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Photo of an older couple using hand weightsDr. Streeten says that exercise, avoidance of smoking and excess alcohol, diet and vitamin D supplementation are important ways to help prevent osteoporosis. It is important to know, however, that genetic factors also lead to osteoporosis and there is no current way to reduce this risk.

“I recommend that patients do the amount of exercise recommended by the American Heart Association to prevent heart disease, which is the leading cause of death in the U.S. This amount of exercise will also help to prevent osteoporosis – at least three hours a week of weight bearing (on your feet or bicycling but not swimming) aerobic exercise,” advises Streeten. “Find exercise that you like to do, so it won't be so hard to keep up with it. Only the bones actively loaded will benefit from exercise. For example when you walk, your lower body will benefit, but not your arms. Include the use of hand weights to help the upper body.”

Some specific recommended exercises include:

  • Weight-bearing exercises – walking, jogging, playing tennis, dancing
  • Resistance exercises – free weights, weight machines, stretch bands
  • Balancing exercises – tai chi, yoga
  • Riding stationary bicycles
  • Using rowing machines
Photo of a couple running together

Dr. Streeten says this type of exercise helps prevent not only heart disease but also osteoporosis.

It's also important to maintain a diet that includes an adequate amount of calcium or to take a calcium supplement and to take a vitamin D supplement at least from September through May (since vitamin D is made in the skin but only in sufficient amounts at our latitude in the summer months and there is not enough vitamin D in food). Dr. Streeten recommends the following:

  • Men and women over 65, and post-menopausal women should get a total of 1200-1500 mg of calcium a day. This includes all sources (dietary and supplement). For example, if you drink a cup of milk (300mg of calcium in a cup) and have an ounce of cheese (200 mg), then you can get the remaining calcium (1000mg) from a supplement. No more than 600 mg of calcium can be absorbed at once.

  • Men under 65 and pre-menopausal women should get 1000 mg of calcium a day.

  • Equally important is vitamin D – although the official RDA (Recommended Dietary Allowances) for vitamin D in adults 18 and older is 400 units, the actual need is at least 800 units of vitamin D daily. Up to 10,000 units of vitamin D daily is safe. The best way to determine if an individual is getting enough vitamin D is a vitamin D [25(OH)D] blood test.

In addition to preventing and treating osteoporosis, says Dr. Streeten “Vitamin D is also important for cardiovascular health, immune function, and it reduces the risk of cancer, especially colon, breast and prostate cancer.”

For those who do not want to take a vitamin D supplement in the summer, she recommends getting 15 minutes a day of direct sunlight at the peak of the day (11 a.m. - 3  p.m.) without sunscreen, which will increase vitamin D production in the skin.

If you are getting vitamin D in supplement form, there are two types: D2 and D3. “The body appears to prefer D3 (cholecalciferol) which is the type made in our skin,” says Streeten.

Good dietary sources of calcium include milk (all milk regardless of fat content contains 300 mg of calcium per 8 oz.), yogurt and cheese, as well as foods with added calcium such as orange juice, some cereals and some breads. But Streeten warns that “taking too much calcium (eg. over 2000 mg daily) is not good. “Going over the recommended daily amount could increase the risk of kidney stones.”

Conversely, there are certain foods/drink to avoid.

“Avoid excessive alcohol. Two servings or less a day is safe for bone health,” says Dr. Streeten. High protein diets are not good for the bones, she says, because they cause more loss of calcium through the urine. In addition, she notes that “caffeine in excess and excessive sodas can also be bad for the bones.”