Osteoporosis occurs when the body either loses too much bone, makes too little bone, or both (National Osteoporosis Foundation, n.d.).
It develops slowly over several years and at the early stages it is very much a silent disease; once underway, it might manifested by visible symptoms such as height loss and stooped posture.

Back pain is very common in patients with osteoporosis, and because the bones have weakened, a bone fracture can occur easier than expected (Mayo Clinic, 2016).
In fact, in many unfortunate cases, patients might not be aware of the condition until they break a bone (Medlineplus, 2014).

Osteoporosis risk factors

Anyone can develop osteoporosis, but women from a white ethnicity background are at greater risk. This is because bone mass is approximately 30% less in women than men and 10% less in white than black people (Craig, 2013). Also, osteoporosis occurs mostly in postmenopausal women because of the bone mineral density loss during menopause that is linked to estrogens (Cauley, 2015). Other risk factors are:

  • Hormone-related conditions such as hyperthyroidism, reduced amounts of estrogen or testosterone, hyperparathyroidism, disorders of the pituitary gland, disorders of the adrenal glands.
  • A family history of osteoporosis
  • Parental history of hip fracture
  • A body mass index (BMI) of 19 or less
  • Long-term use of high-dose oral corticosteroids (widely used for conditions such as arthritis and asthma), which can affect bone strength
  • Having an eating disorder, such as anorexia or bulimia
  • Heavy drinking and smoking
  • Rheumatoid arthritis
  • Malabsorption problems, as experienced in coeliac disease and Crohn’s disease
  • Some medications used to treat breast cancer and prostate cancer which affect hormone levels
  • Long periods of inactivity, such as long-term bed rest

(NHS Choices, 2016.)

Osteoporosis prevention

To prevent or minimize the chances of bone mass loss problems, there are some lifestyle factors that can have a very positive impact on osteoporosis. These are adding a variety of exercises (strength training, flexibility, stability and balance exercises), limiting or eliminating alcohol intake, and quitting smoking.

Additionally, healthy eating can provide essential nutrients for bone health such as calcium (National Osteoporosis Foundation, n.d) potassium, fluoride, magnesium, zinc, copper, boron and manganese. Deficiency in those nutrients is linked with reduced bone mass or slow healing of fractures (Jugdaohsingh, 2007). Vitamin K is also essential for bone health. In fact, one or more servings per day of Vitamin K-rich green vegetables is associated with a 45% reduced risk of bone fracture. In contrast, 3 or more cups of coffee a day, increased the risk of hip fracture by 53%.

Exposure to sun is another essential way of taking care of our bones. This is because the human body needs sunlight to produce vitamin D which is essential for absorbing Calcium and Magnesium.
The advantage of sun exposure is the natural regulation of vitamin D production and protection from its toxicity (compared to a vitamin D supplement). The intake, however, depends on factors such as season, time and length of day, cloud cover, smog, skin melanin content, and sunscreen usage (NIH, 2016.). The downside of sun exposure is that prolonged periods of it can increase the risk of skin cancer. A doctor can calculate the needed time of exposure based on your skin color, condition and external factors. People who stay indoors must be aware that UVB radiation which is needed for vitamin D production, does not penetrate glass.

Doctors also have a variety of prescription and over the counter drugs in their toolbox to use against osteoporosis. According to a study, however, the efficacy of some osteoporosis drugs has only been shown if vitamin D and calcium supplements were concurrently given (Rachner, Khosla, Hofbauer, 2011).

Calcium and Vitamin D supplements

The two most prescribed supplements in osteoporosis, are Calcium and vitamin D.

  • Vitamin D comes in many forms, but supplements and fortified food contain the D2 form of the vitamin, which is made by plants, and D3 which is made by human skin when exposed to sunlight. It is usually suggested that patients take 100-200,000 IU of vitamin D2 or D3 every day for up to six months, and 800-1,500 milligrams of calcium (Natural Standard, 2013). Supplements should be taken under the supervision of a healthcare provider to ensure their efficiency; Their safety should be monitored as well, since supplements can side effects and malignant interactions with other minerals; for example Vitamin D increases aluminum absorption which is contained in most antacids (WebMD, n.d.).
  • Calcium comes from many forms that have different levels of bioavailability. Some of the variations of calcium levels and forms in different supplements are listed below:
  1. Calcium carbonate: 40%
  2. Tricalcium phoshate: 38%
  3. Dicalcium phosphate 31%
  4. Oyster shell 28% (may contain lead)
  5. Dolomite 22% (may contain lead)
  6. Calcium citrate 21%
  7. Calcium lactate 13%
  8. Calcium gluconate 9%

To ensure optimal absorption, calcium supplements must be taken with meals in divided doses, but they should not been taken at the same time with drugs such as levothyroxine, antibiotics in the tetracycline family, and phenytoin because their absorption decreases. (Sunyecz, 2008) Interaction with Ceftriaxone (Rocephin) can be fatal even if they are not taken at the same time with calcium (FDA, n.d) Therefore ,a consultation with a doctor is very important before the use of any kind of supplements.


In conclusion, it is important to maximize bone mass while the body matures, while minimizing the rate of bone loss during aging. (Craig, 2013) Healthy choices can prevent, eliminate or reduce several health-related conditions and osteoporosis is one of them.

Resat Alagiali

References and Bibliography

Choices, N.H.S., 2016. Osteoporosis – NHS Choices [WWW Document]. URL http://www.nhs.uk/conditions/Osteoporosis/Pages/Introduction.aspx (accessed 12.24.16).

National Osteoporosis Foundation. What is Osteoporosis and What Causes It? [WWW Document], n.d. . National Osteoporosis Foundation. URL https://www.nof.org/patients/what-is-osteoporosis/ (accessed 12.24.16).

Medlineplus, (2014) Osteoporosis [WWW Document]. URL https://medlineplus.gov/osteoporosis.html (accessed 12.24.16).

National Institute of Health (2016). Office of Dietary Supplements. Vitamin D [WWW Document]. URL https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ (accessed 12.25.16).

Natural Standard, (2013). Vitamin D Background [WWW Document], n.d. URL http://www.mayoclinic.org/drugs-supplements/vitamin-d/background/hrb-20060400 (accessed 12.25.16).

Craig, W. (2013). Nutrition and Wellness. 2nd ed. Berrien springs, Michigan: Golden Harvest.

Rachner, T. D., Khosla, S. and Hofbauer, L. C. (2011) ‘Osteoporosis: Now and the future’, The Lancet, 377(9773), pp. 1276–1287. doi: 10.1016/S0140-6736(10)62349-5.

Vitamin D | FAQs | Food Safety Authority of Ireland (no date). Available at: https://www.fsai.ie/faq/vitamin_d.html (Accessed: 17 February 2017).

Jugdaohsingh, R. (2007) ‘Silicon and bone health.’, The journal of nutrition, health & aging. Europe PMC Funders, 11(2), pp. 99–110. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17435952 (Accessed: 17 February 2017).

Calcium/Vitamin D – National Osteoporosis Foundation (no date). Available at: https://www.nof.org/patients/treatment/calciumvitamin-d/ (Accessed: 17 February 2017).

Research, C. for D. E. and (no date) ‘Drug Safety Information for Heathcare Professionals – Information for Healthcare Professionals: Ceftriaxone (marketed as Rocephin) 9/2007’. Center for Drug Evaluation and Research.

Sunyecz, J. A. (2008) ‘The use of calcium and vitamin D in the management of osteoporosis.’, Therapeutics and clinical risk management. Dove Press, 4(4), pp. 827–36. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19209265 (Accessed: 18 February 2017).

Riggs, B. L. (2000) ‘The mechanisms of estrogen regulation of bone resorption.’, The Journal of clinical investigation. American Society for Clinical Investigation, 106(10), pp. 1203–4. doi: 10.1172/JCI11468.

Cauley, J. A. (2015) ‘Estrogen and bone health in men and women’, Steroids, 99, pp. 11–15. doi: 10.1016/j.steroids.2014.12.010.

VITAMIN D: Uses, Side Effects, Interactions and Warnings – WebMD (no date). Available at: http://www.webmd.com/vitamins-supplements/ingredientmono-929-vitamin d.aspx?activeingredientid=929 (Accessed: 20 February 2017).

Moon, J., Davison, A. and Bandy, B. (1992) ‘Vitamin D and aluminum absorption.’, CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. Canadian Medical Association, 147(9), pp. 1308, 1313. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1340782 (Accessed: 20 February 2017).



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