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Osteoporosis

Lifestyle modifications

NUTRITION

  • A healthy nutrient rich diet (3)

  • Adequate vitamin D (women: 800 IU/day) and calcium intake (women: 1200mg/day from diet or supplements) for maintaining good bone health (1, 6). However there is mixed evidence for vitamin D and calcium supplementation reducing fracture risk (1)

  • Avoid heavy alcohol intake (5). Alcohol intake is a risk factor for osteoporosis (3)

  • Compared to abstainers, persons consuming 0.5-1 drinks a day have 1.38 times the risk of developing osteoporosis (4)

  • Protein intake: There is mixed evidence on a high protein intake and bone density. Some studies show that increased protein intake reduces the risk of hip fractures, while other studies suggest that a high protein intake may increase bone resorption and calcium excretion (5)


PHYSICAL ACTIVITY

  • Regular exercise, preferrably weight bearing, which help maintain good bone health (1, 5)

  • Balance training reduces the risk of falling (1)

  • Exercises that increase muscular strength and improve balance may be the most beneficial (5)

  • Exercise improve bone mineral density of the lumbar spine. There is however uncertainty about the recommended dose, frequency and type of activity (1)

  • Exercise reduces the risk of (osteoporotic) fractures (5)

  • Prevention: Regular exercise plays a role in prevention of osteoporosis in people over 65 years of age, improving BMD of the lumbar spine and hip (2) 

  • Excessive exercise in premenopausal women may cause amenorrhea and weight loss leading to osteoporosis (5)


SMOKING

  • Smoking cessation reduces the risk of fractures (3)

  • Smoking one pack of cigarettes per day throughout life is associated with 5-10% reduction in bone density (5)

  • Smoking may also reduce the effectiveness of estrogen therapy (5)


WEIGHT

  • Maintaining optimal body weight (3)


Prevention

  • Recomended intake of calcium: 1000mg/day (men) and 1200mg (women). Vitamin D: 800-1000 IU/day (2, 5). Higher vitamin D doses in some people may be necessary (2)

  • A diet high in high in fruit and vegetables, fish, poultry and whole grains reduces the risk of low BMD and hip fractures (3)

  • A typical western dietary pattern high in processed and red meat, animal fat, refined sugar and soft drinks may increase the risk of low BMD and hip fractures (3)

  • A vegan diet is associated with increased risk of fractures (3)

References

Resources

Evidence Pyramid

EXPLANATION TO EVIDENCE PRESENTATION

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Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD

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Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE

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Evidence based on randomized controlled trials is written in plain font

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Evidence based on observational / cohort studies is written in CURSIVE

Figure: Evidence pyramid

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