What Women Can Do To Prevent and Treat Osteoporosis

By: Holly L. Thacker, MD • Posted on May 08, 2022

Women are four times more likely to develop osteoporosis compared to men. After age 35, women’s bones start breaking down more than building up, resulting in a gradual loss of bone mass. According to the Bone Health & Osteoporosis Foundation, approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis.

But there is good news! There are steps women can take to prevent osteoporosis from every developing. And there are treatments available that can slow the rate of bone loss if osteoporosis is already present. Any fragility fracture (a broken bone that occurs after a fall from a standing position) is considered Clinical Osteoporosis. A bone density (DXA-Dual-Energy X-Ray Absorptiometry) with Trabecular Bone Scoring and with clinical assessment can categorize a person into low risk, moderate risk, high risk and very high risk for fractures. Osteoporotic fractures can lead to immobility, more fractures and even death.

7 Ways Women Can Help Prevent Osteoporosis

1. Proper Nutrition

Consuming a diet rich in calcium throughout your life, including dairy products, fish with bones, leafy green vegetables, almonds and bread.

2. Weight-Bearing Exercise and Balance Training

Weight-bearing exercise is physical activity performed while standing that allows you to use your own weight and works the bones and muscles against gravity. Those exercises include:

Strength training
Brisk walking
Jogging
Dancing
Kickboxing
Hiking

3. Calcium in the Diet

It is best to get calcium from your everyday diet. Skim milk is an excellent source of dietary calcium as well as low-fat dairy products such as yogurt and low-fat cheese.

If you want to avoid dairy because of an allergy or intolerance, there are non-dairy milks such as almond, coconut and soy milk that are all rich in calcium.

4. Calcium Supplement

If you are not getting enough calcium from your diet, you can take a calcium supplement. Most people need 1,000 to 1,200 mg per day in divided doses.

If you're on calcium supplements because you don't get enough in your diet and you are getting constipated, you may want to add a magnesium supplement - about 250 to 400 mg per day - if you don’t have kidney failure.

However, if you've had a history of kidney stones and you have low calcium in your diet, the only supplement of calcium you should take is calcium citrate. There is no need to add other substances to the calcium.

5. Vitamins K2 and D3

Vitamin K2 can be obtained by eating a healthy diet with green, leafy vegetables. You don't need to take supplements with heavy metals in them - boron and strontium is not specifically recommended. And adequate levels of vitamin D and estrogen help the gut absorb calcium in the diet.

6. Estrogen/Hormone Therapy/SERM therapy

Hygienic and lifestyle measures do not treat estrogen deficiency, so that’s when hormone therapy can be used to prevent and treat osteoporosis. However, some women will lose bone density despite being on estrogen, so they still need to be followed by their physician. SERM (estrogen agonist estrogen antagonist) therapy like with Evista (raloxifene) reduces bone loss in the spine and reduces ER positive breast cancer and does not stimulate the uterus and is not a hormone. This is an option for women without hot flashes or blood clot risk who want to reduce Osteoporosis risk and breast cancer risk

7. Medications

Prolia® (denosaumb)

Prolia (denosaumb) is an effective osteoporosis medication. Each shot only lasts for six months. There has been long-term data on this medication, which acts like a natural substance in the body to regulate the bone break-down and build-up process. If you stop therapy, you will resume bone loss. Therefore, you need to be periodically monitored by your physician every year. Prolia is an excellent, well-studied medication that is generally well-tolerated by most women. We have long term data for 10 years. The nurse injects this medicine subcutaneously every 6 months PLUS one day

Forteo® (teriparatide)

Forteo is a drug that improves bone density. Forteo is an anabolic bone-building drug given by injection for 2 years. It needs to be refrigerated.
Bonsity™ is a bio similar injectable medicine to Forteo/(teriperatide) and can be used for 2 years.

Tymlos® (abaloparatide)

Tymlos (abaloparatide) is another FDA-approved medication that is an anabolic bone-building agent. It does not need to be refrigerated.

Evenity® (romosozomab)

Evenity (romosozumab) is a monthly subcutaneous infection by a nurse for 12 months of an anabolic agent that build up bone. It is a sclerostin inhibitor that has dual mechanism of action.
All anabolic agents need to be followed up with anti-resorptive therapies such as a bisphosphonate or RANK-Ligand inhibitor such as Prolia to maintain the gains in bone density.

It's best for you to visit with your bone specialist physician to determine what the best course of therapy is for you. We have a robust menu of therapies. The sequence and timing of therapy is important. In high risk women, anabolic bone building therapy is generally preferred BEFORE anti-resorptive therapy.

Bisphosphonates (oral and intravenous)

Generally, after 5 to 10 years of being on a anti-resorptive medication such as Actonel® (risedronate), Fosamax® (alendronate), Boniva® (ibandronate), or IV Reclast® (zoledronic acid) some physicians may recommend a "drug holiday" if you are otherwise stable and not at high risk for fracture. Typically, "drug holidays" are around two years and then the patient is re-evaluated with bone density and clinical assessment.

Be Strong, Be Healthy, Be in Charge!

-Holly L. Thacker, MD

About Holly L. Thacker, MD, FACP

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Specialized Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Dr. Thacker is also the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause. Her special interests and areas of research including menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health.

women's health, osteoporosis, bone health, bone density, bone mass, bones, nutrition, exercise, calcium, vitamin K2, vitamin D, estrogen, hormone therapy, dr. holly thacker, Dr. Thacker

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