Being told that you have osteoporosis can be upsetting. It may make you feel fearful and anxious, especially when you see pharmaceutical advertisements that warn of dire dangers. Remember that the vast majority of women with osteoporosis live full, rich, active lives.

In addition to medication your doctor may prescribe to slow bone loss and manage your pain (if you have pain), there are many measures you can take to prevent your bones from becoming weaker and, in some cases, even replace some of the bone you have lost. There are also steps you can take to minimize your chance of having a fall and fracturing a bone.

These include:

• getting enough calcium and vitamin D
• lifestyle changes, to quit smoking and limit your intake of alcohol and caffeine
• exercise, with a specific focus on weight-bearing activities
• preventing fractures by modifying your activities and your physical environment  

If your osteoporosis causes you pain and limits your mobility, this may affect the activities you can do and the social roles you play. Some women feel isolated and depressed as a result. There are support groups for people living with osteoporosis. These allow you to talk to others in similar situations and learn from guest speakers. To find a support group near you, call 1-800-463-6842, Monday to Friday, between 9 a.m. and 5 p.m., or click here to find the Osteoporosis Canada chapter closest to you.

Calcium and vitamin D

Calcium is an essential nutrient. Almost every cell in your body needs calcium. The heart, nerves, muscles, blood, colon and bones need calcium every day.

Your bones depend on calcium for strength. About 99 per cent of your body's calcium is stored in your bones. The rest circulates in your blood and takes part in important functions. If there is not enough calcium circulating in your blood, the body takes the calcium it needs from your bones.

Vitamin D is also vital to the health of your bones. It has been shown to increase the bone mineral density (BMD) of older adults and reduce their risk of falls. Often referred to as the "sunshine vitamin," vitamin D increases calcium absorption in the gut and regulates calcium and phosphorus balance in the blood.

Not only is vitamin D critical for your bone health, but higher amounts may also help fight off infections and reduce the risk of certain cancers. Despite these benefits, many adults are vitamin D-deficient.

Calcium and vitamin D recommendations

Osteoporosis Canada recommends that individuals with osteoporosis and that adults over the age of 50 get 1,500 milligrams of elemental calcium and 800 international units (IUs) of vitamin D daily. Recent studies  suggest that women over age 70, those with a history of heart attacks and strokes, and those with reduced kidney function, should limit their calcium intake to 1,000 milligrams per day.  Adults ages 19 to 50, including pregnant or lactating women, should aim to get 1,000 milligrams of calcium and 400 IUs of vitamin D daily.

Food sources of calcium

Each serving below provides 300 milligrams of calcium:

The best source of calcium is milk and calcium-rich foods. Consider supplements if it is impossible to get enough calcium from your diet. Your doctor or a registered dietitian can recommend the amount and type of calcium supplements you need to take.

Sources of vitamin D

Vitamin D occurs naturally in very few foods: cod liver oil, fatty fish, such as salmon, tuna, mackerel or sardines, and egg yolks. Vitamin D is also added to milk and some rice and soy beverages. For adults over 50 years of age, it is almost impossible to get the recommended daily intake of vitamin D through food sources alone.

Sunlight helps your body to produce vitamin D. In the fall and winter months, the sun becomes weak in Canada and does not allow us to get as much of the vitamin. For this reason, vitamin D supplements are often required.

Be aware that it is possible to get too much vitamin D. How much is too much is the subject of debate: Health Canada advises against taking more than 2,000 IUs a day whereas others say anything under 10,000 is safe.

Lifestyle

There are factors we cannot control, like our sex or age, that put us at greater risk for fracturing a bone. However, there are behaviours that we can change to slow bone loss and prevent a fracture. For example, we can quit smoking and limit the amount of alcohol and caffeine we consume.

Smoking
Smoking increases bone loss. This may be because smokers are less able to absorb calcium. Smoking also interferes with the nourishment of bone tissue. Regardless of your age, quitting smoking is good for your bone health.

Alcohol
Try to drink no more than two alcoholic beverages a day. Having a drink or two a day has not been shown to be detrimental for women with osteoporosis, but excessive alcohol consumption decreases your body’s ability to absorb calcium and increases the amount of calcium you lose through the urine.

Caffeine
Some studies have found that drinking large amounts of caffeine (three cups of coffee or more) may increase your risk of a fracture if you do not get enough calcium. This is because caffeine increases the amount of calcium you lose in your urine. It is, however, safe to drink moderate amounts of caffeine (in coffee, tea and pop).

Exercise

Physical activity:

• stimulates bone formation
• improves muscle strength
• improves posture and co-ordination
• improves balance and reduces the risk of falls

The best physical activity program for osteoporosis is one that combines weight-bearing exercise (such as walking, running, dancing, aerobics classes) with a muscle strengthening routine (using weight machines or free weights, for example). When lifting weights, be sure to protect your back by pulling in your abdominal muscles and bending your knees. Also, always keep the weight you are lifting close to your body, to avoid straining your back. Exercises that improve your balance (such as tai chi or yoga) can also be beneficial for women with osteoporosis.

If you are about to start an exercise program, consider getting advice from a fitness instructor, physiotherapist or personal trainer who has experience working with people who have osteoporosis. Having someone show you how to do certain exercises and design a program tailored for you will help ensure that you exercise safely. There are also many fitness classes designed specifically for people with osteoporosis.

If you have had a fracture, avoid

• jumping and twisting movements
• high-impact activities (like high-impact aerobics)
• abdominal curl-ups
• bending forward from the waist
• lifting anything heavy

Studies show that women who exercise are more likely to have good balance and better bone density than their inactive counterparts.

Preventing fractures

Taking precautions to prevent falls is critical for women with osteoporosis because falls are the most common cause of fractures. Approximately 90 per cent of hip fractures occur as a result of a fall. A fall can also lead to fractures of the vertebrae and wrist.

Occupational therapists can teach women with osteoporosis how to reduce their risk of fractures. They focus on two areas:

• preventing falls
• modifying your daily activities to avoid straining your back

Tips for preventing falls

• Ensure that your bathtub is not slippery by using rubber mats or non-skid decals. 
• Equip your home with good lighting. In the middle of the night, it helps to have a well-lit path to the bathroom (i.e. use night lights). 
• Ensure that your dresses, skirts and pajamas are short enough to avoid tripping over the hem. 
• Secure all loose rugs to avoid slipping. 
• If you use wax on your floors, use non-skid wax.
• Secure all wiring and electrical cords away from common traffic areas. Remove any clutter from these areas.
• Be aware of the potential to trip over pets.
• Falls frequently occur on stairs. Installing stable handrails, ensuring proper lighting (especially at the top and bottom) and wearing appropriate footwear can help prevent falls. Take your time going up and down stairs.
• Cover porch steps with gritty, waterproof paint.
• Sprinkle salt or sand on your front steps and walkway in the winter, when there is snow and ice on the ground.
• When walking on smooth floors, wear footwear that has a tread, and avoid wearing socks without shoes. It’s also a good idea to avoid high heels and slip-on shoes and sandals.

In addition to taking these steps to “fall-proof” your environment,

• avoid medications that cause dizziness or drowsiness, if possible
• visit your eye doctor regularly, as poor vision can increase your chances of falling
• do exercises that strengthen your core muscles and improve your balance, such as pilates and Tai Chi, or do simple exercises like standing on one leg while you lift the other leg slightly off the floor

Modifying your daily activities

If you have osteoporosis, you should always be aware of the position your body is in and how you can protect your back during your daily activities. Here are some general principles to follow:

• Always carry items close to your body.
• Avoid bending over to pick up items. Instead, keep your back straight while bending your knees.
• Keep your tummy muscles pulled in.

These are some ways you can modify how you perform everyday activities to minimize your risk for vertebral fractures:

• Activities that involve lifting weight, bending over or a combination of these movements (for example, lifting groceries), can put considerable stress on the spine and contribute to spinal fractures.
• When objects are heavy, it is best if they are positioned at waist height before you attempt to lift them. If the object is on the ground, bend your knees and try to keep your spine straight while you bring the object as close to you as possible. Once in this position, use your legs to lift while continuing to keep your spine as straight as you can. Pulling in your abdominal muscles as you do this can also help prevent back strain.
• When getting out of bed, roll over onto one side first and then use your arm to help you sit up. Avoid getting out of bed by sitting straight up from a position of lying on your back.
• When making your bed, do one side at a time. Leave blankets and sheets untucked. If you choose to tuck in the sheets and blankets, do so one layer at a time and avoid lifting the mattress with a rounded back. Squatting low (with a straight back) or getting down on your knees is another way to make the bed without flexing your upper spine.

It may not always be possible to perform certain activities in the suggested manner; however, the more often you can incorporate these changes into your daily routine, the more likely you will be to form some good habits that will help to minimize your risk of vertebral fractures.