Although you can’t completely reverse osteoporosis, there are ways to manage it. Some of those methods are things you can do every day through diet and exercise. Your doctor may also recommend that you take medicine.
Diet: Calcium and Vitamin D
Food sources of calcium include nonfat milk, low-fat yogurt, plant-based milks or orange juices that are fortified with calcium, broccoli, cauliflower, salmon, tofu, and leafy green vegetables.
How much calcium do you need? Get 1,000 milligrams of calcium each day if you’re age 19-50. You need 1,200 milligrams per day if you’re a woman age 51 or older, or a man age 71 and older.
It’s best to get your calcium from foods. If you want to take supplements, talk to your doctor first. They can check that it won’t make it harder for your body to use any other medicines you take. Your doctor can also tell you if you need to take calcium supplements at a different time than your other medications.
To help the body absorb calcium from either food or supplements, doctors recommend vitamin D. Get 600 international units (IU) per day up to age 71, and then bump it up to 800 IU daily.
You can get vitamin D from fortified foods and also from sunshine. But it gets harder to make vitamin D as you get older and during winter. Supplements help. Just don’t take too much, or it could cause health problems.
If you’re very low on vitamin D, your doctor may give you a prescription for it.
There are some other easy ways to get more calcium at home. For instance, you can add nonfat dry milk to everyday foods and beverages, including soups, stews, and casseroles. Each cup of dry milk adds about a third of the calcium you need each day.
Foods to Avoid
Don’t get too much phosphorus from your diet, because it can promote bone loss. High-phosphorus foods include red meats, soft drinks, and those with phosphate food additives.
Also, don’t drink too much alcohol or get too much caffeine. They cut down on how much calcium your body absorbs.
To help keep estrogen levels from dropping sharply after menopause, and thus help prevent osteoporosis, some health care professionals tell postmenopausal women to eat more foods that have plant estrogens, especially tofu, soybean milk, and other soy products. However, there is no proof that these foods help prevent or delay osteoporosis.
Make it a habit to do weight-bearing activities such as running, walking, tennis, dancing, stair climbing, aerobics, and weightlifting. When you do this regularly, this helps your bone density, so your bones are stronger.
Do this type of exercise at least three times per week for 30 to 45 minutes.
Although bicycle riding and using an elliptical machine are great for your heart, they may not be the best choice to help you with osteoporosis, because they don’t put enough stress on your bones. So you can still do them for their cardio benefits. Just make sure you do bone-strengthening workouts, too.
It’s simple: Women who smoke tend to have worse bone mineral density than those who don’t smoke. That makes you more likely to break a bone.
Your doctor may prescribe medications to treat osteoporosis, too.
Some of these drugs target the breakdown of bones. They slow down bone loss. Your doctor may call these meds bisphosphonates. They include:
Alendronate (Binosto, Fosamax), which is a pill that you need to take at least half an hour before you eat or take any other meds.
Ibandronate (Boniva), which is a pill that you need to take at least an hour before you eat or take any other meds.
Risedronate (Actonel, Atelvia), which is a pill that you need to take at least half an hour before you eat or take any other meds.
Zoledronic acid (Reclast, Zometa), which you take once a year as a 15-minute infusion. It’s said to increase bone strength and reduce fractures in the hip, spine, wrist, arm, leg, and ribs.
Another osteoporosis med, raloxifene (Evista) works like estrogen in keeping up your bone mass. Studies show that it doesn’t increase the risk of breast or uterine cancers like estrogen. Evista can cause blood clots and often increases hot flashes.
The medications abaloparatide (Tymlos) orteriparatide (Forteo) treat osteoporosis in postmenopausal women and men who are at high risk for a fracture. They’re a man-made form of parathyroid hormone. Either is taken through a self-administered a shot every day, for up to 24 months. Side effects can include nausea, leg cramps, and dizziness. Doctors only prescribe them if the benefits outweigh the risks, and you can’t take either one if you’re at an increased risk for certain bone cancers.
Romosozumab-aqqg (Evenity) is a new medication that is als used to treat osteoporosis in postmenopausal women who are at high risk for a fracture. It is an antsclerostin antibody and works mainly by increasing new bone formation. A dose is given as two injections, one after another. It is limited to only 12 doses which must be administered by your doctor.
There’s also a biologic drug — denosumab (Prolia, Xgeva) — for osteoporosis. It turns off the process that makes the body break down bones. You get it as a shot, once every 6 months. It may be an option for postmenopausal women with osteoporosis and high risk of fracture, and when other osteoporosis medicines have not worked.
What About Hormone Replacement Therapy?
Menopausal hormone replacement therapy — either estrogen alone or a combination of estrogen and progestin — is known to help preserve bone and prevent fractures. The drug Duavee (estrogen and bazedoxifene) is a type of HRT approved to treat menopause-related hot flashes. It may also prevent osteoporosis in high-risk women who have already tried treatment that doesn’t include estrogen.
But doctors don’t prescribe hormone replacement therapy to only prevent osteoporosis, due to potential health risks.
In women who have been on hormone replacement therapy in the past and then stopped it, their bones start to thin again, at the same pace as during menopause.
Referenced on 19/05/2021
- National Institutes of Health, Office of Dietary Supplements: “Calcium,” “Vitamin D.”
- Mayo Clinic: “Osteoporosis: Self-management: Lifestyle and Home Remedies.”
- UpToDate: “Patient Education: Osteoporosis prevention and treatment (Beyond the Basics).”