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Prevention

Childhood to adolescence
Adulthood
Calcium-rich foods
Exercise
Prevent and protect against falls
Early detection
Medication

Although genetic factors will determine whether an individual is at heightened risk of osteoporosis, lifestyle factors can influence the acquisition of bone mass in youth and the rate of bone loss later in life.

Childhood to Adolescence

Nutrition


Couple

The prevention of osteoporosis begins with optimal bone mass acquisition during growth. Bones are living tissue, and the skeleton grows continually from birth to the end of the teen years, reaching a maximum strength and size (peak bone mass) in early adulthood. An efficient way of preventing osteoporotic fractures is to build up the strongest bones possible during childhood and adolescence.

Children and adolescents should:

  • ensure an adequate calcium intake which meets the relevant dietary recommendations in the country or region concerned
  • avoid undernutrition and protein malnutrition
  • maintain an adequate supply of vitamin D through sufficient exposure to the sun or oral supplementation
  • increase the level of physical activity
  • avoid smoking
  • educate adolescents about the risk of high alcohol consumption

For further information about bone development in youth, see the IOF report "Invest in Your Bones: How diet, life styles and genetics affect bone development in young people".

Adulthood

Bone mass acquired during youth is an important determinant of the risk of osteoporotic fracture during later life. The higher the peak bone mass, the lower the risk of osteoporosis.

Once peak bone mass has been reached, it is maintained by a process called "remodelling." Remodelling is a continuous process in which old bone is removed (resorption) and new bone is created (formation). The renewal of bone is responsible for bone strength throughout life. During childhood and the beginning of adulthood, bone formation is more important than bone resorption. In later life, however, the rate of bone resorption is greater than the rate of bone formation and results in net bone loss. Any factor which causes a higher rate of bone remodelling will ultimately lead to a more rapid loss of bone mass and thus more fragile bones.

The above nutritional and lifestyle criteria for building strong bones in youths is also applicable to adults to prevent excessive bone loss:

  • Adequate calcium and vitamin D intake (recommendations range from country-to country, varying between 800 to 1500 mg per day, also depending on age)
  • weight-bearing exercise
  • no smoking
  • avoid heavy drinking

Persons at middle age and beyond should follow these fundamental principles. They should also assess their risk of developing osteoporosis and, with medical advice, consider medications to help maintain an optimal bone mass and to prevent/decrease the risk of fracture.

Calcium-rich foods

Calcium-rich foodsDairy foods such as whole or skim milk, yogurt and cheese are rich in calcium that is easily absorbed by the body. Some calcium-fortified beverages (such as orange juices or soy milk) may contain as much calcium as milk. Certain vegetables and fruits (eg. broccoli, lentils, beans and figs) also provide calcium, as does fish containing bones (canned salmon and sardines). Too much salt and caffeine may increase the loss of calcium through the urine.

Calcium content of some common foods:

Food Serving size Calcium (mg)
Milk, semi-skimmed 236 ml / 8 fl oz 272
Yoghurt (low-fat, fruit) 150 gm / 5 oz 210
Yoghurt (low-fat, plain) 150 gm / 5 oz 243
Hard cheese 28 gm / 1 oz 205
Cheese, cottage 112 gm / 4 oz 142
Cheese mozzarella 28 gm / 1 oz 101
Ice cream, dairy, vanilla 112 gm / 4 oz 112
Broccoli, cooked 112 gm / 4 oz 45
Spinach, cooked 112 gm / 4 oz 179
Sardines, canned in oil,
drained, whole
84 gm / 3 oz 420
Salmon, canned in brine,
drained, flesh only
84 gm / 3 oz 76
Bread, white, sliced 30 gm / 1 medium slice 53

Reference: Food Standards Agency (2002) McCance and Widdowson’s The Composition of Foods, Sixth summary edition. Cambridge: Royal Society of Chemistry.

Recommended daily calcium allowance:

Calcium (mg/day)
Infants and children:
0-6 months 300-400
7-12 months 400
1-3 years 500
4-6 years 600
7-9 years 700
Adolescents:
10 to 18 years 1300*
Women:
19–menopause 1000
Postmenopause 1300
During pregnancy (last trimester) 1200
Lactation 1000
Men:
19-65 1000
65 + 1300
* particularly during the growth spurt

Figures based on Western European, American and Canadian data. Source: FAO/WHO: Human Vitamin and Mineral Requirements, 2002

Exercise

Exercise is not just important to general health, it plays an important role in building bone in youth and helps slow down bone loss in adults. Exercise is also a factor in helping to reduce the risk of falls in that it strengthens muscles, increases flexibility, and improves coordination and balance. Even patients who have suffered fractures can benefit from special exercises and training (under medical supervision!), which can improve muscle strength and muscle function to allow mobilization and improve daily life activities.

Not all types of exercise are equally beneficial in terms of bone health. Weight-bearing exercise, which ‘loads’ bones, is especially good for bone health. This type of exercise includes walking, jogging, tennis, volleyball, and similar sports, aerobics, tai chi and dancing. Resistance training, also known as weight or strength training, is also good for muscles and helps maintain bone mass.

It is important that the exercise you choose is suited to your age and health condition. People with osteoporosis or previous factures in particular should consult their doctors before embarking on an exercise program. Professionally supervised and targeted exercise programs will help patients avoid possible injury and maximize the benefits of exercise.

For more general information about the role of exercise in bone health see the IOF report ‘Move it or Lose it: How exercise helps to build and maintain strong bones, prevent falls and fractures, and speed rehabilitation

Prevent and protect against falls

Fractures occur in the elderly because of skeletal fragility and increased risk of falls. Some risk factors for falls in elderly people include poor muscle strength, postural instability, visual impairment, use of certain medications causing dizziness/drowsiness, and hazards indoors and outdoors. Therefore, for the aged population, effective prevention involves identifying and modifying their risk of falls, in addition to regular weight-bearing exercise (e.g., walking), and a healthy diet and lifestyle.

Any bone will break if the force is strong enough, but reducing the impact of the force may prevent fracture. Hip protectors have been developed to reduce the impact of trauma and protect the bone when a fall occurs from a standing position. Studies have demonstrated the protective value of hip protectors worn by vulnerable older women and men who have already sustained a fracture, particularly those in nursing homes.

Early diagnosis

Early diagnosis is the first step towards timely treatment and care for people who have osteoporosis or are at risk of developing it. An awareness of one's personal risk for osteoporosis, especially after the age of 50, is a first step. People with risk factors for diagnosis should consider taking a bone mineral density (BMD) test. This quick, non-invasive and painless test measures bone mass and helps to determine if a person has osteoporosis and/or is at risk for bone fracture.

Read more about risk factors and diagnosis and take the IOF One-Minute Osteoporosis Risk Test

Medication – safe and effective

Today there is a wide range of therapeutic options and several safe and effective pharmacological treatments that have been shown to act quickly (within one year) and to reduce the risk of fracture by up to 50%. It is important that the choice of treatment be tailored to a patient's specific medical needs and lifestyle. Read more about treatment.

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