Men and women between the ages of 19 and 50 should get about 1,000 milligrams (mg) of calcium daily while those over 50 should get 1,200 mg. Dr. McGowan recommends spreading out the calcium over the day so that you get better overall absorption of the calcium, and taking it with food helps, too.

You also need enough vitamin D every day in order to absorb calcium from the diet. Vitamin D is found in food, particularly fortified food, but can also be made by your body after exposure to the sun; 15 minutes outside in the sun per day is usually sufficient for your body to make all the vitamin D you need. If you have limited sun exposure, especially during the winter, you should take vitamin pills with 200 to 400 international units (IU) of vitamin D per day if you are below age 70, or 600 IU if you are over 70. Too much vitamin D can be harmful, so don't take more than 800 IU per day without a doctor's supervision.

Myth: We have highly effective drugs to prevent and treat osteoporosis.

The U.S. Food and Drug Administration (FDA) has approved several medications for the prevention or treatment of osteoporosis. However, Dr. McGowan cautions, "None of these can completely stop fractures and may not be suitable for taking the rest of your life since we don't yet know what their long-term effects are."

Millions of women were taking estrogen along with progestin - known as hormone replacement therapy or HRT - beginning at menopause, and planning to continue it for the rest of their lives. "Estrogen used to be considered a sheet of armor for your bones," Dr. McGowan says. But NIH's long-term clinical trial, the Women's Health Initiative (WHI), revealed last year that, although estrogen and progestin combined to prevent fractures, the overall health risks of taking HRT outweighed the benefits.

Another part of the WHI that is not scheduled to be completed until 2005 is investigating the effect of 1,000 mg of calcium carbonate plus 400 IU of vitamin D daily on hip and other osteoporosis-related fractures and colorectal cancer. Until these studies are finished, women should consult their doctor or health care provider about the risks and benefits of the various options available for treating or preventing osteoporosis.

There are several FDA-approved medications available. Most inhibit the osteoclasts, the cells that break down bone; only one, teriparatide, actually stimulates the growth of new bone. These drugs have not been available for very long, so we don't yet know all their long-term effects. Here is a brief description of each:

Teriparatide (brand name Forteo®) is a synthetic form of human parathyroid hormone (PTH) that FDA has approved for the treatment of osteoporosis in postmenopausal women at high risk of fracture. This drug must be injected daily for no longer than two years.

Two drugs in a class known as bisphosphonates, alendronate (brand name Fosamax®) and risedronate (brand name Actonel®), reduce the risk of fractures in postmenopausal women with osteoporosis and now come in a once-a-week pill. Both can cause problems in your stomach and esophagus (the tube that connects the mouth with the stomach) if not taken with 6 - 8 ounces of water and if you do not remain upright for 30 minutes after taking it.

Raloxifene (brand name Evista®) mimics estrogen's positive effects on bone without the negative effects on the breast or uterus. It prevents bone loss and reduces the risk of vertebral fractures. However, it could cause blood clots and hot flashes.

Calcitonin (brand names Miacalcin® and Calcimar®) is a synthetic protein similar to a hormone made by the thyroid. It is approved for treating osteoporosis in women at least five years beyond menopause. It can be taken as a daily nasal spray or by injection under the skin. Calcitonin increases spinal bone density but its effects on fracture risk are still unclear. The nasal form has few side effects but may not be as effective as the injected one, which may cause an allergic reaction.

NIAMS is funding trials to test various combinations of these drugs. Recently, a trial of PTH and alendronate showed that the concurrent combination provided no additional improvement in BMD than PTH alone. Ongoing studies will determine whether the sequential use of the two drugs is superior to just one of the drugs. NIAMS and several other NIH components are investigating other agents for preventing or treating osteoporosis as well. These include statins (cholesterol-lowering drugs), phytoestrogens (chemicals found in plants that can act like estrogen), and nitric oxide (a drug given to heart patients in the form of nitroglycerin).

Final Advice

Dr. McGowan has one last recommendation: Do regular weight-bearing exercise, such as walking, jogging, stair-climbing, tennis, weight-training and dancing. These activities may not only help strengthen your bones; they can build muscle and help with your balance, reducing your risk of falling. As doctors are learning with many other functions of the body, use it or lose it - in this case, exercise or lose your bone and muscle strength.

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Tags: Osteoporosis

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NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.