Nutrition

Calcium (Ca) and Vitamin D

• Prevention of osteoporosis
  • Lifelong intake of adequate Ca is associated with higher peak bone mass which reduces the risk of osteoporosis/fracture in later life
  • Recommended Ca intake for patients >50 years of age: 500-1200 mg/day
  • The main sources of Ca are from dairy products; vegetables (eg broccoli, cabbage) are also a good source
  • Vitamin D helps in intestinal Ca absorption and bone mineralization, and enhances response to bisphosphonate therapy
  • Recommended vitamin D intake for patients ≥50 years of age: 800-1000 IU/day
    • Higher doses may be needed in patients with malabsorption, obesity, older individuals, transplant patients 
  • The main sources of vitamin D are from sun exposure (>15 minutes/day), fortified milk, cereals, egg yolks, salt water fish and liver
• Treatment of osteoporosis
  • Ca and vitamin D supplements may be administered as adjunct to other drug therapies in the treatment of osteoporosis
  • Helps to increase bone mineral density (BMD) and may reduce fracture risk in postmenopausal women with osteoporosis
• Glucocorticoid-induced osteoporosis (GIOP)
  • Recommended in secondary prevention and treatment
  • Has been shown to reduce bone loss

Good General Nutrition

• Excessive dieting and low body weight are associated with increased risk of fracture
  • Recommend body mass index (BMI) ≥19 kg/m²
• Maintenance of adequate energy and protein intake is important as well as consuming a balanced diet

Exercise

• Regular weight-bearing exercises and muscle strengthening exercises can improve agility, strength, posture and balance, which may help to prevent falls
  
  • Jogging, brisk walking, tai chi, weight training
  • Type of exercise will depend on age of patient and physical ability
  • At least 30 minutes of regular exercise 3-4x/week is recommended
• May modestly increase bone density (for as long as exercise is being done)

Avoid Cigarette Smoking and Excessive Alcohol Consumption

• Both associated with increased risk of osteoporotic fractures and should be avoided
• Alcohol intake may be limited to <2 units/day 

• Caffeinated drinks should be limited to <1-2 servings/day (240-360 mL/serving)