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Lifestyle & Dietary Measures

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Other lifestyle interventions that can preserve bone density include the cessation of smoking and reducing or abstaining from excessive alcohol consumption.  In addition, dietary modifications can also be of benefit.

 Specifically increasing dietary calcium intake is of value, especially given that most people do not meet the recommended daily intake of 800-1000mg.  This is further compromised by the fact that dietary absorption decreases as we age and as such a higher amount of calcium is required.   Dairy food is a classical example of food rich in calcium, whereby Yoghurt generally contains about 400mg/cup, milk 300mg/cup, and cheese 150-180mg/oz.

Another option would be to supplement dietary calcium intake by taking Calcium tablets.   The options being Calcium Carbonate (Caltrate) or Calcium Citrate (Citrocal) with the main difference being that the former option requires acidity in the stomach, which is a problem for those taking antacid medications.

It should be noted that when used as sole treatment for osteoporosis, calcium is not likely to reduce the risk of fracture to any significant degree.  However, it is thought that calcium intake may optimise the effect of the other medications used in the disease.  Recently, there is debate (read about the calcium controversy) as to whether calcium supplementation may actually increase the risk of heart disease and renal stones.  Therefore, the use of calcium supplementation should be discussed with your doctor.

Calcium absorption in the gut is facilitated by the action of vitamin D.  Therefore, vitamin D deficiency has become recognised as a factor towards the development of osteoporosis.  As previously mentioned, vitamin D is synthesised by the skin under the action of UV light.  However, the association between UV exposure and the risk of skin cancer has appropriately led to the population avoiding sun exposure increasing the incidence of vitamin D deficiency.  The groups at highest risk are the elderly (especially those in residential care) and those of certain religious faiths (such as muslims) that promote females to be covered.  Thankfully though, vitamin D has been formulated into an oral form allowing effective supplementation.

The option of vitamin D replacement includes daily Ostelin or Osteovit D3 in doses of 1,000 – 3,000 international units (IU) daily.  Higher doses have been produced, such as 37,500 IU up to 500,000 IU, which are given less frequently.  Interestingly though, the megadoses (for eg 500,000 IU) have ironically been associated with an increase in the risk of fracture.  However at the other doses, there is conflicting evidence of whether vitamin D supplementation reduces the risk of fracture.  The general consensus is that it likely has a modest benefit, probably most realised in the institutionalised elderly.

In addition and of increasing interest, is the benefit of vitamin D on muscle function as well as immune function.  It appears that increasing the vitamin D level reduces body sway and hence the risk of falling.  As a result and especially given the absence of any complications of therapy at the usual therapeutic doses used, vitamin D therapy is usually prescribed in the treatment of osteoporosis.

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