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There is a lot about osteoporosis that is outside your control, but there are at least 10 risk factors for which you can take action to slow down and sometimes even reverse the disease.

Osteoporosis is the most common metabolic bone disease. It can be silent for years, causing no symptoms at all. Then there is a sudden, unexpected, "fragile" fracture. The brittle bones of osteoporosis result in pain and disability for millions of people, and once you realize you have the disease, it may seem that it is too late to do anything about it. But there are at least 10 risk factors that can still be controlled once the disease process has become obvious.

1. Avoid falls!

If you have brittle bones, the last thing you want to do is to take a tumble. According to the (US) National Institute on Aging, six out of every 10 falls occur at home. Fall-proofing your home prevents fractures, pain, and disability. Here are some essentials:

  • Have handrails on both sides of steps and stairs, and use them when you go up and when you go down. If you have to carry something, use one hand to carry the object and the other hand to grasp the handrail.
  • Use the lights! Make sure stairways and hallways are well lit.
  • Make sure carpets are firmly affixed to the floor so they don't slip. Don't use area rugs. 
  • Mount grab bars inside the tub and/or shower and next to the toilet.
  • Keep a flashlight next to your bed for use when the power is out.
  • Avoid clutter. Don't have power cords stretching across the floor.
  • Never stand on a chair or a table to reach something on a shelf. Use a "reach stick" or get help.
  • Don't trip over pets. Or children.
And if you are still worried about falling, consider getting an emergency response system. You need only press a button on a necklace or bracelet to call for emergency help. This service is usually not covered by insurance.

2. Whenever possible, keep moving

Bones rebuild themselves in response to signals from muscles. If you spend all your time lying perfectly still in bed, you may minimize your pain, but you also minimize bone mineralization. It's not necessary to go to the gym. Moving your own body weight from place to place is also exercise and also helps maintain bone. Sitting or lying down all the time carries the risk of deep vein thrombosis (DVTs), which pose an acute danger to life and health.

3. And when you have to stay in bed, make sure you turn every hour or two

Staying in the same position in bed too long invites pressure ulcers. These breaks in the skin are painful and can become infected. A septic infection from a pressure ulcer left untreated is a potentially deadly complication of bone disease.

4. Use orthotic devices as necessary

Orthotic devices, also known as orthoses, help stabilize joints and bones so pain is minimized as fractures heal. Braces can be very helpful for spinal fractures, and they are usually covered by insurance.

5. If you smoke, stop — if you live with a smoker, get them to stop

Every health expert is going to tell you to stop smoking, and there's no doubt that smoking makes osteoporosis worse. The bad news about smoking and osteoporosis is that even second-hand smoke interferes with bone growth. The good news about smoking cessation and osteoporosis is that as soon as you quit, your bones begin to improve.

6. Get out in the sun several times a week

Everybody needs at least a little sun. Twenty minutes of bright morning sunlight is enough to stimulate vitamin D production without increasing the risk of skin cancer (except in a very few people who are extremely sun-sensitive). The extra vitamin D your body makes helps build bone and prevents spasms of muscles adjacent to fractures. For "insurance," consider taking 1000 to 5000 IU of supplemental vitamin D daily during the winter or rainy weather.

7. If your doctor has prescribed bisphosphonates (such as Fosamax), do your best to take them

Bisphosphonates are a mainstay of osteoporosis treatment. They don't work forever, and there can be detrimental effects if they are taken for years on end. Two years is about the time after which bisphosphonate treatment should be reevaluated. But do your best to put up with any undesirable side effects of bisphosphonate treatment. The benefits of bisphosphonates vary from person to person, but overall they reduce the incidence of fractures from 20 to 60 percent.

8. Don't drink your coffee black

Researchers have found that drinking two cups of caffeinated coffee or more daily is associated with lower bone mineral density in the hip and spine in women after menopause. However, the effect is canceled out by drinking a glass of milk every day.

9. Eat green vegetables and/or cabbage every day

Japanese researchers have found that foods that are rich in nitrites, such as leafy greens, seem to slow down the progression of osteoporosis.

10. Don't rely on calcium and vitamin D as your sole form of treatment

Calcium and vitamin D are essential for building healthy bone. But only one clinical study has ever found that just adding calcium and vitamin D supplements to the daily routine reduces the risk of fractures. Take your calcium and D. But let them be a tiny part of what you do for bone health.

  • Abrahamsen B, Brask-Lindemann D, Rubin KH, Schwarz P. A review of lifestyle, smoking and other modifiable risk factors for osteoporotic fractures. Bonekey Rep. 2014 Sep 3.3:574. doi: 10.1038/bonekey.2014.69. eCollection 2014. Review. PMID: 25228987.
  • Al-Bashaireh AM, Haddad LG, Weaver M, Chengguo X, Kelly DL, Yoon S. The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms. J Osteoporos. 2018 Dec 2. 2018:1206235. doi: 10.1155/2018/1206235. eCollection 2018. Review. PMID: 30631414.
  • Barrett-Connor E, Chang JC, Edelstein SL. Coffee-associated osteoporosis offset by daily milk consumption. The Rancho Bernardo Study. JAMA 1994.271:280-3.
  • Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ. 2015 Sep 29. 351:h4580. doi: 10.1136/bmj.h4580. Review. PMID: 26420387.
  • Sanderson J, Martyn-St James M, Stevens J, Goka E, Wong R, Campbell F, Selby P, Gittoes N, Davis S. Clinical effectiveness of bisphosphonates for the prevention of fragility fractures: A systematic review and network meta-analysis. Bone. 2016 Aug
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  • Photo courtesy of SteadyHealth

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