Bones of Contention

By Andrew Weil, M.D.

Confusion surrounds the subject of osteoporosis. That is especially troubling for women, who face the risk of bone loss decades earlier than men do. Should they take calcium pills? Are dairy products the best dietary source of calcium? Are prescription medications safe and effective? To my mind, most of these are open questions. Osteoporosis is strongly influenced by genetics. One day we may be able to identify those at highest risk and urge them to take preventive measures. In the meantime, last month's Women's Health Initiative (WHI) report suggested that calcium pills offer only modest, if any, protection. I believe that supplemental vitamin D is more important than supplemental calcium. If you are getting enough vitamin D, particularly in early life, you should absorb calcium from foods efficiently. What is enough? I recommend at least 1,000 IUs daily taken with a fat-containing meal. (Women in the WHI study took only 400 IUs of the vitamin with their calcium pills.) If you do take calcium pills, the citrate form is best but still not as good as calcium in foods.

Calcium-rich foods include dark, leafy greens, broccoli, sesame seeds, canned sardines and salmon mashed up with the bones, cooked dried beans, soy foods and, of course, milk. But I agree with Harvard's Walter Willett and others that dairy products are not the preferred sources. In the Nurses' Health Study, Willett found that postmenopausal women who drank two glasses of milk a day were no better protected against bone fractures than women who drank a glass or less a week.

If you are looking for a solution to osteoporosis at the pharmacy, be cautious. Many women cannot tolerate the side effects of the popular bisphosphonate drugs: Fosamax, Actonel and Boniva. The most common problem is gastroesophageal irritation, but dentists and oral surgeons have begun to warn of a more serious problem in a subgroup of patients--necrosis (death) of the jawbone.

As with most chronic diseases, prevention of osteoporosis is preferable to having to treat it. That means adopting habits that build strong bones early in life. By 35, it's all downhill. The only thing you can do--and it's still important--is slow bone loss.

You help your body build strong bones by eating a varied diet, with plenty of fresh vegetables and fruits and adequate protein. Too much protein may accelerate bone loss, an argument against relying on dairy products for calcium or going on high-protein, low-carb diets for weight loss. I recommend eating 20% to 30% of calories as protein. Smoking and excessive caffeine, alcohol or soft-drink consumption may increase bone loss.

Weight-bearing exercises also help. The teens and twenties are good times for men and women to start strength training. Working out with weights a few times a week builds bones and muscle mass, which you'll thank yourself for as you age.

Remember, the health of our bones reflects the dynamic interaction of opposing forces. Our bodies contain cells that create bone and others that destroy it. That dynamism enables us to sculpt and reshape the skeleton to respond to changing physical needs. If you are predisposed to osteoporosis, taking preventive action can help ensure that the bone-building forces prevail.

Have a question for Dr. Weil about osteoporosis? Go to time.com/askdrweil