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Osteoporosis: A guide to prevention and treatment

Each year, osteoporosis contributes to more than 1.5 million bone fractures, with most of these breaks occurring in the hips, spine, and wrist. While many people consider broken bones mere nuisances, the burden of these breaks is often quite heavy. They can steal the ability to perform simple daily tasks, result in pain and deformity, and can even lead to life-threatening complications, such as pneumonia or blood clots.

Thankfully, osteoporosis symptoms need not threaten the health of your bones or your quality of life. This report describes how you can prevent and treat osteoporosis through diet, exercise, and medications. You'll also find advice on choosing a calcium supplement, tips on fall-proofing your home, and help with putting together a personalized plan to preserve or boost your bone strength.

Prepared by the editors of Harvard Health Publications in consultation with David M. Slovik, M.D., Endocrinologist, Massachusetts General Hospital and Associate Professor of Medicine, Harvard Medical School. 52 pages. (2008)

  • The basics of bone
    • Bone remodeling
    • Peak bone mass
  • What causes osteoporosis?
    • Primary osteoporosis
    • Secondary osteoporosis
  • Who gets osteoporosis?
    • Osteoporosis risk in women
    • Osteoporosis risk in men
  • The consequences of osteoporosis
    • Hip fractures
    • Spinal fractures
    • Wrist fractures
    • Other consequences
  • Detecting osteoporosis
    • Biochemical markers
  • Protecting your bones
    • Calcium
    • Vitamin D
    • Exercise
    • The bisphosphonates
    • Raloxifene (Evista)
    • Hormone therapy
    • Calcitonin
    • Parathyroid hormone
  • Preventing falls
    • Ten ways to prevent falls
  • Developing a plan of action
    • An early start
    • Women in early postmenopause
    • If you are 65 or older
  • Coping with fractures
    • Living with vertebral fractures
    • Living with a hip fracture
    • Support groups
  • Sources of calcium
    • Dietary calcium
    • Calcium supplements
  • The importance of exercise
    • Weight-bearing exercises
    • Exercising with weights
  • Glossary
  • Resources
    • Organizations
    • Books and report

While experts recommend getting your nutrients from foods instead of supplements, you may find that it just isn’t practical or possible for you to get all the calcium you need from your diet. In that case, a supplement can shore up your calcium intake and your bones. In fact, a 2002 analysis of several studies of postmenopausal women found that the women who took calcium and vitamin D supplements for at least two years were 23% less likely to suffer a spinal fracture.

A dizzying array of calcium supplements is available -- so many, in fact, that choosing one can be tricky. You can choose from flavored chews, pills, chewable tablets, and liquids. When making a decision, it’s wise to consider cost, convenience, and how well your body tolerates the supplement.

The calcium in supplements is found in combination with another substance, typically carbonate or citrate. (Some products combine calcium with phosphate, lactate, or gluconate, but these are less common and tend to be more expensive.)

Calcium carbonate tends to be the best value, because it has the highest amount of elemental calcium. Elemental calcium is the actual amount of calcium in each supplement. The compound calcium carbonate contains 40% calcium by weight, while calcium citrate is 21% calcium. This means that you may need to take more tablets of a calcium citrate product in order to meet your daily needs.

Because calcium carbonate requires stomach acid for absorption, it’s best to take this product with food. Most people tolerate calcium carbonate well. However, some people complain of mild constipation or feeling bloated.

On the other hand, calcium citrate is absorbed more easily than calcium carbonate and can be taken on an empty stomach. But as mentioned above, you may need to take more tablets to get your daily requirement.

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