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Never Again: A 5-Part Guide to Preventing A Second Bone Fracture (Part III)

Part III: Strategies to Reduce Your Risk of Fractures: Nutrition and Medication

Armed with information and the support of your doctor, you can significantly improve your bone health and reduce your risk of future fractures with a combination of diet, exercise, lifestyle modifications and possibly medications. Get vital nutrients.? A diet rich in calcium and vitamin D, adequate protein and limited amounts of salt add up to better bone health:

  • Calcium is needed to maintain healthy, strong bones throughout your life. Unfortunately, most Americans do not get enough calcium from their diets. Dairy products such as milk, cheese, and yogurt are excellent sources of calcium, and some nondairy foods such as broccoli, almonds, and sardines can provide smaller amounts. In addition, many foods that you may already enjoy—juices, breads, and cereals—can now be found fortified with calcium. Calcium supplements can ensure that you get enough calcium each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women up to age 50, increasing to 1,200 mg for women over age 50 and men over age 70.??Calcium supplements are available without a prescription in a wide range of preparations and strengths. Many people ask which calcium supplement they should take. The "best" supplement is the one that meets your needs based on tolerance, convenience, cost, and availability. In general, you should choose calcium supplements that are known brand names with proven reliability. Also, you will absorb calcium better if you take it several times a day in smaller amounts of 500 mg or less each time.
  • Vitamin D plays a significant role in helping your body absorb calcium. The relationship between calcium and vitamin D is similar to that of a locked door and a key. Vitamin D is the key that unlocks the door, allowing calcium to enter your bloodstream. According to a new study published in the New England Journal of Medicine, vitamin D appears to have a stronger role in protecting bones than previously thought. Researchers analyzed the results of 11 double-blind, randomized, controlled trials of oral vitamin D supplements that involved various dosing schedules (such as daily, weekly, or every 4 month dosages), with or without calcium and compared with a placebo or calcium alone, all in people 65 and older—the age group that suffers 75 percent of all fractures. In all, the studies they looked at represented more than 31,000 people. The researchers found that the dose of vitamin D was the key determinant—taking between 800 and 2000 international units (IU) of vitamin D every day reduced the risk of hip fracture by up to 30 percent and the risk of other bone fractures by up to 14 percent. Lower doses, with or without calcium, seemed to have a negligible effect, which is why some earlier individual studies hadn't found a benefit—the vitamin D doses used was too low to make a difference. In sunny climates, getting vitamin D is often easy—just 10 to 20 minutes in the sun. The problem with that is the potential skin cancer risk, since the exposure should be unprotected. Vitamin D is found in egg yolks, some fatty fish like tuna and salmon and fortified milk (read the label—just one glass may give you 200 IU), and if you take a daily multivitamin, it may deliver 400 IU. Once you add up your daily D intake, ask your doctor if a vitamin D supplement is in order. And definitely don't go overboard—too much D can be hazardous to your health.
  • Sodium, a main component of table salt, affects our need for calcium—the more salt you eat, the greater the amount of calcium excreted in urine. As a result, people with diets high in sodium seem to need more calcium than people with low-sodium diets to ensure that, on balance, they retain enough calcium for their bones.
  • Protein in excess amounts also increases the amount of calcium we excrete in urine, but it provides benefits for bone health as well. For example, protein is needed for fracture healing. In addition, studies have shown that elderly people with a hip fracture who do not have enough protein in their diets are more likely to experience loss of independence, institutionalization and even death after their fracture. The recommended daily intake for protein is 56 grams for men and 46 grams for women. Greek yogurt is a great way to get protein and calcium into your diet, so is a protein drink that can give you nutrients on-the-go.

Osteoporosis medications. Several drugs help prevent and treat osteoporosis, including bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMS); parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor. Your doctor can help you understand the benefits and risks of each of these medications and select one that is right for you.

In men, reduced levels of testosterone may be linked to the development of osteoporosis. Men with abnormally low levels of testosterone may be prescribed testosterone replacement therapy to help prevent or slow bone loss.

Next up: In Part IV of this series, you'll learn about the role of exercise to reduce your repeat fracture risk.