You think there's nothing you can do to prevent osteoporosis. But the truth is, no matter your age, you can make changes that stop the disease in its tracks. Learn how to fracture-proof your body with this three-part plan and testing advice.
Preventing Osteoporosis  
Just as muscles grow stronger the more you use them, a bone becomes denser when you place demands on it—certainly until your early 30s. The best bone-building exercise is resistance training—lifting free weights, using the resistance machines at the gym, even Pilates and yoga. But any kind of weight-bearing exercise—where your legs support your body—helps prevent osteoporosis (jogging and dancing count; swimming and stationary bicycling are not weight bearing and therefore are less helpful). And it's never too late to start, according to several studies. In one, postmenopausal women who lifted weights for 45 minutes twice a week for a year increased their bone mass by 1 percent, while the control group, which did no resistance training, lost 2 to 2.5 percent. Experts recommend doing weight-bearing exercise at least four times per week for 30 to 60 minutes and resistance training two or three times, long enough to work each muscle group.

Preventing Osteoporosis
Every woman under 51 should be aiming for 1,000 milligrams of calcium a day. Raise that to 1,200 after menopause. Most women are falling short. To figure out how you're doing, add up the servings of yogurt, cheese, milk and calcium-fortified orange juice or cereal you tend to get every day. One serving is an average of 300 milligrams. Recently, there's been some controversy about whether or not dairy products are a good source of calcium. A few experts are arguing that these foods actually leach the mineral from your bones (they reason that the dairy proteins raise levels of sulfur-containing amino acids in your blood that the body then must neutralize with calcium it raids from your skeleton). But Robert Heaney, M.D., of Creighton University in Omaha, one of the country's top calcium experts, says not to worry: He has analyzed scores of randomized studies showing that dairy foods help keep bones strong.

The advice about supplements can get as finicky as the mineral itself. Calcium isn't easily absorbed in large amounts, so it's best to break up your daily intake into two to three doses and to take it with meals, says Heaney. For the calcium to reach your bones, you need to make sure you're getting 200 international units (IU) of vitamin D a day if you are 50 or younger; 400 IU, ages 51 to 69; 600 IU, 70 and older. Your body probably produces enough of the vitamin if you simply step out into the sunlight every day. But you may need to take a D supplement if you're supervigilant about sunscreen or if you're African-American, since melanin acts as a shield. You may have heard that supplements with calcium citrate are absorbed more easily than the calcium carbonate found in antacids, but Heaney says the evidence for both is equally strong. And if you can't be bothered with rules, just down your daily quotient all at once. It's better than not taking any at all.

Preventing Osteoporosis
Calcium and exercise can only do so much. Andrea, 46, a lawyer in San Francisco who asked that her last name not be used, had a heel scan at a health fair, which indicated she was in the danger zone. When a DXA scan confirmed she was osteopenic, her doctor prescribed Fosamax, which prevents the tiny cracks caused by the osteoclasts. The drug, along with a similar drug, Actonel, has been approved to treat osteopenia—but because the osteoclasts don't get truly destructive until after menopause, the approval is only for postmenopausal women. If a woman simply has delicate bones, there's no evidence either drug will help. "I'd rather err on the side of prevention," says Andrea, who hasn't hit menopause yet. She knows several other women in their 40s whose doctors put them on the drug as well.

"That's my worst fear," says the NORA study's Siris. "A woman in her 30s or 40s finds out she has low bone density and her doctor puts her on expensive drugs she doesn't need. It's incorrect for a healthy premenopausal woman to be on Fosamax." Evista, a third drug approved to treat osteopenia in postmenopausal women, is a Selective Estrogen Receptor Modulator, or SERM, which acts like estrogen in some parts of the body but not others. Though Evista is known to slow bone loss in postmenopausal women, it has never been studied for this purpose in younger women. And last November, the first drug that actually stimulates bone growth, Forteo, was approved by the FDA, but again only for women who've been through menopause (it involves a daily injection). None of these drugs has been studied for long-term safety.

Medication is an option for postmenopausal women with osteopenia, although even then, there's no need to rush into it. No one goes from osteopenia to osteoporosis in a year. "If your bone density is low, you might decide you want to get on one of those drugs, and that's a reasonable choice. Or you might wait and get retested in a year," says Siris. The good news is that the osteoporosis drugs have dramatically helped women who already have the disease, reducing their fracture risk by as much as half.

Many experts think it makes sense to get tested at menopause, or even earlier so you have a baseline score to compare later scans. The peripheral heel or wrist scan has been shown to be an accurate initial screening tool; if you get a low score, you should follow up with a DXA scan. "My personal opinion is that all women at menopause should be tested," says Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation. "But we can't recommend that officially, because it would cost too much." So for now, the foundation advises that women first get tested at menopause only if they have certain risk factors, including: a small frame or weight of less than 127 pounds, a family history of osteoporosis, a personal history of fracture after age 50 or a smoking habit. Otherwise, you're counseled to wait until you turn 65. After that, new guidelines from the U.S. Preventive Services Task Force recommend screenings at least every two years.

Whenever you do get tested, try not to panic about the results. It's normal to be worried about your bones if your mother has osteoporosis or if you are a slender white woman who hates milk and loves pinot noir. And it's right to want to take charge of your health. "But the thing to remember," says Siris, "is that if you have osteopenia, it doesn't mean your bones are going to fall apart overnight. And there's a lot you can do to keep them strong right now."


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