Patient education: Osteoporosis prevention and treatment
●Osteoporosis causes bones to become abnormally thin, weakened, and easily broken. This condition can be treated and prevented with diet, exercise, and avoiding smoking.
●Calcium and vitamin D can prevent and treat thinning bones. The main dietary sources of calcium include milk and other dairy products, such as cottage cheese, yogurt, or hard cheese, and green vegetables, such as kale and broccoli (table 1). Milk is a primary source of dietary vitamin D, containing approximately 100 international units per 8 oz (236 mL).
●Calcium and vitamin D can also be taken as a supplement (eg, in a pill) (table 2). A total of at least 1000 mg of calcium per day (total diet plus supplement) is recommended for premenopausal women and men. Women after menopause should consume 1200 mg calcium per day (total diet plus supplement). Experts also recommend 800 international units of vitamin D each day for men over 70 years and postmenopausal women, and 600 international units daily for younger men and premenopausal women.
●Exercise can help to prevent and treat thinning bones. Exercise should be done for at least 30 minutes three times per week. Any weightbearing exercise regimen is appropriate (eg, walking).
●Smoking cigarettes can cause bones to become thinner and weaker. Stopping smoking can reduce this risk.
●Falling can cause fractures in older adults. Preventing falls can lower the risk of fractures.
●Some medications can cause bone thinning. Such medications include glucocorticoid medications (eg, prednisone), heparin, and certain antiepileptic drugs (eg, phenytoin, carbamazepine, primidone, and phenobarbital). Patients should ask their health care provider about the possibility that these medications should be replaced or the dose lowered. (See 'Medications' above.)
●Alendronate (brand name: Fosamax) or risedronate (sample brand name: Actonel) are recommended to treat women after menopause who have osteoporosis or have low bone density and are at high risk for fracture (see 'Bisphosphonates' above). Zoledronic acid (sample brand name: Reclast) may be suggested for patients who cannot tolerate oral bisphosphonates or who have difficulty taking the medication, including an inability to sit upright for 30 to 60 minutes. Raloxifene is generally less effective than other medications and is usually recommended for women who cannot tolerate or are not candidates for any bisphosphonates or for postmenopausal women with osteoporosis who are also at high risk for invasive breast cancer.
●Denosumab (brand name: Prolia) improves bone density and reduces fracture in postmenopausal women with osteoporosis. It is another option for patients who are intolerant of or unresponsive to oral and/or intravenous bisphosphonates. (See 'Denosumab' above.)
●Parathyroid hormone (PTH) (teriparatide [brand name: Forteo]) is another medication that can be used to treat osteoporosis. We recommend this medication for men or postmenopausal women with severe hip or spine osteoporosis. (See 'Parathyroid hormone' above.)
●Hormone replacement (eg, estrogen, progesterone) is not usually recommended to prevent osteoporosis in women after menopause. Hormone therapy is recommended for young women whose ovaries do not make estrogen normally. (See 'Estrogen-progestin therapy' above.)
●Testing may be recommended to monitor how the bones respond to osteoporosis treatment. This may include a bone density scan (dual-energy x-ray absorptiometry [DXA]) or laboratory tests. (See "Patient education: Bone density testing (Beyond the Basics)".)
●Osteoporosis causes bones to become abnormally thin, weakened, and easily broken. This condition can be treated and prevented with diet, exercise, and avoiding smoking.
●Calcium and vitamin D can prevent and treat thinning bones. The main dietary sources of calcium include milk and other dairy products, such as cottage cheese, yogurt, or hard cheese, and green vegetables, such as kale and broccoli (table 1). Milk is a primary source of dietary vitamin D, containing approximately 100 international units per 8 oz (236 mL).
●Calcium and vitamin D can also be taken as a supplement (eg, in a pill) (table 2). A total of at least 1000 mg of calcium per day (total diet plus supplement) is recommended for premenopausal women and men. Women after menopause should consume 1200 mg calcium per day (total diet plus supplement). Experts also recommend 800 international units of vitamin D each day for men over 70 years and postmenopausal women, and 600 international units daily for younger men and premenopausal women.
●Exercise can help to prevent and treat thinning bones. Exercise should be done for at least 30 minutes three times per week. Any weightbearing exercise regimen is appropriate (eg, walking).
●Smoking cigarettes can cause bones to become thinner and weaker. Stopping smoking can reduce this risk.
●Falling can cause fractures in older adults. Preventing falls can lower the risk of fractures.
●Some medications can cause bone thinning. Such medications include glucocorticoid medications (eg, prednisone), heparin, and certain antiepileptic drugs (eg, phenytoin, carbamazepine, primidone, and phenobarbital). Patients should ask their health care provider about the possibility that these medications should be replaced or the dose lowered. (See 'Medications' above.)
●Alendronate (brand name: Fosamax) or risedronate (sample brand name: Actonel) are recommended to treat women after menopause who have osteoporosis or have low bone density and are at high risk for fracture (see 'Bisphosphonates' above). Zoledronic acid (sample brand name: Reclast) may be suggested for patients who cannot tolerate oral bisphosphonates or who have difficulty taking the medication, including an inability to sit upright for 30 to 60 minutes. Raloxifene is generally less effective than other medications and is usually recommended for women who cannot tolerate or are not candidates for any bisphosphonates or for postmenopausal women with osteoporosis who are also at high risk for invasive breast cancer.
●Denosumab (brand name: Prolia) improves bone density and reduces fracture in postmenopausal women with osteoporosis. It is another option for patients who are intolerant of or unresponsive to oral and/or intravenous bisphosphonates. (See 'Denosumab' above.)
●Parathyroid hormone (PTH) (teriparatide [brand name: Forteo]) is another medication that can be used to treat osteoporosis. We recommend this medication for men or postmenopausal women with severe hip or spine osteoporosis. (See 'Parathyroid hormone' above.)
●Hormone replacement (eg, estrogen, progesterone) is not usually recommended to prevent osteoporosis in women after menopause. Hormone therapy is recommended for young women whose ovaries do not make estrogen normally. (See 'Estrogen-progestin therapy' above.)
●Testing may be recommended to monitor how the bones respond to osteoporosis treatment. This may include a bone density scan (dual-energy x-ray absorptiometry [DXA]) or laboratory tests. (See "Patient education: Bone density testing (Beyond the Basics)".)
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