Osteoporosis: A guide to prevention and treatment

Each year, osteoporosis contributes to more than 2 million bone fractures in the United States. This Special Health Report, Osteoporosis: A guide to prevention and treatment, can help you keep your bones strong and healthy, and avoid fractures. It describes how you can prevent and treat osteoporosis through diet, exercise, and medications. You'll also find advice on the right amount of calcium and vitamin D, tips on fall-proofing your home, and help with putting together a personalized plan to preserve or boost your bone strength.

Osteoporosis: A guide to prevention and treatment Cover

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Don’t let osteoporosis erode your bones!

Learn what you can do now to keep your bones strong and lower your risk of osteoporosis-related fractures.

Osteoporosis can be intimidating and inhibiting. The prospect that a simple fall could break your hip or wrist can make you watch every step you take. Fear can replace the freedom to do all the things you love.

The two major risk factors for osteoporosis are being a woman and having passed through menopause. In the years after menopause, women can lose up to one-fifth of their bone mass. But men aren't immune to the disease. Two million American men have osteoporosis and one in four over age 50 will suffer an osteoporosis-related fracture.

In Osteoporosis: A guide to prevention and treatment, Harvard Medical School doctors will show you the positive, proactive, and practical steps you can take to protect your bones now and in the years ahead.

You will be alerted to red flags that signal you’re at greater risk for a broken bone. You'll be warned about medications that hasten bone loss. And you’ll find out if you should have your bone density checked — and which tests are the best.

The report will show you the importance of getting calcium from food and why you probably need a vitamin D supplement. You’ll learn about other bone-protective strategies, too, including specific exercise routines, and discover some surprising foods that help weaken bones.

Osteoporosis is not inevitable. The good news is there’s a lot you can do to shield your bones from this disease. And the sooner you act, the better off you — and your bones — will be.

Prepared by the editors of Harvard Health Publishing in consultation with David M. Slovik, M.D., Endocrinologist, Massachusetts General Hospital, Chief, Division of Endocrinology, Newton-Wellesley Hospital, and Associate Professor of Medicine, Harvard Medical School. 53 pages. (2020)

  • The basics of bone
  • What causes osteoporosis?
  • Know your risk factors
  • The consequences of osteoporosis
    • Hip fractures
    • Spinal(vertebral) fractures
    • Wrist fractures
    • Other consequences
  • Detecting osteoporosis
    • DEXA scans for bone density
    • Vertebral fracture assessment
    • Tests of bone quality
    • Lab tests for bone turnover
  • Developing a plan of action
    • If you have osteopenia (T-score between –1 and –2.5)
    • If you have osteoporosis (T-score –2.5 and below)
    • If your bone density is normal
  • Protecting your bone: Nutrition
    • Calcium and Vitamin D
    • Vitamin K
    • Potential dietary dangers
  • Protecting your bones: Exercise
    • How weight-bearing exercise benefits bones
    • Classic strength training
    • Safety first
    • Exercises and other measures to help prevent falls
    • Strength training and balance exercises for bone health
  • Protecting your bones: Medication
    • Bisphosphonates
    • SERMs
    • Monoclonal antibodies
    • Hormones
  • Coping with fractures
    • Living with a vertebral fractures
    • Living with a hip fracture
    • Support groups
  • Resources
  • Glossary

Sources of vitamin D

Vitamin D is called “the sunshine vitamin,” and for good reason. Your skin cells use sunlight to produce a precursor chemical that the liver and kidneys then convert into active vitamin D. Some people make all the vitamin D they need by going outside for a few minutes a day with bare arms and legs. (Don’t wear sunscreen during this short time, except on your face to avoid the photoaging effects of the sun.) Keep your exposure time short—just 10 minutes or so a day— to guard against skin cancer. And if you’re out longer than that, do cover up or apply sunscreen.

However, it’s unlikely that sunlight alone will generate adequate amounts of vitamin D for most Americans during much of the year. For example, if you live farther north than 40° latitude (the latitude of Denver, Indianapolis, and Philadelphia), the winter sunlight isn’t strong enough to enable you to produce significant amounts of vitamin D. Sunscreen, glass, and clothing also interfere with this process, diminishing your ability to produce the vitamin. People with dark skin produce less vitamin D than those with fair skin. And no matter who you are, as you age, your skin can’t produce vitamin D as readily, your intestines have more difficulty absorbing this vitamin from food or supplements, and your kidneys convert less vitamin D to the active form that your body uses.

For this reason, many vitamin D experts would recommend that you not only follow the National Osteoporosis Foundation’s recommendations for vitamin D intake, but also have your blood tested for vitamin D to gauge how much is actually getting into your system.

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