Prevention

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Getting adequate calcium and vitamin D is an important factor in reducing your risk of osteoporosis. If you already have osteoporosis, getting adequate calcium and vitamin D, as well as taking other measures, can help prevent your bones from becoming weaker. In some cases you may even be able to replace bone you've lost.

The amount of calcium you need to stay healthy changes over your lifetime. Your body's demand for calcium is greatest during childhood and adolescence, when your skeleton is growing rapidly, and during pregnancy and breast-feeding. Postmenopausal women and older men also need to consume more calcium. As you age, your body becomes less efficient at absorbing calcium, and you're more likely to take medications that interfere with calcium absorption.

How much calcium and vitamin D?
Premenopausal women and postmenopausal women who use HT should consume at least 1,000 milligrams (mg) of elemental calcium and a minimum of 800 international units (IU) of vitamin D every day. Postmenopausal women not using HT, anyone at risk of steroid-induced osteoporosis, and all men and women older than 65 should aim for 1,500 mg of elemental calcium and at least 800 IU of vitamin D daily.

Getting enough vitamin D is just as important as getting adequate amounts of calcium. Not only does vitamin D improve bone health by helping calcium absorption, but it also may improve muscle strength. Scientists are continuing to study vitamin D — which may also protect against certain types of cancer — to determine the optimal daily dose, but it's safe to take up to 2,000 IU a day.

Although many people get adequate amounts of vitamin D from sunlight, this may not be a good source if you live in high latitudes, if you're housebound, or if you regularly use sunscreen or you avoid the sun entirely because of the risk of skin cancer. Although vitamin D is present in oily fish such as tuna and sardines and in egg yolks, you probably don't eat these on a daily basis. Calcium supplements with added vitamin D are a good alternative.

As for calcium, dairy products are one, but by no means the only, source. Almonds, broccoli, cooked kale, canned salmon with the bones, oats and soy products such as tofu also are rich in calcium. If you find it difficult to get enough calcium from your diet, consider calcium supplements. Supplements are inexpensive and generally are well tolerated and well absorbed if taken properly. Sometimes calcium supplements can cause constipation. If this is a problem for you, drink more water and try using a fiber supplement. In addition, check the type of calcium you're using. Calcium phosphate and calcium citrate tend to be less constipating.

Calcium and vitamin D supplements are most effective taken together in divided doses with food.

Other tips for prevention
These measures also may help you prevent bone loss:

Exercise. Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life. Combine strength training exercises with weight-bearing exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports — mainly affect the bones in your legs, hips and lower spine. Swimming, cycling and machines such as elliptical trainers can provide a good cardiovascular workout, but because they're low impact, they're not as helpful for improving bone health as weight-bearing exercises are.

Add soy to your diet. The plant estrogens found in soy help maintain bone density and may reduce the risk of fractures.

Don't smoke. Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman's body makes and by reducing the absorption of calcium in your intestine. The effects on bone of secondhand smoke aren't yet known.

Consider hormone therapy. Hormone therapy can reduce a woman's risk of osteoporosis during and after menopause. But because of the risk of side effects, discuss the options with your doctor and decide what's best for you. Testosterone replacement therapy works only for men with osteoporosis caused by low testosterone levels. Taking it when you have normal testosterone levels won't
increase bone mass.

Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation and reduce your body's ability to absorb calcium. There's no clear link between moderate alcohol intake and osteoporosis.

Limit caffeine. Moderate caffeine consumption — about two to three cups of coffee a day — won't harm you as long as your diet contains adequate calcium.