Diet, not meds, best for osteoporosis

U. ILLINOIS (US) — Increasing dietary calcium and vitamin D or taking supplements should be considered before medication to ward off osteoporosis.

Prescription bone-building medications are expensive and have side effects, including, ironically, an increase in hip fractures and jaw necrosis. A new study suggests they should be used as a last resort if diet and supplements don’t work.

“Bisphosphonates, for instance, disrupt normal bone remodeling by shutting down the osteoclasts—the cells that break down old bone to make new bone,” says Karen Chapman-Novakofski, professor of nutrition at the University of Illinois. “When that happens, new bone is built on top of old bone. Yes, your bone density is higher, but the bone’s not always structurally sound.”

A new study, published in the journal Nutrients, finds that increasing calcium and vitamin D increases bone mineral density and reduces hip fracture risk in most adults. A majority of the results came from supplements, but food is also a good source.

“For many people, prescription bone-building medicines should be a last resort,” Chapman-Novakofski says. “I suspect that many doctors reach for their prescription pads because they believe it’s unlikely that people will change their diets.

A woman in midlife can get enough calcium in her diet without gaining weight, says Karen Plawecki, director of University of Illinois’ dietics program.

“Menopausal women should consume 1,200 milligrams of calcium a day. Three glasses of 1 percent to skim milk will get you up to 900 milligrams. The rest can easily be obtained through calcium-rich and calcium-fortified foods” including orange juice, yogurt, cereal, bread, and breakfast bars.

The study also looked at the effects of dietary protein, vitamin K, soy, and sodium. The new USDA food pyramid guidelines recommend decreasing sodium intake.

“Following a low-sodium diet does seem to have a positive effect on bone density. Some people have the habit of adding a generous sprinkle of salt to most foods before eating, but there’s more involved here than learning not to do that. You have to choose different foods,” Plawecki says.

Cheese, smoked or processed meats, bacon, lunch meat, and processed foods all contain high levels of sodium and could sabotage bone health. A “portfolio diet” that contains a number of nutrients, including extra fruits and vegetables, more calcium, vitamin D, protein, magnesium, and potassium, and less sodium is recommended.

The National Osteoporosis Foundation recommends more physical activity. Chapman-Novakofski recommends a combination of aerobic, strength, balance, and flexibility exercises with a focus on improving your core muscles.

Any exercise needs to be changed every so often because bones stop responding to familiar activity and rebuilding slows.

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