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All about osteoporosis maintaining bone health types of osteoporosis causes of osteoporosis osteoporosis risk factors risk factors for primary osteoporosis risk factors for secondary osteoporosis consequences of osteoporosis symptoms of osteoporosis diagnosis of osteoporosis osteoporosis treatments osteoporosis medications treatment for osteoporosis in men treatment for osteoporosis in women osteoporosis lifestyle therapy osteoporosis exercises osteoporosis diet prevention of osteoporosis osteoporosis and calcium osteoporosis and magnesium osteoporosis and vitamin D

What factors are involved in building and maintaining skeletal health throughout life?

Growth in bone size and strength occurs during childhood, but bone accumulation is not completed until the third decade of life, after the cessation of linear growth. The bone mass attained early in life is perhaps the most important determinant of life-long skeletal health. Individuals with the highest peak bone mass after adolescence have the greatest protective advantage when the inexorable declines in bone density associated with increasing age, illness, and diminished sex-

steroid production take their toll. Bone mass may be related not only to osteoporosis and fragility later in life but also to fractures in childhood and adolescence. Genetic factors exert a strong and perhaps predominant influence on peak bone mass, but physiological, environmental, and modifiable lifestyle factors can also play a significant role. Among these are adequate nutrition and body weight, exposure to sex hormones at puberty, and physical activity. Thus, maximizing bone mass early in life presents a critical opportunity to reduce the impact of bone loss related to aging. Childhood is also a critical time for the development of lifestyle habits conducive to maintaining good bonehealth throughout life. Cigarette smoking, which usually starts in adolescence, may have a deleterious effect on achieving bone mass.


Good nutrition is essential for normal growth. A balanced diet, adequate calories, and appropriate nutrients are the foundation for development of all tissues, including bone. Adequate and appropriate nutrition is important for all individuals, but not all follow a diet that is optimal for bone health. Supplementation of calcium and vitamin D may be necessary. In particular, excessive pursuit of thinness may affect adequate nutrition and bone health.

Calcium is the specific nutrient most important for attaining peak bone mass and for preventing and treating osteoporosis. Sufficient data exist to recommend specific dietary calcium intakes at various stages of life. Although the Institute of Medicine recommends calcium intakes of 800 mg/day for children ages 3 to 8 and 1,300 mg/day for children and adolescents ages 9 to 17, only about 25 percent of boys and 10 percent of girls ages 9 to 17 are estimated to meet these recommendations. Factors contributing to low calcium intakes are restriction of dairy products, a generally low level of fruit and vegetable consumption, and a high intake of low calcium beverages such as sodas. For older adults, calcium intake should be maintained at 1,000 to 1,500 mg/day, yet only about 50 to 60 percent of this population meets this recommendation.

Vitamin D is required for optimal calcium absorption and thus is also important for bone health. Most infants and young children in the United States have adequate vitamin D intake because of supplementation and fortification of milk. During adolescence, when consumption of dairy products decreases, vitamin D intake is less likely to be adequate, and this may adversely affect calcium absorption. A recommended vitamin D intake of 400 to 600 IU/day has been established for adults.

Other nutrients have been evaluated for their relation to bone health. High dietary protein, caffeine, phosphorus, and sodium can adversely affect calcium balance, but their effects appear not to be important in individuals with adequate calcium intakes.


Regular physical activity has numerous health benefits for individuals of all ages. The specific effects of physical activity on bone health have been investigated in randomized clinical trials and observational studies. There is strong evidence that physical activity early in life contributes to higher peak bone mass. Some evidence indicates that resistance and high impact exercise are likely the most beneficial. Exercise during the middle years of life has numerous health benefits, but there are few studies on the effects of exercise on BMD. Exercise during the later years, in the presence of adequate calcium and vitamin D intake, probably has a modest effect on slowing the decline in BMD. It is clear that exercise late in life, even beyond 90 years of age, can increase muscle mass and strength twofold or more in frail individuals. There is convincing evidence that exercise in elderly persons also improves function and delays loss of independence and thus contributes to quality of life. Randomized clinical trials of exercise have been shown to reduce the risk of falls by approximately 25 percent, but there is no experimental evidence that exercise affects fracture rates. It also is possible that regular exercisers might fall differently and thereby reduce the risk of fracture due to falls, but this hypothesis requires testing.

Gonadal Steroids

Sex steroids secreted during puberty substantially increase BMD and peak bone mass. Gonadal steroids influence skeletal health throughout life in both women and men. In adolescents and young women, sustained production of estrogens is essential for the maintenance of bone mass. Reduction in estrogen production with menopause is the major cause of loss of BMD during later life. Timing of menarche, absent or infrequent menstrual cycles, and the timing of menopause influence both the attainment of peak bone mass and the preservation of BMD. Testosterone production in adolescent boys and men is similarly important in achieving and maintaining maximal bone mass. Estrogens have also been implicated in the growth and maturation of the male skeleton. Pathologic delay in the onset of puberty is a risk factor for diminished bone mass in men. Disorders that result in hypogonadism in adult men result in osteoporosis.

Growth Hormone and Body Composition

Growth hormone and insulin-like growth factor-I, which are maximally secreted during puberty, continue to play a role in the acquisition and maintenance of bone mass and the determination of body composition into adulthood. Growth hormone deficiency is associated with a decrease in BMD. Children and youth with low BMI are likely to attain lower-than-average peak bone mass. Although there is a direct association between BMI and bone mass throughout the adult years, it is not known whether the association between body composition and bone mass is due to hormones, nutritional factors, higher impact during weight-bearing activities, or other factors. There are several observational studies of fractures in older persons that show an inverse relationship between fracture rates and BMI.

More information on osteoporosis

What is osteoporosis? - Osteoporosis is a thinning and weakening of the bones, usually associated with the aging process. Osteoporosis is a disease, often with no detectable symptoms.
Building and maintaining skeletal health - Factors involved in building and maintaining skeletal health are adequate nutrition and body weight, exposure to sex hormones at puberty, and physical activity.
What types of osteoporosis are there? - Osteoporosis can be classified in various ways based on diagnostic categories, etiology. Osteoporosis can be classified as either primary osteoporosis or secondary osteoporosis.
What causes osteoporosis? - Osteoporosis is related to the loss of bone mass that occurs as part of the natural process of aging. Osteoporosis results when there is excess bone loss without adequate replacement.
What are the risk factors for osteoporosis? - Many disorders are associated with increased risk of osteoporosis. Osteoporosis is far more prevalent in women after menopause due to the loss of the hormone estrogen.
What're the risk factors for primary osteoporosis? - Risk factors for primary osteoporosis include age, gender, race, figure type, lifestyle, diet, and lack of sunlight.
What're the risk factors for secondary osteoporosis? - Risk factors for secondary osteoporosis include genetic disorders, hypogonadal states, endocrine disorders,hematologic disorders, nutritional deficiencies, drugs.
What are the consequences of osteoporosis? - Consequences due to osteoporosis are increased risk of fracture with minor trauma, frequency of traumatic events from lifting and bending impact.
What are the symptoms of osteoporosis? - Patients with uncomplicated osteoporosis may be asymptomatic or may have pain in the bones or muscles, particularly of the back. Osteoporosis becomes apparent in dramatic fashion.
How is osteoporosis diagnosed? - The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination.
What're the treatments for osteoporosis? - Treatment for osteoporosis includes eating a diet rich in calcium and vitamin D, getting regular exercise, and taking medication to reduce bone loss and increase bone thickness.
What osteoporosis medications (drugs) are available? - Medications (drugs) to cure osteoporosis include bisphosphanates (Fosamax), calcitonin (Miacalcin), raloxifene, estrogen, and selective estrogen receptor modulators (SERMs).
How to treat osteoporosis in men? - Alendronate and teriparatide have been approved to treat osteoporosis in men. Calcitonin may work in men, treatment with testosterone appears to increase bone density.
How to treat osteoporosis in women? - The non-hormonal bisphosphonate drugs, alendronate and risedronate prevent and treat postmenopausal osteoporosis. Raloxifene is approved for preventing and treating osteoporosis.
What lifestyle changes can help osteoporosis? - Alcohol consumption should also be kept within safe limits. Supplements of calcium plus vitamin D may help maintain bone density. Limiting sodium and avoiding junk food.
What osteoporosis exercises are suggested? - Exercise is very important for slowing the progression of osteoporosis. Taking regular exercise is the single most important action improve the strength of their bones.
What osteoporosis diet is suggested? - A good calcium intake is essential throughout life for healthy bones. Vitamin D helps the absorption of calcium from the intestines. Reducing salt may be useful for osteoporosis patients.
What can be done to prevent osteoporosis? - For prevention and treatment of osteoporosis, patients should be encouraged to stop smoking, limit alcohol consumption and perform weight-bearing exercise.
Osteoporosis and calcium - Calcium could alter the physical-chemical properties of the bone mineral. The daily recommended dietary calcium intake varies by age, sex, and menopausal status.
Osteoporosis and magnesium - Magnesium supplementation is as important as calcium supplementation in the treatment and prevention of osteoporosis.
Osteoporosis and vitamin D - Vitamin D is necessary for the absorption of calcium in the stomach and gastrointestinal tract and is the essential companion to calcium in maintaining strong bones to prevent osteoporosis.
Bone, joint, & muscle disorders

Topics in bone, joint, and muscle disorders

Bone diseases
Bone tumors
Bone cancer
Muscle diseases
Spine (neck and back) disorders
Dupuytren's contracture
Plantar fasciitis
Rheumatoid arthritis
Juvenile rheumatoid arthritis
Septic arthritis (infectious Arthritis)
Psoriatic arthritis
Reiter's syndrome (reactive arthritis)
Ankylosing spondylitis
Gout (gouty arthritis)

All information is intended for reference only. Please consult your physician for accurate medical advices and treatment. Copyright 2005,, all rights reserved. Last update: July 18, 2005