4 steps to battle early signs of brittle bones

If protecting your bones isn't already a top priority, a diagnosis of osteopenia will change that. Osteopenia is an indication that your bone density is decreasing, and that you're at increased risk for osteoporosis — a disease of thin, weak bones that can break easily and often.

Osteopenia can progress slowly or rapidly to osteoporosis, depending on your health. This realization brings the potential for fractures, disability, and a loss of independence into sharp focus. What can you do to avoid the risks?

1. Talk to your doctor about medication

Medications that slow bone loss and reduce fracture risks aren't necessarily the first line of defense against osteopenia. These drugs — such as alendronate (Fosamax), ibandronate, and risedronate (Actonel) — are typically reserved for people with

• osteopenia and a previous spine or hip fracture
• osteopenia and a high risk for fractures in the next 10 years, as calculated with a bone density test (a DEXA scan) and a fracture risk assessment (FRAX) score
• osteoporosis.

But what if you don't fit into one of those categories? "If you have osteopenia and you're likely to lose bone density over time, one could argue that it makes more sense to take the medication and maintain bone density now rather than try to regain it later," says Dr. Harold Rosen, an endocrinologist and director of the Osteoporosis Prevention and Treatment Center at Harvard-affiliated Beth Israel Deaconess Medical Center.

He suggests having a frank discussion with your doctor about the pros and cons of treating osteopenia with medication, including the rare risk of an atypical thighbone fracture and bone loss in the jaw, and the need to take a drug holiday every five years.

2. Exercise

Bones become stronger when we put force on them and pull on them by using our muscles. Weight-bearing exercise — such as resistance (strength) training or body-weight exercises — is an effective way to do this. But Dr. Rosen says we also need aerobic, balance, and posture exercise to fight osteoporosis.

"We have good evidence that simply walking at a brisk pace reduces the likelihood of osteoporosis. You also need to improve your balance so you'll reduce your tendency to fall, and improve your posture to reduce the risk that you'll develop severe curvature of the upper back [kyphosis]. 'Superman' stretches are great for posture. You lie on your stomach for a few seconds at a time, with your head up and your arms and legs stretched out like you're flying," Dr. Rosen says.

3. Get the right nutrients

Bones rely on calcium to get stronger, and your body needs vitamin D to absorb calcium.

Dr. Rosen recommends taking a vitamin D₃ supplement of 1,500 to 2,000 IU per day, and getting about 1,000 milligrams per day of calcium. Try to get as much calcium as you can from food, such as dairy products, sardines, and leafy greens. If you're not getting enough calcium in your diet, Dr. Rosen recommends taking a low-dose calcium citrate supplement to make up the gap.

You should also consume plenty of protein, which helps build strong bones. Good sources include poultry, fish, legumes, and dairy products.

Limit alcohol intake to no more than one drink per day, since alcohol can interfere with bone health.

4. Rattle your bones

One add-on treatment for low bone density is vibration therapy, which involves standing on a small vibrating platform or pad. "The idea is to fool the bones into thinking they're being stressed, so they build up accordingly," Dr. Rosen says.

You'll find large vibration pads in clinics, or you can purchase a home version (about the size of a scale). But it's unclear if the vibrations make it up past your knees. An approach still under development involves wearing a vibration device as a belt, closer to the hips and low spine; Dr. Rosen is involved as a consultant for this product, which is not yet available. But he says we don't have enough proof yet that any type of vibration therapy improves bone strength or reduces fracture risk.

Prognosis

Bone loss speeds up significantly after age 60, and if you don't do anything about it (especially if you have osteopenia), the loss will continue. But taking the steps we've laid out might help build bone and stave off osteoporosis. It's a battle we all have to fight as we age, and one that needs to be at the top of the daily to-do list.

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