to build and maintain strong bones. Eat plenty of calcium-rich foods, such as nonfat or low-fat milk, low-fat yogurt, broccoli, cauliflower, salmon, tofu, and leafy green vegetables. One glass of skim milk has the same amount of calcium as whole milk: 300 milligrams.
Women who still get their periods, or who are postmenopausal but taking menopausal hormone therapy, should get 1,000 milligrams of calcium each day. That jumps to 1,000-1,300 milligrams per day for pregnant or breastfeeding women. Postmenopausal women not on hormone replacement therapy should get 1,200 milligrams of calcium per day.
For men, the recommended amount of calcium is 1,000 milligrams per day between ages 25 and 70 and 1,200 milligrams per day from age 71 and up.
Because most women get only about one-half or one-third as much calcium as they need in their diets, most doctors recommend calcium supplements to make up the difference. There are many forms, but calcium citrate and calcium gluconate appear to be more effective at reducing bone loss.
Your body also needs vitamin D to absorb calcium and move it into and out of bones. Adults ages 19-70 need 600 international units per day and those 71 and older need 800 international units per day. Fatty fish like salmon and tuna are good sources. But not many other foods are rich in vitamin D, so you may need to take a supplement to get enough.
Because calcium supplements can keep the body from absorbing certain drugs, check with your doctor before you start taking them if you are on any medications. You may need to take the supplements at a different time of day from your other meds.
How to Eat for Bone Health
Along with foods that are naturally rich in calcium, there are other ways to get more of it in your diet:
- Add nonfat dry milk to everyday foods and drinks, including soups, stews, and casseroles. Each teaspoon of dry milk adds about 20 milligrams of calcium.
- Making soup stock from bones? Add a little vinegar to the mix. It will dissolve some of the calcium out of the bones and into the broth. A pint of this soup can have as much as 1,000 milligrams of calcium.
- Avoid foods with a lot of the mineral phosphorous, which can promote bone loss. They include red meats, soft drinks, and those with phosphate food additives. Drinking a lot of alcohol and caffeine may also reduce the amount of calcium your body absorbs. People with osteoporosis should avoid getting too much.
- Some people say postmenopausal women should get more plant estrogens, especially through items like tofu, soybean milk, and other soy products. The idea is to keep estrogen levels from dropping. However, there is no evidence to prove that these things help prevent or delay osteoporosis.
Exercise Your Bones
Exercise is a key way to keep bones strong. Make sure you get two main types:
- Weight-bearing exercise, which puts stress on bones. Running, walking, tennis, ballet, stair-climbing, and aerobics fall into this category.
- Muscle-strengthening exercises, such as weight lifting
To get the most benefit, you should try to do your workouts at least three times per week for 30-45 minutes, but even doing a little at a time helps.
Swimming and bicycle riding, although good exercises for your heart, don’t seem to be as helpful in preventing osteoporosis because they're not weight bearing -- they don’t make your bones work and get stronger.