Osteoporosis Disease Specific Site

General Recommendations

The best course of therapy for management osteoporosis focuses on prevention. The goals of prevention are to optimize bone mass and preserve skeletal integrity.

The National Osteoporosis Foundation (NOF) recommends the following steps to minimize a patient's risk for developing this disease. These are universal recommendations for the general population.¹

Adequate intake of dietary calcium and vitamin D.
Calcium: At least 1200 mg/day, with supplementation as necessary
Vitamin D: Supplementation (400 to 800 IU per day) recommended for individuals at risk of deficiency.
Regular weight-bearing and muscle-strengthening exercise.
Avoidance of tobacco use and alcohol abuse.

Effects of Exercise on BMD

Since bone adapts to its mechanical loading environment (i.e., the mechanical stress placed on the bone by weight-bearing activity) by altering its density distribution, the effects of exercise on bone mineral density have long been examined. Physical activity loads the skeleton; however, the quantitative relationships between exercise and bone mass remain to be determined, as the best osteogenic stimulus (in terms of type, duration, and intensity of loading) is not yet known.²It is likely that exercise provides modest gains in bone mineral density, but it probably must load the site of interest (i.e., weight bearing exercise for the hip and spine) and be continued for these gains to be sustained.

Because exercise increases cardiovascular endurance, strength, agility, flexibility, and balance, sedentary elderly persons who begin an exercise program will likely benefit from a lower incidence of falls and fractures, although this remains to be proven.

According to the NIH Consensus Statement 2000³, there is strong evidence that physical activity early in life contributes to higher peak bone mass. 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.³

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