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Managing Osteopenia or Osteoporosis

This information explains what osteopenia and osteoporosis are and how to manage them.

Osteopenia is a condition in which your bone mass density is lower than normal. Having osteopenia can lead to osteoporosis, a disease in which your bones become weak and more likely to fracture (break).

Osteoporosis is often called a silent disease because there are usually no symptoms unless you have a fracture. The fractures usually occur in the spine, hip, ribs, and wrist. They can occur from doing normal everyday activities.

Causes of Osteopenia and Osteoporosis

Your body is constantly making new bone and shedding old bone. Osteoporosis develops when the amount of bone that your body makes is less than the amount of bone that it sheds.

Lifestyle factors that can increase the risk of osteoporosis for both men and women include:

  • Lack of exercise
  • Eating a diet low in nutrients, especially calcium and vitamin D
  • Drinking too much alcohol
  • Consuming too much caffeine
  • Smoking

Other things that can lead to bone loss include:

  • Bone marrow or connective tissue disorders
  • Diseases that affect levels of hormones, such as estrogen and testosterone
  • Thyroid disorders
  • Certain medications, such as corticosteroids, heparin, some anticonvulsants, and methotrexate
  • Hormonal therapy for prostate and breast cancers
  • Going through menopause or taking medications like leuprolide (Lupron®) or goserelin (Zoladex®) that stop your ovaries from producing estrogen

If your doctor believes that you are at risk for osteopenia or osteoporosis, he or she will recommend that you have a bone density test. This test measures bone density in your wrist, spine, and hip. It is a painless test that is similar to an x-ray, but uses much less radiation.

Managing Osteopenia or Osteoporosis

There are things you can do to decrease the chance that osteopenia will progress to osteoporosis, as well as reduce your risk for fractures.

Lifestyle choices

You can make changes in your lifestyle in order to reduce your risk of osteoporosis and its effects.

  • Do not smoke. If you need help quitting, contact the MSK Tobacco Treatment Program at (212) 610-0507.
  • Limit your intake of alcohol
  • Exercise
    • Your doctor may recommend exercises to strengthen your bones and muscles. These may be weight-bearing exercises that help increase bone density, such as walking, jogging, or running. They may also be non-weight-bearing exercises such as swimming.
    • Always talk to your doctor before starting a new exercise routine. If you have trouble establishing an exercise routine, talk to your doctor about whether physical therapy is right for you.
  • Eat a diet rich in calcium and vitamin D
    • Make sure that you are getting enough calcium. Most adults need 1,200 to 1,500 milligrams of calcium every day, but your doctor can tell you how much calcium is right for you. The best way to get calcium is through food (see the table “Foods Rich in Calcium”). If you do not get enough calcium from your diet, you may need to take a calcium supplement. Calcium supplements come in different forms, including calcium carbonate and calcium citrate.
    • You need vitamin D to absorb and use calcium. Adults younger than 70 years of age need at least 600 international units (IU) of vitamin D daily, while adults 70 and older need 800 IU daily. Your doctor can tell you how much vitamin D is right for you. Although the main source of vitamin D is the sun, you can also get it from food (see the table “Foods Containing Vitamin D”). If you are not getting enough vitamin D, you may need to take a vitamin D supplement.
  • Talk with your doctor about medications
    • There are medications available for preventing and treating osteoporosis. Your doctor will discuss your options with you and prescribe the one that best meets your needs. Your nurse will go over any specific instructions for taking your medication.
  • Prevent falls
    • Make your home safe to prevent falls. Here are some things you can do:
      • Remove throw rugs or secure them to the floor.
      • Install safety rails on stairs and grab bars in your shower or tub.
      • Apply nonskid tape or decals to your shower or tub floor.
      • Make sure the rooms in your house or apartment are well lit.
      • Wear sturdy shoes.
      • Stand up slowly after sitting or lying down, so that your body can adjust to the new position.
      • Use a cane or walker to improve your balance.
      • When you bend over, bend at your knees, not at your waist.

Foods Rich in Calcium

Food Portion size Calcium in portion (milligrams) Calories in portion

Fortified, ready-to-eat cereals (various)

¾ cup to 1 cup

250-1,000

100-210

Orange juice, calcium fortified*

1 cup

500

117

Yogurt, plain and fruit flavored*

8 ounces

275-452

127-232

Cheese, various kinds*

1½ ounces

305-452

128-171

Pasteurized, processed cheese, various kinds*

2 ounces

323-438

187-189

Evaporated milk, nonfat

½ cup

371

100

Tofu, regular, prepared with calcium sulfate**

½ cup

434

94

Ricotta cheese, part skim and whole*

½ cup

257-337

171-216

Sardines, canned in oil, drained

3 ounces

325

177

Milk (skim, low-fat, reduced fat, and whole*)

1 cup

276-305

83-149

Soymilk, original and vanilla, with added calcium

1 cup

299

104

Chocolate milk (low-fat, reduced fat, and whole*)

1 cup

272-290

158-208

Low-fat buttermilk (1%)

1 cup

284

98

Rice milk, with added calcium

1 cup

283

113

Tofu, firm, prepared with calcium sulfate and magnesium chloride**

½ cup

253

88

Pink salmon, canned, with bone

3 ounces

181

118

Collards, cooked

½ cup

178

31

Molasses, blackstrap

1 tablespoon

172

47

Spinach, cooked

½ cup

146

30

Soybeans, green, cooked

½ cup

130

127

Turnip greens, cooked

½ cup

124

24

Ocean perch, Atlantic, cooked

3 ounces

116

103

Oatmeal, plain and flavored, instant, fortified*

1 packet prepared

99-110

97-157

Cowpeas, cooked

½ cup

106

80

White beans, canned

½ cup

96

153

Kale, cooked

½ cup

88

26

Okra, cooked

½ cup

88

149

Blue crab, canned

3 ounces

86

84

Beet greens, cooked

½ cup

82

19

Bok choy (Chinese cabbage), cooked

½ cup

79

10

Clams, canned

3 ounces

78

126

Dandelion greens, cooked

½ cup

74

17

Rainbow trout, farmed, cooked

3 ounces

73

144

*Check product labels, as amount of calcium varies.

**Calcium content is for tofu processed with a calcium salt. Tofu processed with other salts does not provide significant amounts of calcium.

Source: Dietary Guidelines for Americans, 2010

http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf

Foods Containing Vitamin D

Food Portion size Vitamin D in portion (IU) Calories in portion

Cod liver oil

1 tablespoon

1,360

123

Salmon, sockeye, cooked

3 ounces

447

144

Mackerel, cooked

3 ounces

388

223

Tuna fish, canned in water, drained

3 ounces

154

73

Orange juice fortified with vitamin D*

1 cup

137

117

Milk (nonfat, reduced fat, and whole, vitamin D-fortified)

1 cup

115-124

83-149

Yogurt, fortified with 20% of the daily value for vitamin D*

6 ounces

88

162

Margarine, fortified

1 tablespoon

60

100

Liver (beef), cooked

3.5 ounces

49

191

Sardines, canned in oil, drained

2 sardines

46

50

Egg, yolk included

1 large

41

78

Ready-to-eat cereal, fortified with 10% of the daily value for vitamin D*

¾-1 cup

40

100-210

*Check product labels, as amount of added vitamin D varies.

Sources:
National Institutes of Health Office of Dietary Supplements

http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

National Nutrient Database for Standard Reference

http://ndb.nal.usda.gov/ndb/search/list