Non-pharmacological strategies for osteoporosis focus on dietary intake, physical activity, and lifestyle modifications to reduce fracture risk and enhance bone health. Adequate calcium and vitamin D intake are crucial for bone density maintenance, with dietary sources and supplements playing key roles.
The recommended daily intake for calcium is 750mg but is safe to consume up to 2500mg, finding sources of calcium is easiest in dairy products which can present a challenge for those with osteoporosis and to dairy intolerance. To consume 300 mg of calcium the portion size of these high calcium foods would be;
Milk 250ml
Cheese 48g
Almonds (with skin) 115g
Soy drink calcium enriched 300ml or 2.5 liters if not calcium enriched.
Spinach 215g
Weight-bearing exercises, such as walking, jogging, and strength training, have been shown to improve bone mineral density and muscle strength, reducing fall risk. Balance and flexibility exercises, including tai chi and yoga, help prevent falls by enhancing stability and coordination.
When investigating the effects of exercise intensity on increasing bone density a review of many studies found that low and medium intensity exercise was not effective at increasing bone density and that only high intensity exercise was associated with increased bone density. However, it should be noted that high intensity exercise should be completed only after appropriate preparation is done before to reduce the risk of injury from intense exercise. Therefore resistance training using >80% of maximal weight for 6 or less repetitions appears a more safe option for persons with osteoporosis.
Table 1; Classification of exercise intensity (Kistler-Fischbacher, M., et al., 2021).
Additionally, lifestyle changes, such as quitting smoking and reducing alcohol consumption, are essential, as these factors negatively impact bone health. Fall prevention strategies, like improving home safety and using assistive devices, are critical for elderly individuals. Collectively, these non-pharmacological interventions are effective in managing osteoporosis and reducing fracture incidence.
References:
Tang, B. M., et al. (2007). "Calcium intake and bone mineral density: systematic review and meta-analysis." BMJ, 335(7617), 1039.
Bischoff-Ferrari, H. A., et al. (2005). "Effect of vitamin D on falls: a meta-analysis." JAMA, 293(16), 2257-2264.
Martyn-St James, M., & Carroll, S. (2006). "Meta-analysis of walking for preservation of bone mineral density in postmenopausal women." Bone, 39(3), 524-532.
Sherrington, C., et al. (2008). "Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations." New South Wales Public Health Bulletin, 19(3-4), 72-78.
Kanis, J. A., et al. (2005). "Smoking and fracture risk: a meta-analysis." Osteoporosis International, 16(2), 155-162.
Kistler-Fischbacher, M., et al., (2021) “The effect of exercise intensity on bone in postmenopausal women (part 1): A systematic review.” Bone 143 15596, 1-61.
Biver, E. et al. (2023) ‘Dietary recommendations in the prevention and treatment of osteoporosis’, Joint Bone Spine, 90(3), p. 105521. doi:10.1016/j.jbspin.2022.105521.
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