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Postmenopausal Osteoporosis Care Guidelines

Lifestyle Measures for Bone Health

Prepared by: Jennifer C. Braimon, MD

Medical Director, Endocrinology


Postmenopausal osteoporosis increases fracture risk, but targeted nutrition, exercise, and fall prevention strategies can meaningfully support bone strength and reduce complications.



Nutrition for Bone Health

Calcium

Daily goal: 1000 to 1200 mg

Take no more than 630 mg at one time, because your body can not absorb more than this at one time.


Start by estimating how much calcium you get from food. If a nutrition label lists calcium as a percentage, add a zero to estimate milligrams. Example: 30% calcium is approximately 300 mg.


Common Food Sources of Calcium

  • 8 oz milk or Lactaid: 300 mg

  • 8 oz fortified non-dairy milk: 300 to 450 mg

  • 8 oz orange juice with calcium: 350 mg

  • ½ cup tofu with calcium: 435 mg

  • ½ cup cooked dark leafy vegetables: 5 to 135 mg

  • 1 handful almonds: 200 mg

  • 1 cup figs: 250 mg

  • 1 oz sesame seeds: 300 mg

  • 1 cup flaxseed: 400 mg

  • 1 can sardines: 350 mg


If dietary intake is inadequate, supplement with 500 to 1000 mg elemental calcium daily in divided doses at mealtime to reach a total intake of approximately 1200 mg per day (including diet plus supplements).


Calcium Supplement Options

Calcium carbonate

Take with food.

  • Caltrate 600 + D3: 600 mg calcium carbonate; 800 units (20 mcg) vitamin D

  • Os-Cal + D: 500 mg calcium carbonate; 200 units (5 mcg) vitamin D

  • TUMS: 200 mg calcium carbonate

  • TUMS EX: 300 mg calcium carbonate

  • TUMS Ultra: 400 mg calcium carbonate

  • VIACTIV: 650 mg calcium carbonate; 500 units (12.5 mcg) vitamin D


Calcium citrate

Preferred if taking antacids or proton pump inhibitors.

  • Citracal Petite: 200 mg calcium citrate; 250 units (6.25 mcg) vitamin D

  • Citracal Max: 315 mg calcium citrate; 250 units (6.25 mcg) vitamin D

  • Citracal + D Slow Release: 600 mg calcium citrate + carbonate; 500 units (12.5 mcg) vitamin D


Vitamin D

Goal vitamin D level: greater than 40

Recommended intake: 1000 to 2000 units daily (total).

Vitamin D supports calcium absorption and overall bone health.


Overall Diet

  • Ensure adequate caloric intake to avoid malnutrition

  • Ensure adequate protein intake


Both are important to preserve muscle mass and bone strength.



Smoking and Alcohol

  • Smoking cessation is strongly recommended

    • Smoking 1 pack per day over years is associated with 5 to 10 percent loss of bone density

  • Avoid heavy alcohol use

    • More than 3 servings per day



Fall Prevention and Exercise

Reducing fall risk is essential to prevent fractures. Exercise is associated with decreased risk of hip fracture.

There is no evidence of greater benefit from high-intensity exercise, such as running, compared to lower-intensity exercise, such as walking.

Exercises that increase muscular strength and improve balance are most beneficial for fracture reduction because they decrease fall risk.


Weight-Bearing Exercise

Goal: 30 minutes most days of the weekSupports hip strength.

Examples include:

  • Walking

  • Jogging

  • Tai Chi

  • Stair climbing

  • Dancing


Resistance Training, Muscle-Strengthening, and Posture Exercises

Goal: 2 to 3 days per weekSupports spinal strength.

Example:

  • Weight training using 1 to 3 lb upper body weights


Strength and balance training are particularly important for reducing fall-related fractures.



Additional Resources

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