Calcium, exercise, no smoking, no excess drinking, bone density tests -- all these are necessary, says Kathryn Diemer, MD, professor of medicine and osteoporosis specialist at Washington University School of Medicine in St. Louis.
"These are basic things that all women should do," Diemer tells WebMD. But they’re especially important for women with low bone density. While you can never regain the bone density you had in your youth, you can help prevent rapidly thinning bones, even after your diagnosis.
Here’s a breakdown of five lifestyle steps to help you on the road to better bone health.
Bone Health Step 1: Calcium and Vitamin D
Calcium builds strong bones, but vitamin D helps the body absorb calcium. That's why postmenopausal women need 1,200 milligrams calcium and at least 400 IU to 600 IU vitamin D daily for better bone health.
Most American women get less than 500 milligrams of calcium in their daily diet. "Sun exposure helps produce vitamin D, but as we get older, our skin is not as efficient at making vitamin D. Also, if we're careful to use sunscreen, we're at risk of having low vitamin D level."
Here are ways to give your body a boost of both calcium and vitamin D:
Calcium in food: We know that dairy has calcium, but other foods do, too.
- Low-fat milk or soy milk (8 ounces): 300 milligrams calcium
- Cottage cheese (16 ounces): 300 milligrams calcium
- Low-fat yogurt (8 ounces): 250-400 milligrams calcium
- Canned salmon (3 ounces): 180 milligrams calcium
- Calcium-fortified orange juice (6 ounces): 200 milligrams-260 milligrams calcium
- Cooked spinach, turnip greens, collard greens (1/2 cup): 100 milligrams calcium
- Cooked broccoli (1/2 cup) 40 milligrams calcium
A calcium supplement may be necessary to make sure that you're getting enough, says Diemer.
Calcium supplements: All the calcium bottles on store shelves can be confusing. Basically, there are two types of calcium -- calcium carbonate and calcium citrate -- that can be purchased over the counter.
- Calcium carbonate must be taken with food for the body to absorb it. Many women have side effects from calcium carbonate -- gastrointestinal upset, gassiness, and constipation, Diemer tells WebMD. If you take calcium carbonate with magnesium, however, you won't likely have the constipation. "It acts just like Milk of Magnesia and seems to help move things through."
Certain medications can interfere with absorption of calcium carbonate -- including Nexium, Prevacid, Prilosec, and others used to treat acid reflux (GERD) or peptic ulcers. If you take those medications, you should probably take calcium citrate.
- Calcium citrate is generally well tolerated, and can be taken without food. You might need to take more than one pill to get the recommended dosage, so take them at separate times -- to help your body absorb the calcium. If you take more than about 500 milligrams of calcium at one time your body will simply pass it as waste.
Check the supplement's label before buying. Look for either "pharmaceutical grade" or "USP (United States Pharmacopeia) standards. This will ensure high-quality pills that will dissolve in your system. "Even generic brands are fine if they have that information," Diemer advises.
Don't forget vitamin D. Most calcium pills -- and most multivitamins -- contain vitamin D. However, you can get vitamin D in food (fortified dairy products, egg yolks, saltwater fish like tuna, and liver). Research suggests that vitamin D3 supplements may be a little bit better absorbed and retained than Vitamin D2.
If you're taking osteoporosis medications, take calcium, too. "A lot of patients think if they start treatment they don't need calcium," she adds. "That's not true, and physicians often don't emphasize the point."
Take prescription calcium if necessary. In some cases, doctors prescribe higher-strength calcium and vitamin D tablets.
Bone Health Step 2: Weight-Bearing Exercise
Calcium supplements and osteoporosis medications can stop bone loss -- which allows the bone to rebuild itself, Diemer explains. "But the body needs 'encouragement' to rebuild bone," she adds. "The skeleton needs to be under stress so it will get stronger." That's why exercise is important for better bone health.
Be sure to talk with your doctor before you begin any exercise regimen. Here are some types of exercises your doctor may suggest.
Make walking a daily ritual. Walking, jogging, and light aerobics make your bones and muscles work against gravity -- which puts stress on the skeleton, which strengthens bones. Bicycling is also good for bones; it offers some resistance, which improves muscle mass and strengthens bones.
Swimming, however, is not a good bone-booster, says Diemer. "Swimming is great for joints if you have arthritis, but it's not doing anything for osteoporosis. With swimming, the skeleton is comfortable so it is not working to hold itself up."
She advises 30 minutes of weight-bearing exercise five days a week if you can. "I'm satisfied if they get 30 minutes, three times a week."
Core strengthening is critical, too. Abdominal exercises, lower back exercises, yoga, Pilates, and tai chi help strengthen the spine. "All that stuff is great, because the most common fractures are in the spine," Diemer tells WebMD. "Strengthening muscles to the spine gives more support to the spine. The other thing about yoga, Pilates, and tai chi -- they improve balance, which prevents falls."
Tell your instructor that you have osteoporosis. If you're taking yoga or Pilates, make sure you have a certified instructor. You need close supervision to make sure you don't harm yourself.
Bone Health Step 3: Don't Smoke & Moderate Alcohol
"Nicotine is toxic to bone," Diemer tells WebMD. "The first thing I tell patients who smoke is, if you don't stop smoking there's very little we can do for your bones. You counteract all medications."
Alcohol in moderation is fine, but just one or two drinks a week, she advises. "Alcohol in excess causes about 2% bone loss in a year's time. Nicotine also causes 2% bone loss. If you're having alcohol and nicotine both in excess, the combined bone loss is actually doubled -- 8% bone loss."
Bone Health Step 4: Talk to Your Doctor
Many factors affect bone strength. Use of certain medications to treat chronic diseases, for example, is an often-overlooked risk factor for developing osteoporosis. Also, certain medications may cause dizziness, light-headedness, or loss of balance -- which could put you at risk for a fall.
Your doctor can explain your own risk -- as well as options for preventing and treating bone loss.
These are questions you might ask your doctor:
- How can I best improve my bone health?
- What is the best calcium to take?
- What medication can help me?
- Has this medication been proven to lower risk of fractures of spine and hip?
- What are the side effects?
- Do I need special instructions for taking my bone medication?
- Will the medications affect other drugs that I'm taking for other conditions?
- How will I know if the treatment is working?
- How soon will I see a change?
- How long will I take this medication?
- Am I taking any medications that put me at risk for a fall?
- What exercise is safest for me?
- Are there exercises I should not do?
- How can I know if I've fractured a bone in my spine?
- How soon should I schedule my next appointment?
- What should I do to prevent falls?
Bone Health Step 5: Bone Density Testing
A bone mineral density test (BMD) is the only way to determine the extent of your bone loss. The gold-standard bone density test is dual energy X-ray absorptiometry (DEXA), says Diemer. "It's a low-radiation test and is the most accurate bone test we have."
Your doctor will determine how frequently you should have a bone density test. If you're taking osteoporosis medications -- or have certain risk factors -- you may need a test every six months. Before having the test, check with your insurance company. Some will only cover bone density tests every two years.
"Usually we can get insurance companies to agree to cover yearly tests, at least for the first year after treatment starts," Diemer tells WebMD. "If the physician says it needs to be done, they usually will pay. But you may need to be persistent in getting it covered."