Prevention of osteoporosis in the whole population focuses on nutritional and lifestyle changes. The goals include:
- Acquiring maximal peak skeletal bone mass
- Maintaining this bone mass for as long as possible
Increasing awareness of the modifiable risk factors for osteoporosis through patient education is an important primary
care role. A recent study of attitudes and knowledge about osteoporosis in a group of well-educated New Zealand women
did not show a high level of knowledge. Although most demonstrated high levels of health motivation and most considered
osteoporosis to be a serious disease, the women had low perceptions of personal susceptibility.4
Adequate calcium intake
Adequate calcium intake is necessary for the acquisition of peak bone mass by the age of 35 and its subsequent maintenance.
When exogenous supply is inadequate, bone tissue is resorbed to maintain serum calcium at a constant level. Calcium needs
vary throughout life and between genders (see Table 1).
It is estimated that 20% of New Zealanders have an inadequate intake of calcium.6 Inadequate intake was higher
amongst women and 15 to 18 year olds. In these groups, low calcium intake puts them at particular risk. Calcium intake
was also inadequate in low socioeconomic groups and Māori.
Adequate Vitamin D
For more information see Best Tests - Vitamin D Testing in Primary Care, January
2007, www.bpac.org.nz keyword: vitaminD.
Vitamin D, which is produced in the skin, is essential for the acquisition and maintenance of bone mass.
Adequate exposure to sunlight is required to maintain vitamin D levels. This means about 15-20 minutes of sun exposure
to the face and arms every day, avoiding sun exposure around midday in the summer. People with dark skin require approximately
three to four times more exposure to gain the same benefit.
Although vitamin D is contained in some foods in small amounts such as oily fish (e.g. salmon, sardines, herring), adequate
intake is not usually attained through diet alone.
Vitamin D deficiency is more prevalent in the following groups:
- Older people in residential care
- Older people admitted to hospital
- People with hip fracture
- People with dark skin
- People unable to obtain regular sun exposure
For these people, consider supplementation without testing. An appropriate dose is a single tablet of cholecalciferol
Regular exercise increases and maintains bone density
Regular weight bearing exercise should be recommended at all ages. This type of exercise can increase bone density
and strength, particularly during childhood and adolescence. Exercise should be regular and ongoing as the beneficial
effects on bone strength are lost when exercise is stopped.
Weight bearing exercise and muscle strengthening exercises may help prevent falls and fractures by improving agility,
strength, co-ordination, posture and balance especially in older adults. Water exercise and cycling are regarded as non-weight
bearing exercises but are still useful as muscle strength and fitness is maintained.
A person with established osteoporosis is at higher risk of fractures from high impact, jarring or twisting exercises
such as running, jumping and aerobics.
Smoking is a significant risk factor for osteoporosis
There is some evidence that the significant risk of osteoporosis associated with smoking is a direct effect that
is independent of confounding factors.7 Smoking cessation is recommended.
Avoid excessive alcohol
Current evidence about the role of alcohol and bone density is conflicting.8 Most publications report that
an alcohol intake of three or more drinks per day is detrimental to bone density.1 However, the exact mechanism
of action remains unclear.