There are several non-drug measures that can improve bone strength:

• A balanced diet rich in calcium, energy and vitamins without excess protein
• Calcium (1000 to 1500 mg/day) is important to attain peak bone mineral density in the young and prevent bone loss in the aged
• If required, vitamin D can be added in a dose of 400 to 800 IU daily
• If magnesium deficiency is present (for example, in diabetics, alcoholics or those who are using diuretics), magnesium should be supplemented
• Limited alcohol consumption
• No more smoking
• Avoiding drugs which are toxic to bone
• Taking up physical exercise and (in the elderly) preventing falls to limit osteoporotic fracture

It should be noted that routine supplementation with magnesium, vitamins and trace elements is not recommended. This should only be done when the patient's diet is inadequate.

How can people who already have osteoporosis prevent themselves from losing further bone mass and suffering deformities?

There are several lifestyle adaptations that can be used in conjunction with drug treatment:

• Physical activity to maintain bone mass. Ideal physical activity to maintain bone mass should be weight- bearing( i.e. to carry one’s own body weight, not weight lifting) as in walking. Immobilisation definitely increases the rate of loss of bone mass and should be avoided.
• Physical activity to prevent deformity and pain in the spine. This needs to be carefully prescribed and in some cases, supervised, in those with osteoporosis of the spine. Appropriate mechanical loading and exercises stressing both the muscles and skeleton are important in the maintenance of bone mass and in preventing fractures and deformity. Back strengthening exercises are very important in preventing the postural deformity, which is common in osteoporosis.
• Prevent falls and prevent the fracture. Almost all hip fractures in the elderly are caused by falls. Factors in the exterior and interior environment can be modified to make falls less likely. Simple measures such as good lighting, rails on steps, even paving, good night lights, skid-proof mats on floors and in the bath will significantly reduce the incidence of falls.
• Limit the impact of falls. Hip protectors can absorb energy at the hip and reduce the likelihood of fracture as a result of a fall. They are designed to divert a direct impact away from the most vulnerable part of the hip joint during a fall.

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