How to improve bone density and prevent osteoporosis?

From the Guidelines

To improve bone mass, focus on a combination of weight-bearing exercise, proper nutrition, and healthy lifestyle choices, as recommended by the most recent and highest quality study 1. Engage in regular weight-bearing activities like walking, jogging, dancing, or resistance training for at least 30 minutes most days of the week, as these activities stimulate bone formation. Ensure adequate calcium intake of 1,000-1,200 mg daily through foods like dairy products, leafy greens, and fortified foods, or supplements if necessary, as low dietary calcium may be associated with an increased risk for osteoporosis 1. Vitamin D is equally important (600-800 IU daily for most adults) as it helps your body absorb calcium; get it from sunlight exposure, fatty fish, fortified foods, or supplements. Limit alcohol consumption to no more than one drink daily for women and two for men, and avoid smoking as both can decrease bone density. For those with diagnosed osteoporosis, medications may be prescribed, including bisphosphonates (like alendronate/Fosamax, risedronate/Actonel), denosumab (Prolia), teriparatide (Forteo), or romosozumab (Evenity), as recommended by the American College of Physicians 1. These medications work by either slowing bone breakdown or increasing bone formation. Bone mass naturally peaks around age 30, so starting these habits early is ideal, but improvements can be made at any age through consistent application of these strategies. Some key points to consider include:

• The benefits of physical activity for healthy ageing are well established, and various physical activity interventions for prevention and treatment of osteoporosis have been designed and evaluated 1.
• Risk factors for osteoporotic fracture include increasing age, female sex, post-menopause for women, hypogonadism or premature ovarian failure, low body weight, history of parental hip fracture, ethnic background, previous clinical or morphometric vertebral fracture, previous fracture due to minimal trauma, rheumatoid arthritis, current smoking, alcohol intake, low bone mineral density, vitamin D deficiency, low calcium intake, hyperkyphosis, falling, and immobilization 1.
• Osteoporosis can be diagnosed by the occurrence of fragility fracture, and dual-energy x-ray absorptiometry (DXA) is the current gold standard test for diagnosing osteoporosis in people without an osteoporotic fracture 1.

From the FDA Drug Label

Alendronate sodium tablets, USP are indicated for the treatment of osteoporosis in postmenopausal women. In postmenopausal women, alendronate sodium tablets, USP increase bone mass and reduce the incidence of fractures, including those of the hip and spine (vertebral compression fractures). Alendronate sodium tablets, USP are indicated for the prevention of postmenopausal osteoporosis Alendronate sodium tablets, USP are indicated for treatment to increase bone mass in men with osteoporosis Prolia is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy Prolia is indicated for treatment to increase bone mass in men with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy

To improve bone mass, the following treatment options are available:

• Alendronate sodium tablets can be used to increase bone mass in postmenopausal women and men with osteoporosis 2, 2.
• Prolia (denosumab) can be used to increase bone mass in postmenopausal women and men with osteoporosis at high risk for fracture 3. It is essential to consult a healthcare professional to determine the best course of treatment for individual cases of osteoporosis.

From the Research

Improving Bone Mass

To improve bone mass, several lifestyle interventions and nutritional factors can be considered.

• Exercise, such as strength exercises and aerobic exercises, has been shown to have a positive effect on fracture risk and bone mineral density 4.
• A balanced diet that includes adequate calcium and vitamin D intake is essential for maintaining bone health 4, 5, 6.
• Protein intake has also been associated with improved bone health, with studies suggesting that higher protein intake may lower fracture risk 6.
• Consuming dairy products, particularly fermented dairy products, has been linked to a lower risk of hip fractures 6.
• Adherence to a Mediterranean diet or a prudent diet has also been associated with a lower fracture risk 6.

Lifestyle Interventions

Lifestyle interventions, such as self-management programs, can have a positive effect on balance and quality of life 4.

• Combining exercise, calcium, and vitamin D supplementation has been shown to be effective in improving lumbar bone mineral density, reducing the risk of falls, and improving balance 4.
• Avoiding smoking and excessive alcohol intake, as well as engaging in weight-bearing and resistance-training exercise, can also help prevent fractures 7.

Nutritional Factors

Nutritional factors, such as calcium and vitamin D supplementation, can have a positive impact on bone mineral density and fracture risk 4, 8.

• Soy protein supplementation has been shown to be effective in improving lumbar bone mineral density 4.
• Vitamin K supplementation has been linked to improved femur bone mineral density 4.
• However, it is essential to note that the evidence for some nutritional factors, such as the effectiveness of calcium supplements, is not yet conclusive, and more research is needed to fully understand their effects on bone health 8.