Osteoporosis can be prevented, worsening can be limited by a few factors:

  • Calcium– It plays a very important role in the bone formation, keeping the bones strong. Intake of more calcium rich foods at young age help in preventing osteoporosis later in life, in menopausal women and lowers the risk of fracture in people diagnosed with osteoporosis.

Calcium rich foods include milk and dairy products such as yogurt, cheese, green leafy vegetables, broccoli, soy products such as tofu, calcium fortified cereals, etc.

Daily requirement of calcium according to age is:

  • Women and men at 9 to 18 years of age: 1,300 mg per day
  • Women and men at 19 to 50 years of age: 700 mg per day
  • Pregnant or nursing women up to age 18: 1,300 mg per day
  • Pregnant or nursing women 19 to 50 years: 1,000 mg per day
  • Women and men over 50 years of age: 1,200 mg per day

Taking calcium supplements available over the counter may help when daily requirement is not met through diet.

Vitamin D It helps the body in absorbing calcium from food.

 

Exposure to sunlight in the morning and evening at least for about 15-30 minutes daily, eating more vitamin D rich foods such as milk and dairy products, fish, egg yolk, oranges, etc. may help with optimum intake of vitamin D.

Daily requirement of vitamin D is 200-600 IU. When daily requirement is not met, taking over the counter multivitamin supplements may generally help in providing adequate amount of vitamin D. If Vitamin D levels are extremely low, a prescription of vitamin D supplements may be recommended as well.

Protein – Eating more protein rich foods may be important as well.

  • Regular exercise

Exercises done regularly at least 3-4 times a week may be considered important for strong bones as for muscles. It is important to start at young age and maintained throughout life.

Strengthening exercises, balancing exercises, weight bearing exercises such as brisk walking, jogging, running, hiking, climbing up stairs, treadmill workout, weight lifting, etc. may be best among others, in preventing osteoporosis.

Consulting the treating doctor is recommended before starting exercises by people diagnosed with osteoporosis, as even a minor fall may increase risk of fractures.

Treatment: 

Treatment may be difficult as it is diagnosed late, usually due to insignificant and late symptoms. There are no set treatment methods yet, as lost bone mass cannot be restored but further bone loss and damage due to it can only be prevented. Hence it is directed towards alleviating the pain and preventing fractures.

Medications may be prescribed when the risk of fractures is high with significant loss of bone density. They help in increasing bone mass and hence, in preventing fractures.

  • Bisphosphonates such as Alendronate, Risedronate, Ibandronate, etc. are widely used.
  • SERMs Estrogens halt progressive loss of bone mass in postmenopausal women.  But there may be risk of breast cancer. Hence, adding medications such as new anti-estrogens called Selective Estrogen Receptor Modulators (SERM) such as Raloxifene may be considered.
  • Teriparatide may act by increasing bone formation, that is usually helpful in treating postmenopausal women and men with osteoporosis, at high risk of fractures.
  • Calcitonin may help with pain and also in decreasing the bone loss.

Nutrition and lifestyle changes may be advised without medications when the risk of fractures is not high.

  • High protein diet.
  • Calcium supplements.
  • Vitamin D supplements.
  • Guarded exercises (to prevent a fall, injury leading to fracture) as weight bearing physical activity may stimulate bone formation, generally.
  • Braces such as of spine (ASH brace, Taylor brace, etc.) may help in stabilizing the site for a few weeks, after a fracture.
  • Avoid smoking, excessive intake of alcohol.
  • Preventing fall by wearing non-slippery soles of foot wear, keeping the floor dry, etc.

References:

Book of Essential Orthopaedics by J. Maheshwari.

https://orthoinfo.aaos.org/en/diseases–conditions/osteoporosis/

https://www.mayoclinic.org/diseases-conditions/osteoporosis/diagnosis-treatment/drc-20351974

https://orthoinfo.aaos.org/en/recovery/activities-after-hip-replacement/

https://www.iofbonehealth.org/teriparatide

https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/

By, Dr. Divya Teja

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