Contact Order Book How to Be a Savvy Patient reneenwman.com


Author interview

Bone density tests

Sample reports

My books

Osteo book info

Exercise Tips

Prevention 2019 versus 2002




























Author interview

Bone density tests

Sample reports

My books

Osteo book info
























Author interview

Bone density tests

Sample reports

My books

Osteo book info

Exercise Tips

Prevention 2019 versus 2002

 Welcome to avoidboneloss.com

A website created to help you prevent osteoporosis and select competent, education-oriented medical professionals. This web page gives preventive tips. Other avoidboneloss.com pages provide the following types of information:

    ■  Short answers to basic questions about osteoporosis

    ■  How to get maximum benefit from your bone density tests

    ■  How to be a savvy patient

    ■  Osteoporosis treatment in 2019 versus 2002 and suggestions for the next decade

    ■  How to get maximum benefit from exercise


This website also gives some background information about me under Author Interview. If you’re interested in buying supplements, drugs, herbs, or "miracle" cures for osteoporosis, you’d better go elsewhere. There are no shopping carts on this website or advertisements, except for links and information about my books. However, there is a strong emphasis on getting the right type of exercise and nutrition and on getting complete copies of your test results and discussing them with qualified professionals.


 Ten Tips for Preventing Osteoporosis

1. Keep active and exercise your entire body. Walking is not sufficient; it targets the feet, ankles and legs, not your hips, spine, shoulders and wrists. According to the U.S. Surgeon General "The evidence suggests that the most beneficial activity regimens for bone health include strength-training or resistance-training activities. These activities place levels of loading on bone that are beyond those seen in everyday activities." (Page 171 of Bone Health and Osteoporosis: A Report of the Surgeon General)

    For optimal results, you should have a well-rounded exercise program that targets the weak areas of your skeleton. For example, if you have low bone mass in your hips, it helps to add hip exercises such as squats, lunges, and single leg lifts and circles (side, front and back) with and without weights, and to use the hip adduction and abduction and leg press machines at a gym. Consult your doctor before beginning an exercise regime, start gradually, and have professionals verify that you’re doing exercises correctly. If you have osteoporosis, have a physical therapist show you which exercises are safest and best for you. For more detailed exercise advice, go to the webpage How to Get Maximum Bone Benefit from Exercise.  

    One way to get well rounded exercise and have fun at the same time is to join the YMCA or another fitness center that offers group classes such as Gold's Gym, LA Fitness, and 24 Hour Fitness. For around $30 to $40 per month, you can take as many classes as you wish and have access to their equipment and pool if they have one. If you are 65 or older, you may be able to have your gym fees paid for by your supplemental or Medicare Advantage insurance. For more information contact your insurance agent and http://www.silversneakers.com.

     Bodyworks and muscle conditioning classes are especially helpful for preventing bone loss. Avoid high impact exercise such as jumping because it can cause joint and spinal disc problems. There are better ways to build bone. People with arthritis and other physical problems can usually benefit from water exercise classes.

     Exercise is a key factor for avoiding bone loss in space. A September 2012 article from the Journal of Bone & Mineral Research (pp1896-1906) stated “astronauts who have access to sufficient resistance exercise, coupled with adequate energy intake and vitamin D status can return from spaceflight missions of 4 to 6 months with measured bone mass and BMDs seemingly no different from baseline measuresfor most skeletal regions” (p 1900). The article was entitled: Benefits for Bone From Resistance Exercise and Nutrition in Long-Duration Spaceflight: Evidence from Biochemistry and Densitometry.”   

     At the Bone Clinic in Australia, osteoporosis patients have increased their bone density and strength with heavy weight lifting www.theboneclinic.com.au.

For more information about their success, see the February 2018 Journal of Bone & Mineral Research Article  "High-Intensity Resistance and Impact Training improves Bone Mineral Density and Physical Function in Postmenopausal Women with Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial."


2. Get good nutrition. For example, in place of soda pop, drink vegetable juice, fruit juice with pulp, milk, green tea or water. Instead of doughnuts and packaged cookies, eat fruit desserts, frozen yogurt or home-made muffins. Instead of snacking on potato or corn chips, have some unsalted almonds or walnuts, which offer a variety of beneficial nutrients for your heart and your bones. Replace trans fats with poly- and monounsaturated fats by eating foods such as avocados, olives, nuts and fatty fish. A well-balanced diet with at least ten servings of fruits and vegetables including greens and sulfur rich vegetables such as kale, broccoli and cabbage is ideal. Your bones need more nutrients than calcium and vitamin D. They also need protein, magnesium, potassium, phosphorous, zinc, manganese, boron, Vitamin B12, Vitamin C, Vitamin K and other vitamins, which is why you should eat a variety of nutrient-dense foods.

     Besides including fruits, vegetables and calcium-rich foods in your diet, it's especially important to get adequate protein because protein makes up approximately 50% of the volume of bone. The high protein content of Western diets has been cited as a risk factor for osteoporosis or bone fractures, but many researchers disagree. The May 2008 issue of the Journal of Clinical Nutrition discusses various studies about the influence of the amount and type of protein on bone health. It concluded:

Despite a widely held belief that high-protein diets (especially diets high in animal protein) result in bone resorption and increased urinary calcium, higher protein diets are actually associated with greater bone mass and fewer fractures when calcium intake is adequate. Perhaps more concern should be focused on increasing the intake of alkalinizing fruits and vegetables rather than reducing protein sources. The issue for public health professionals is whether recommended protein intakes should be increased, given the prevalence of osteoporosis and sarcopenia. Currently, little or no attention is paid to ensuring adequate protein intake for elderly fracture patients. In the hospital setting, there should be nutrition protocols in place for hip-fracture patients that include higher protein and calcium intakes. Moreover, health professionals may need to be reeducated about the important role of protein in bone health.

3. Take vitamin and mineral supplements if you're not getting enough calcium, vitamin D, magnesium and other bone nutrients from your diet. The latest recommendations for vitamin D are higher than those in my book. Many doctors now recommend at least 800–1000 IU per day and in some cases 2000 IU per day. For best absorption, take Vitamin D with meals that contain some fat, because Vitamin D is a fat soluble vitamin. 

     The National Osteoporosis Foundation recommends 1000-1200 mg/day of calcium, including the amount you get from food and milk. Calcium is best absorbed when taken in amounts of 500 mg or less at one time. Taking calcium citrate instead of calcium carbonate may help prevent kidney stones if you drink enough water and don't over indulge in foods high in oxalates such as spinach and nuts. If you need to take a supplement in order to get adequate calcium, nutritionists recommend taking magnesium along with the calcium in order to maintain a good calcium/magnesium balance.

     Taking too much calcium or drinking too much milk will not make your bones stronger. I heard of one lady who in addition to taking 1500 mg/day of calcium also drank several glasses of milk hoping to increase her bone density. Instead, she developed heart arrhythmias and painful muscle cramping. After she reduced her total calcium intake and added magnesium to balance her calcium, her heart palpitations and cramping stopped. Too much of a good food or supplement can end up being harmful.

4. Avoid smoking and excessive drinking. They impair calcium absorption and inhibit the growth of bone-building cells.

5. Check for underlying factors for bone loss such as:

   ■ Excessive alcohol

   ■ Vitamin D deficiency

   ■ Bone-robbing drugs such as corticosteroids (e.g., prednisone), antiseizure medications, chemotherapy

   ■ Thyroid problems and excessive thyroid medication

   ■ Over-dieting

   ■ Antacids that contain aluminum. The aluminum can interfere with calcium absorption if you take too much.

   ■ Chronic kidney, liver or lung disease 

   ■ Malabsorption and inflammatory bowel disease, which can prevent the absorption of required bone nutrients. If you have intestinal problems and/or acid reflux, consult a doctor and try eliminating dairy products and gluten grains such as wheat, barley and rye. You may have food allergies. 

  6. If a resolution of the preceding factors is not possible or sufficient for preventing osteoporosis, consider taking preventive medication. Some doctors have stopped prescribing bisphosphonate drugs (e.g. Fosamax (alendronate), Actonel (risedronate), Boniva (ibandronate), and Reclast (zolendronic acid) for more than five years because studies have not shown a fracture benefit past five years. In addition, these doctors want to avoid over-suppressing their patients' bone turnover (the natural process of breaking down and building up of bone), which in turn may occasionally lead to unusual thigh bone fractures or a jaw-bone condition called osteonecrosis. In order to avoid potential negative effects of bisphosphonate drugs from long-term use and/or high doses, some patients prefer to take reduced dosages or only take them for a couple of years and then take a drug holiday for a year or two while monitoring their bone density before restarting the drug. For more information on over-suppression of bone remodeling see: Severely Suppressed Bone Turnover: A Potential Complication of Alendronate Therapy.

    Some of the most serious side effects have occurred in people who take a monthly or once-a-year bisphosphonate drug, particularly when it has been given intravenously and taken for a long period of time. For first-hand accounts of some drug reactions to a once-a-year bisphosphonate drug, go to


    If you need to take an osteoporosis bisphosphonate drug but would like to avoid possible flu-like symptoms, extreme bone and joint pain, and even a possible trip to the hospital, consider taking a once-a-week drug such as Fosamax or Actonel, rather than a once-a-month or once-a-year drug. It's common sense that the higher the dosage of a drug, the greater the chance of a negative side effect. Keep in mind that none of the osteoporosis drugs prevent loss of muscle. With proper exercise, you can maintain bone and avoid the muscle atrophy associated with aging. The generic form of Fosamax, alendronate, is the lowest priced osteoporosis drug on the market and is very effective at stopping and slowing bone loss. In addition it doesn't have any life-threatening side effects like those of some newer osteoporosis medications. Alendronate also continues to work after you stop taking it. I've taken it twice for a period of 1 to 2 years each time in a 16 year period and never had any side effects. By limiting the duration that I took it, I avoided oversuppressing my bone turnover. In my opinion, alendronate has helped me avoid bone fractures and a diagnosis of osteoporosis. My cost for a year's supply of alendronate in 2020 was just $8---($2 for a 3-month supply of twelve 70-mg-tablets). Most of the other osteoporosis drugs would have cost me thousands of dollars and would have had more risks.

   In 2010, another type of bone-loss-prevention drug called Prolia (denosumab) became available. It reduces the incidence of fractures and is administered with two injections per year. As with bisphosphonates, extended use of Prolia can occasionally lead to unusual thigh bone fractures and osteonecrosis of the jaw. When Prolia is discontinued, bone loss occurs and fracture risk increases.  Www.prolia.com provides information about the drug and states: It is not known if the use of Prolia® over a long period of time may cause slow healing of broken bones. The most common side effects of Prolia® are back pain, pain in your arms and legs, high cholesterol, muscle pain, and bladder infection.

     Unlike the previous drugs which are designed to slow bone loss, another injectable drug called Forteo (teriparatide) can actually create bone. It's generally reserved for patients with advanced cases of osteoporosis who have a high fracture risk. Forteo is very expensive (about $40,800/year) and cannot be administered for more than two years because of a possible risk of bone cancer, which occurred in rat trials. For more information, go to www.forteo.com.

     Strontium ranelate, another drug that can create bone, is available outside the US. However because of its occasional side effects of blood clots and heart attacks, the European Pharmacovigilance Risk Assessment Committee (PRAC) recommended in January 2014 that strontium ranelate no longer be used to treat osteoporosis. People taking strontium citrate supplements should consider stopping them too. The supplements are unregulated and strontium in any form will show false increases in bone density, making your bone density reports unreliable.

      Abaloparatide (brand name Tymlos; formerly BA058) is a bone-growing prescription medication given by subcutaneous injection that was approved in April 2017 by the Food and Drug Administration (FDA) for reducing fracture risk. During animal drug testing, TYMLOS caused some rats to develop a bone cancer called osteosarcoma. It is not known if people who take TYMLOS will have a higher chance of getting osteosarcoma. The most common side effects are dizziness, nausea, headache, fast heartbeat, fatigue, upper stomach pain and vertigo. For more information go to: www.Tymlos.com.

     In April 2019, Romosozumab by Amgen (brand name Evenity) was approved as an injection for post-menopausal women with a high risk of fracture as a way to rapidly build new bone in one year and reduce fracture risk. Possible side effects include increased risk of having a heart attack, stroke, or death from a cardiovascular (heart or blood vessel) problem. For more information go to www.Evenity.com.

7. Take additional action at perimenopause to prevent hormone-related bone loss. When your periods become more irregular, do more muscle strengthening exercise to help offset decreasing estrogen levels that lead to bone loss. Usually the stronger your muscles are, the stronger your bones can be. Make sure you’re getting sufficient Vitamin D, calcium, magnesium and an especially nutritious diet with at least ten servings/day of fruits and vegetables, healthy poly- and mono-unsaturated fats and a variety of protein foods such as fish, poultry, dairy, eggs and beans. If you smoke, stop smoking. Perimenopause is a good time to get a baseline bone density test and measure your muscle strength so that you can determine later if your preventive measures are sufficient. You will probably have to pay for the DXA  bone density test yourself.

     A January 2013 Journal of Bone & Mineral Research (JBMR) print article confirmed that bone loss increases significantly during the transmenopause phase and that it begins before menopause “Bone Mineral Density Loss in Relation to the Final Menstrual Period . . .” (pp 111-129). Taking drugs such as Fosamax (alendronate) and Actonel (risedronate) on a limited basis is an option for women who are unable to do sufficient exercise to maintain bone. However, many professionals now are opposed to taking these drugs if you don’t have osteoporosis. Personally, I would rather take the drugs for a year or two just after menopause in order to maintain bone than have to take stronger drugs later for a longer period of time.

     For some women, hormone therapy may be warranted. An October 9, 2012 article by LL Schierbeck in the British Medical Journal supported using hormone replacement therapy in some women at menopause. See "Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women": BMJ 2012;345:e6409. 

     Some people are misled into thinking they needn't be concerned about a bone fracture because their 10-year risk of fracture is relatively low. As a result, they don't take adequate preventive measures to maintain bone and muscle. Pay more attention to your lifetime risk of fracture and create an effective exercise and nutritional program for yourself now so that you can remain fracture-free and strong throughout your entire life, not just for the next ten years. 

8. If your bone density is low, find out about dynamic motion therapy when it becomes available in your area. This involves standing for 10–20 minutes a day on a medical device called the Juvent Platform that uses safe, micro-impacts, not high-power whole-body vibration. It calibrates using a built-in computer and accelerometer to determine the most efficient frequency for your body to stimulate bone formation.

     In 2006, the Juvent Platform was approved and introduced as an osteoporosis therapy in Europe, Canada, Australia, and a number of other countries in Asia and South America by the Juvent company after more than twenty years of research. I had an opportunity to see the device and talk to company officials in Ireland just after it was launched on the market there.

     The newest version, the Juvent product (Juvent 1000N) is registered with the FDA as a Class 1 exercise device and is being sold in the US for muscle strength and restoration because it stimulates key muscles such as the calf (soleus) muscle, which controls postural stance and balance. As a result, it helps prevent falls, fractures and muscle loss. The device is especially helpful for people who are unable to exercise because of surgery, broken bones, joint problems or muscle and ligament injuries.

     The Juvent 1000N was used successfully in a prospective, randomized, double-blind, placebo controlled clinical trial funded and conducted by St. Jude Hospital for Children and improved the tibial bone mineral density by 11% in one year. The Company hopes to raise money to fund two additional studies; osteoarthritis and diabetic neuropathic pain.
     NASA has co-funded many of the research studies behind Juvent's technology. Scientists hope that the technology behind the Juvent device can be used in space to help prevent the bone loss in astronauts that occurs in zero-gravity conditions. Juvents can be found in many prominent physical therapy centers.

9. Learn about bone density tests before being tested
. You’ll profit more from the results. Bone density tests don’t just tell you whether or not you have osteoporosis. They can give information that will help you design an exercise program to strengthen areas of low bone density; moreover, the images can reveal a variety of other medical problems you may not be aware of. It's helpful to deal with a testing center or specialist that will provide this information. For more details click on bone density tests, sample reports, and see Chapters 13, 14, 15 and 17 in Osteoporosis Prevention.

10. Ask for complete copies of your bone density (DXA) reports or QCT reports and chart your progress. People who are involved in their health care and who discuss the results with their doctors are more motivated to take preventative measures to maintain their bone health. Therefore, ask for a printed copy or digital file of your entire bone density report including the images and the ancillary results. If they are not able to e-mail you a copy, there might be a charge for a printed copy or disc, now that reimbursements for bone density tests have drastically declined. To see report examples, click sample GE DXA report and sample Hologic DXA report or QCT report. The detailed results and photos also can be helpful for other medical professionals you may see such as orthopedists, endocrinologists, chiropractors and physical therapists. Make copies for them. The more concrete information they have about you, the better able they are to care for you.

     DXA scanners are also able to measure and visually show your high, medium, low, and non fat body areas, which allows sports medical doctors and fitness trainers to monitor the effect of training and nutrition on body condition. For more information click GE body composition analysis and Hologic body composition reports.

Copyright © 2006 and 2022 by Renée Newman

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