Osteoporosis primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S.[3]

Overview

Changes in lifestyle and calcium supplementation are the best early and long-term measures for the prevention of osteoporosis. There are also medications available that can be used to prevent worsening of osteoporosis. Pharmacologic treatment can stabilize bone mineral density, prevent further bone loss, and reduce the risk of fractures, however it is unlikely to restore bone quality and strength. The prevention of osteoporosis is particularly important because the microarchitechtural changes that occur in osteoporosis are largely irreversible.

Primary prevention

Lifestyle

There are various lifestyle modifications that can be implemented to help prevent the development of osteoporosis.

• Exercise - exercise promotes the mineralization of bone, and bone accumulation particularly during growth. High impact exercise in particular has been shown to prevent the development of osteoporosis, however high impact exercise can have a negative effect on bone mineralization in cases of poor nutrition, such as in anorexia nervosa and celiac disease
• Nutrition - a diet high in calcium and vitamin D prevents bone loss. Patients at risk for osteoporosis, such as persons with chronic steroid use are generally treated with vitamin D and calcium supplementaton. In renal disease, more active forms of Vitamin D such as paracalcitol or (1,25-dihydroxycholecalciferol or calcitriol are used, as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol) which is the storage form of vitamin D.
• Quitting smoking helps prevent osteoporosis, as well as other diseases
• Not drinking alcohol, or drinking only in moderation
• Only taking certain medications linked to osteoporosis (anticonvulsants, corticosteroids) at the minimum dose and for the minimum amount of time needed