Revised 9 March 2011
Recommendations for the Prevention of Osteoporosis in Women
Postmenopausal women have an increased risk of osteoporosis. As well, this risk can be increased further by factors such as family history, smoking, diet, early menopause, chemotherapy, long term corticosteroids and some hormonal therapies that lower estrogen.
The following recommendations are provided to reduce the risk of bone loss during and after treatment. If your bone density scan at the start of treatment indicates that you are at increased risk of osteoporosis you may be advised to use medications such as bisphosphonates (eg. alendronate (Fosamax®) in addition to following the guidelines below.
Calcium and vitamin D are essential for strong bones. A daily dose is the sum of what you consume from food sources and from supplements. The recommended daily intake for calcium is 1200 mg. A daily supplement of 1000 IU of vitamin D is recommended for bone health and the prevention of cancer, in all women.
Food Source |
Portion Size |
Calcium (mg) |
Cheese (Swiss) | 50 g (2 oz) | 440 |
Cheese (Cheddar/Mozzarella) | 50 g (2 oz) | 390 |
Milk (skim,1 or 2% MF or whole) | 250 mg(1 cup) | 300 |
Buttermilk, or Chocolate milk | 250 ml (1 cup) | 300 |
Yogurt, plain | 175 ml (3/4 cup) | 300 |
Milk powder, dry | 45 ml (3 Tbsp) | 280 |
Fortified Beverages(soy, rice, orange juice) | 250 ml (1 cup) | 300 |
Blackstrap Molasses | 15 ml (1 Tbsp) | 180 |
Parmesan Cheese | 15 ml (1 Tbsp) | 90 |
Sardines, with edible bones | 24 gm | 90 |
Cottage cheese, 2% MF | 125 ml (1/2 cup) | 80 |
Figs, dried, uncooked | 3 | 80 |
Orange, raw | 1 medium | 50 |
Broccoli, frozen, boiled, drained | 250 ml (1 cup) | 50 |
Adapted from the Manual of Clinical Dietetics, 6th Edition (p.746-747), by American Dietetic Association et al, 2000.
Calcium intake from all sources should not exceed 2000 mg per day.
Food Source |
Portion size |
Vitamin D (IU) |
Fish, herring | 100 gm (3 oz) | 900 |
Fish, mackerel or salmon | 100 gm ( 3 oz) | 650 |
Fish, sardines or tuna | 100 gm ( 3 oz) | 250 |
Milk or Soy Beverage, fortified | 250 ml (1 cup) | 90 |
Margarine, fortified | 5 ml (1 tsp) | 55 |
Egg | 1 large | 25 |
Adapted from the Manual of Clinical Dietetics, 6th Edition (p.746-747), by American Dietetic Association et al, 2000.
Vitamin D intake from all sources should not exceed 4000 IU per day.
If you can’t meet the recommended amounts with food alone, consider a supplement. Calcium carbonate is the least expensive calcium supplement and is well tolerated by most people when taken with food. The absorption of calcium from supplements is most efficient at doses of 500 mg or less. Some calcium supplements also include vitamin D (check the label for the exact amount). A standard multivitamin and mineral supplement provides approximately 175 mg of calcium and 400 IU of vitamin D and other nutrients.
Adequate protein is required to maintain bone health. Include one of the following protein rich foods at each meal: meat, fish, poultry, beans, lentils, nuts, eggs, milk, yogurt and cheese.
Excess caffeine and salt can have a negative effect on bone. Caffeine is found in coffee and also tea, chocolate (cocoa) and some soft drinks. For optimal bone health limit coffee to less than 4 cups per day.
Foods high in salt generally include processed foods such as canned soups, snack foods, crackers, pastas and sauces. Check the nutrition label on processed foods and limit salt to less than 2100 mg per day.
Being physically active maintains optimal bone health and decreases the risk of a bone fracture by improving bone mass and increasing muscular strength, coordination and balance and thereby reducing falls. Physical activity that is weight bearing is best, examples include walking, dancing, aerobics, skating and weight lifting.
Smoking is related to poor bone and general health. If you smoke, ask your doctor for assistance to stop smoking.
Published: January 2004
Androgen Ablation, Osteoporosis and Prostate Cancer:
GU Tumour Group Guidelines
Osteoporosis is a major health concern in men over 65 years of age and is currently underdiagnosed and undertreated. Most men with prostate cancer are over 65 years of age. Androgen ablation therapy for prolonged periods is also a significant risk factor for inducing osteoporosis. Androgen ablation induced osteoporosis is a potential source of major morbidity, low QOL and mortality. It is entirely treatable and can be stabilised or reversed.
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It is therefore the obligation of a physician who starts patients on androgen ablation to diagnose osteoporosis.
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We recommend Vitamin D (800IU) and calcium supplementation (to a total 1500mg/d) as well as moderate exercise / fall prevention for all men beginning androgen deprivation therapy. See the patient pamphlet: "Guidelines for the Prevention of Osteoporosis…".
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A baseline BMD should be performed if
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prolonged androgen ablation is to be employed defined as > 6 months (adjuvant or palliative)
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baseline hypogonadism is found (10)
(appendix 1:
click here to open); or -
if the BMD may affect the choice of treatment in the elderly.
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It is not within the scope of BCCA practice to routinely screen all men over 65 years of age for osteoporosis. The patient can discuss this matter with their primary care physician.
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This group does not believe that the evidence yet supports treatment to prevent osteoporosis for patients starting androgen ablative therapies. The endpoints of reduction in morbidity, mortality, and skeletal events have yet to be shown in the prophylactic setting of a patient with normal or even mildly osteopenic BMD at baseline.
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If BMD, history or plain films identify 'osteoporosis' (defined here as a T-score <= -2.5) at any time, the patient should be considered for bisphosphonate therapy. We still lack suitable and large enough trials to prove a reduced fracture risk in men with prostate cancer on AA but stabilisation or improvement in bone density seems to occur. Reduction in fractures does occur with bisphosphonates (alendronate) in primary male osteoporosis and in other iatrogenic osteoporosis.
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The responsibility for the prescription and monitoring of side effects of these drugs can be transferred to another physician who may have greater familiarity with these products and their risks and benefits.
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Furthermore, primary care physicians or specialists may need to screen the patient for secondary causes of osteoporosis and identify steps to reduce fracture risk.
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Arrangements for the monitoring of BMD response rest with the physician who ordered the baseline BMD and prescribed the AA. Mechanisms must be in place to ensure followup studies.
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The importance of BMDs being conducted on the same machine each time is emphasised.
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BMD should be repeated every 2 years in patients who are castrate and have normal BMDs at baseline.
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Earlier followup BMDs can be considered in patients at higher risk e.g. osteoporosis/osteopenia at baseline, or other significant risk factors promoting osteoporosis. These patients may be best managed under specialist care.
This group recommends that fracture incidence and BMD should be considered as part of any randomised trial involving prolonged androgen deprivation therapies.
This document does not address the possible relationship between high BMD in men and the risk of developing prostate cancer (10). We do not attempt to address the potential use of bisphosphonates in the treatment and prevention of bone metastases
(9) (3), as this is under review as a Priorities and Evaluation Committee proposal, submitted recently by Dr. K. Chi.
