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Preventing osteoporosis

Last Update: April 9, 2014; Next update: 2017.

As people get older, it is normal for their bones to become weaker and their risk of fractures to increase somewhat. But in osteoporosis bones become less dense earlier and faster. Measures to prevent osteoporosis from developing can be particularly important for women and people with specific risk factors.

Osteoporosis does not cause any symptoms at first. The first sign of osteoporosis is often a bone fracture – and by that point quite a lot of bone tissue has usually already broken down. Some people are at a greater risk of having brittle bones, including older post-menopausal women, men over the age of 65, and people who have a family history of osteoporosis or are overweight. Lack of exercise, smoking and the use of some medications play a role too.

Not all risk factors can be influenced. But there are some things that you can do to help strengthen your bones:

  • make sure that you get enough calcium and vitamin D,
  • stay physically active – this will help prevent breakdown of bone tissue,
  • do not smoke.

How much calcium do we need?

The mineral calcium is important for making bone tissue and for the stability of our teeth and nails. As we grow older, we need more calcium. Eating a diet that is rich in calcium can help to meet this need. The German Osteology Association (DVO) recommends between 1,000 and 1,500 mg of calcium a day. The DVO is an association of scientific societies that promote research related to bone health and issue recommendations related to bone diseases.

What are the advantages and disadvantages of calcium supplements?

Calcium supplements can help people who do not manage to get enough calcium in their diet. But the DVO recommends that people only take calcium supplements if they actually have a calcium deficiency. This is because high doses of calcium can have side effects. The German Federal Institute for Risk Assessment (BfR) recommends not taking more than 500 mg of calcium per day as a supplement to the calcium in your diet.

It is difficult to say what can be expected from taking calcium supplements regularly. One systematic review of studies suggests that taking calcium supplements regularly for several years can prevent bone fractures in about 20 out of 1,000 people. But other studies do not clearly show that calcium can prevent fractures.

There may be a number of reasons for such contradictory results: for example, it is apparently quite important that the participants take the supplements regularly and as prescribed. But many people find this hard to do. In most of the studies the participants actually took only about half of the supplements that they were given. The results probably also depend on whether calcium was taken in combination with vitamin D, and how high the dose of the supplements was.

People who do not have a much higher risk of bone fractures and who get enough calcium in their diet will most likely not benefit from taking calcium supplements.

What possible side effects are there?

The main side effects of calcium supplements include constipation and kidney stones. One study involving nearly 1,500 post-menopausal women showed the following:

  • Without calcium supplements: 110 out of 1,000 women who did not take calcium supplements had constipation.
  • With calcium supplements: 180 out of 1,000 women who took calcium supplements had constipation.

This means that the calcium tablets caused constipation in 70 out of 1,000 women.

Kidney stones are less common. One large U.S. study with over 35,000 post-menopausal women found the following:

  • Without calcium supplements: 21 out of 1,000 women who did not take calcium supplements developed kidney stones.
  • With calcium supplements: 25 out of 1,000 women who took calcium supplements developed kidney stones.

In other words, 4 out of 1,000 women developed kidney stones because they took calcium supplements. It might be possible to lower this risk by drinking more water.

In both of the studies the women took 1,000 mg of calcium per day. These side effects might be less common at a lower dose of 500 mg.

One team of researchers suspects that calcium supplements might increase the risk of heart attack. But this claim is disputed – and there is no evidence of a higher risk if you stay under the maximum dose recommended by the DVO and do not get more than a daily total of 1,500 calcium from your diet and calcium supplements.

What role does vitamin D play?

As well as covering your calcium needs, it is also important to get enough vitamin D. Vitamin D helps bones to absorb enough calcium. Most of the vitamin D in our bodies is also produced there. Our bodies need enough sunlight (UV rays) to do so. But vitamin D can also be found in food or dietary supplements.

You do not need to sunbathe to make enough vitamin D in your skin. And just small amounts of UV rays can be a problem for people with a fair complexion and sensitive skin. Depending on your skin type, the German Federal Institute for Risk Assessment (BfR) recommends spending 5 to 15 minutes per day in the sun during the summer months, and 10 to 25 minutes per day in the sun in spring and fall. It is enough to have your face and hands exposed to the sunlight, and – if it is warm enough – parts of your arms and legs too. In winter, the vitamin D that the body needs is largely supplied by stores built up in the body.

Vitamin D can also be taken as a dietary supplement. Previous studies have not clearly proven that this can prevent bone fractures, though.

Amounts of vitamin D are measured in international units (IU), a fixed amount for the dose of a given substance. The World Health Organization (WHO) recommends that people over the age of 65 get 600 IU vitamin D in their diet per day. The German Federal Institute for Risk Assessment (BfR) recommends that they should not take more than 400 IU vitamin D per day as a supplement. Some dietary supplements, even those with a combination of ingredients, may contain a higher dose than this in a single tablet, so it is important to check the ingredient information on the package in order to stay below this maximum dose.

Are calcium and vitamin D supplements a good idea for people in need of nursing care?

Two studies looked at whether people who are in need of nursing care, and no longer very mobile, benefit from taking calcium and vitamin D supplements. They might have an especially high risk of bone fractures because they spend so little time out in the sun and often no longer get enough exercise.

The studies suggest that a combination of calcium and vitamin D can prevent bone fractures in a small proportion of these people. The study participants took 1,200 mg calcium and 800 IU vitamin D per day in addition to their usual diet.

  • Without calcium and vitamin D: About 13 out of 100 people in need of nursing care who did not take additional calcium and vitamin D had a hip fracture within two years.
  • With calcium and vitamin D: About 12 out of 100 people in need of nursing care who took additional calcium and vitamin D had a hip fracture within two years.

In other words, when people who were in need of nursing care and were not very mobile regularly took calcium and vitamin D supplements along with their usual diet, hip fractures were prevented in about 1 out of 100 of them over the next two years.

How important is exercise for healthy bones?

In general, a lack of exercise is one risk factor for developing osteoporosis: People who (have to) spend most of the day sitting or lying are at a greater risk of developing osteoporosis. Physical activities that require you to carry your own body weight help to promote bone growth. One example of such an activity is walking, but not swimming.

The key question is whether normal daily activity is enough to prevent osteoporosis or whether it is a good idea to get more exercise. Many studies involving post-menopausal women looked into this question. Overall, the studies show that women who do extra exercise in addition to their routine daily activities have a higher bone density. Fewer studies followed up on whether the extra exercise also lowers the risk of bone fractures. This is suggested by one of the studies in which the participants did relatively intensive exercise.

Physical activity is always associated with risk of injury, but it can also give you confidence in your own body and improve physical fitness and coordination. Whatever type of exercise you do – whether it is low-intensity exercises or sports – it is important to make sure it fits your own level of fitness, and to take care not to trip or fall.

One of the easiest types of exercise with a relatively low risk of injury is brisk walking. Most people can still do this in older age too.

Does it help to quit smoking?

Middle-aged and older people who smoke are at a greater risk of osteoporosis and bone fractures than people who do not smoke. There are a number of different scientific theories as to why smoking is bad for your bone health. It is believed that nicotine or cadmium may have a toxic effect on the bones or that smoking could affect the ability of bones to absorb calcium.

Aside from the likely harmful effects of smoking on bone health, there are many other health-related reasons to quit smoking.


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  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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