4 Osteoporosis Prevention Counseling Points

Genetics and lifestyle factors play an important role in determining a person’s risk of developing osteoporosis. Unfortunately, osteoporosis is considered a silent disease until fractures occur. It is estimated that a 10% increase of peak bone mass in all children reduces the risk of an osteoporotic fracture during adult life by 50%.¹ Individuals typically achieve peak bone mass in early adulthood around the mid-20s.¹ Pharmacists can play an important role in osteoporosis prevention education.

Here are 4 osteoporosis counseling points:

1. Recommend adequate calcium and vitamin D for bone health.

The National Osteoporosis Foundation recommends that women 50 years of age and younger and men 70 and younger receive 1,000 mg of calcium per day and women 51 and older and men 71 and older need 1,200 mg per day.² There is mixed evidence regarding whether calcium supplements are associated with an increased risk of cardiovascular disease adverse events.³ The National Osteoporosis Foundation and American Society for Preventive Cardiology published a clinical guidance document discussing dietary calcium and supplements that do not exceed 2000 to 2500 mg per day should not cause cardiovascular issues.⁴

Recommend that patients try to obtain calcium from the diet and to use supplements to make up for what is lacking. Dairy products, such as milk, yogurt, and cheese are high in calcium. Educate patients that food labels list calcium as a percentage of the daily value (DV) based on 1,000 mg per day.² If the product says 30% DV of calcium, then this equals 300 mg of calcium.² Calcium carbonate and citrate contain the most elemental calcium out of the products. Patients should take calcium carbonate with food. Individuals taking acid blockers should take calcium citrate, as it will be better absorbed since food is not needed.

Vitamin D assists the body with absorbing calcium, and individuals under 50 years of age should receive 400-800 International units daily. Patients 50 and older should receive 800-1,000 International units daily. Check out my recent article for more information regarding vitamin D.

2. Exercise is important for bone health.

Recommend weight-bearing and muscle strengthening exercises for building and maintaining bone density. Patients should check with their physician regarding which exercises are safe, depending on medical history. Examples of weight bearing exercises include dancing, aerobics, tennis, hiking, stair climbing, running, walking, treadmill, and elliptical training machines.⁵ Muscle strengthening exercises include lifting weights and using elastic exercise bands.⁵

3. Alcohol and caffeine drinks may increase the risk of osteoporosis.

Excessive alcohol drinking is not healthy and can lead to bone loss. Coffee and soft drinks may decrease calcium absorption and also contribute to bone loss. However, recent studies show that coffee has many health benefits and can even decrease mortality.⁶ Therefore, coffee in moderation of three cups or less per day should be fine.

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4. Monitor patients for medications associated with drug induced osteoporosis.

Pharmacists can play an important role in preventing drug induced osteoporosis. These medications include glucocorticoids, proton pump inhibitors (PPIs), and chemotherapy drugs.⁷ Studies have suggested many adverse effects are associated with long-term use of PPIs such as increased fracture risk.⁸ Deprescribing PPIs may help to prevent long-term use in certain patients and prevent osteoporosis.⁸

References

• International Osteoporosis Foundation. Preventing osteoporosis. https://www.iofbonehealth.org/preventing-osteoporosis. Accessed March 26, 2018.
• National Osteoporosis Foundation. Calcium/vitamin D. https://www.nof.org/patients/treatment/calciumvitamin-d/. Accessed March 26, 2018.
• Anderson JJ, Kruszka B, Delaney JA, et al. Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults: 10-year follow-up of the multi-ethnic study of atherosclerosis (MESA). J Am Heart Assoc. 2016; 5(10):e003815.
• Kopecky SL, Bauer DC, Gulati M, et al. Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults: A clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology. Ann Intern Med. 2016; 165(12):867-868.
• National Osteoporosis Foundation. Osteoporosis exercise for strong bones. https://www.nof.org/patients/fracturesfall-prevention/exercisesafe-movement/osteoporosis-exercise-for-strong-bones/. Accessed March 27, 2018.
• Mayo Clinic. Does coffee offer health benefits? https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/coffee-and-health/faq-20058339. Accessed March 27, 2018.
• Panday K, Gona A, Humphrey MB. Medication-induced osteoporosis: screening and treatment strategies. Ther Adv Musculoskelet Dis. 2014; 6(5):185-202.
• Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors. Can Fam Physician. 2017;63:354-64.