The importance of beginning bone loss prevention at a very young age is now very well understood. Bone health programs are now being developed and implemented that target girls as young as nine to 12 years of age and their parents, focusing on promoting good nutritional choices and participating in regular physical activity.

Nearly one-third of bone loss can occur before a diagnosis of osteoporosis is made. However, you can prevent future bone loss caused by osteoporosis with early detection. Also, once you've had a fracture due to osteoporosis, your risk of future fractures is increased.

Thus, it is important to prevent the first fracture. Taking preventive steps and reviewing risk factors now are especially helpful approaches for women of all ages.

There are five simple steps to reduce your risk for osteoporosis:

• Increase the amount of calcium and vitamin D in your diet.

• Exercise regularly; bones and muscles respond to physical activity by becoming stronger. Weight-bearing exercises like walking and weight lifting are the most beneficial.

• Maintain a healthy body weight. Being underweight or losing weight increases your risk of bone loss and fracture, and ultimately, of developing osteoporosis.

• Quit smoking. Cigarette smoking (nicotine) can reduce bone mass and increase the risk of fracture, thus increasing your risk for osteoporosis. Ask your health care professional to recommend methods to help you quit.

• Drink alcohol in moderation, if you drink. Excessive consumption of alcohol increases your risk of osteoporosis and fractures from falls.

For some women, medication may also be helpful for preventing additional bone loss. Ask your health care professional what the best osteoporosis prevention strategy is for you.

Dietary Strategies for Osteoporosis Prevention

Many vitamins and minerals are important to maintaining healthy bones. That is why it is important to eat a well-balanced diet everyday consisting of a variety of foods, including grains, fruits, vegetables, non-fat or low-fat dairy foods or other calcium-rich foods as well as meat and beans.

Most Americans do not get enough calcium in their diets; so adding calcium to your diet may be the easiest health-related change you can make. It's an important one, too. Calcium may reduce fractures caused by osteoporosis by as much as 50 percent. The Institute of Medicine recommends these calcium guidelines based on age:

• Girls ages nine to 18: 1,300 mg/calcium/daily

• The average woman age 19 to 50: 1,000 mg/calcium/daily

• Women 51 or older: 1,200 mg/calcium/daily. (Postmenopausal women should take adequate supplemental elemental calcium (generally 500 to 1000 mg per day) in divided doses, at mealtime, such that their total calcium intake, inclusive of food calcium, approximates 1,500 mg/day.

If you have asthma, allergies, a thyroid condition or other chronic medical condition, you may need an even higher daily calcium intake.

Good sources of calcium include:

• Low-fat dairy products, such as milk, yogurt, cheese and ice cream. Three eight-ounce glasses of milk plus calcium from a normal diet will meet daily calcium requirements.

• Dark green, leafy vegetables such as broccoli, collard greens, bok choy and spinach

• Sardines and salmon with bones

• Fortified tofu (a soybean product made from curdled soy milk)

• Soy milk

• Almonds

• Calcium-fortified foods and beverages such as orange juice, cereals and breads

Difficulty digesting milk, which is called lactose intolerance, and stomach upset caused by dairy products may be more common as you age. If that's the case, yogurt with active cultures, buttermilk, and cheddar and Swiss cheeses are high in calcium but low in lactose, the sugar found in milk and milk products.

Many people mistakenly believe they are lactose intolerant when a simple sensitivity to dairy products or some other food substance is really the case. So check with your health care professional before you avoid dairy products. Products that don't contain lactose (such as Lactaid) can help people with lactose intolerance to consume dairy products.

When your diet doesn't provide enough calcium, you may wish to take calcium supplements. The most common and least expensive is calcium carbonate, found in antacid preparations for treating heartburn. However, in clinical studies, researchers found that the formulations of calcium supplements greatly affected the level of absorption. Calcium citrate was better absorbed than calcium carbonate. In addition, calcium carbonate is absorbed best when taken with food, while calcium citrate can be taken any time.

Multivitamins generally do not provide enough calcium to meet the daily needs of a postmenopausal woman. In fact, "the mineral" calcium isn't always included in a multivitamin preparation, so be sure to read the label if you are relying on your vitamin supplement to meet your calcium requirement.

Your diet should also be rich in vitamin D. This nutrient helps your body absorb calcium more efficiently and minimize bone loss. Most of us get the vitamin D we need for calcium absorption from exposure to sunlight.

This essential vitamin is found in fortified milk and cereals, as well as vitamin supplements. If your exposure to sunlight is limited, you may want to consider increasing your average intake of vitamin D. At least 800 units (IU) of vitamin D daily is recommended for menopausal women. Higher doses may benefit women over the age of 65.

Exercise Strategies

Bone and muscle respond to physical activity by becoming stronger. Although all exercise is beneficial to overall good health, two kinds of exercise are most effective for preventing osteoporosis: Weight-bearing, in which you work against gravity, and resistance exercises, such as weight lifting.

Weight-bearing exercise is any exercise in which your feet and legs bear your weight while you perform it, such as brisk walking, dancing, racket sports and aerobics. This creates high pressure on the bone that helps to build and maintain its strength.

Resistance exercises that strengthen muscle may also be beneficial, particularly for the large muscles of the shoulder, pelvis, hips, back and trunk. Because falls are the most common cause of fractures, balance-improving activities, such as t'ai chi and strength training, may also significantly reduce your risk for falls. A 2002 study of over 61,000 women conducted at Brigham and Women's Hospital and Harvard Medical School showed that women who walked four hours or more per week had a 41 percent lower risk of hip fracture than women who walked less than an hour a week.

The guideline recommended by the Surgeon General's 2004 report on bone health is weight-bearing physical activity for at least 30 minutes every day for adults and 60 minutes every day for children. However, while bicycling and swimming are non-weight bearing exercises, they are still good for the cardiovascular system, but they won't maintain and build new bone.

For muscle strengthening, you can use stationary weight machines at health clubs and gyms, and free weights or elastic bands in the gym or at home. The important thing to remember is that you don't have to lift heavy weights to benefit from strength training. You should start with a light weight and gradually increase your repetitions and/or resistance as your strength increases. The goal is to build bone strength—not muscle mass, which requires numerous lifts with heavy weights.

In a study whose results surprised even the researchers who conducted it, gardening went a long way to help reduce the risk for osteoporosis among the 3,310 women age 50 and older involved in the study. Gardening activities such as raking, thrusting a shovel into the ground, moving a wheelbarrow filled with dirt, weeds or mulch are all considered weigh-bearing exercises.

If you do not routinely exercise, before you start, ask your health care professional to recommend a simple, safe program and start soon.