UNIVERSAL RECOMMENDATIONS FOR ALL PATIENTS

Several interventions to reduce fracture risk can be recommended to the general population.
These include an adequate intake of calcium and vitamin D, lifelong participation in regular
weight-bearing and muscle-strengthening exercise, cessation of tobacco use, identification and
treatment of alcoholism, and treatment of other risk factors for fracture such as impaired
vision.
Adequate Intake of Calcium and Vitamin D

Providing adequate daily calcium and vitamin D is a safe and inexpensive way to help reduce
fracture risk. Controlled clinical trials have demonstrated that the combination of supplemental
calcium and vitamin D can reduce the risk of fracture. A balanced diet rich in low-fat dairy
products, fruits and vegetables provide calcium as well as numerous nutrients needed for good
health. If adequate dietary calcium cannot be obtained, dietary supplementation is indicated up
to the recommended daily intake.

Advise all individuals to obtain an adequate intake of dietary calcium. Lifelong adequate
calcium intake is necessary for the acquisition of peak bone mass and subsequent maintenance
of bone health. The skeleton contains 99 percent of the body’s calcium stores; when the
exogenous supply is inadequate, bone tissue is resorbed from the skeleton to maintain serum
calcium at a constant level. The NOF supports the Institute of Medicine (IOM)
recommendations that men age 50-70 consume 1,000 mg per day of calcium and that women
age 51 and older and men age 71 and older consume 1,200 mg per day of calcium.23
 Intakes in
excess of 1,200 to 1,500 mg per day have limited potential for benefit and may increase the risk
of developing kidney stones, cardiovascular disease and stroke. The scientific literature is highly
controversial in this area.
24,25,26,27
There is no evidence that calcium intake in excess of these
amounts confers additional bone strength.

Table 9 illustrates a simple method for estimating the calcium content of a patient’s diet. The
average daily dietary calcium intake in adults age 50 and older is 600 to 700 mg per day.
Increasing dietary calcium is the first-line approach, but calcium supplements should be used
when an adequate dietary intake cannot be achieved.