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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EOsteoporosis affects more than half the population aged \u0026gt;55 years, and the prevalence increases with age; by age 80 years, approximately 75% of people will have the condition. Osteoporosis and falls increase the risk of fracture, leading to substantial morbidity and mortality. Given this high morbidity and mortality, effective strategies for preventing and managing osteoporosis are essential. Clinicians may reduce the need for pharmacological treatment of osteoporosis by helping their patients modify lifestyle behaviors.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMetabolic Bone Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EOsteoporosis affects more than half the population aged \u0026gt;55 years, and the prevalence increases with age; by age 80 years, approximately 75% of people will have the condition. Osteoporosis and falls increase the risk of fracture, leading to substantial morbidity and mortality. Approximately 90% of hip fractures are due to a fall, and the National Osteoporosis Foundation estimates that nearly 25% of people with a hip fracture die within the first year after the fracture. In addition, all fragility fractures are associated with increased mortality, and signal an increased risk of other fragility fractures.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EGiven this high morbidity and mortality, effective strategies for preventing and managing osteoporosis are essential. Clinicians may reduce the need for pharmacological treatment of osteoporosis by helping their patients modify lifestyle behaviors.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003E\u201cIt\u0027s worth our effort to work with patients to help them understand and reduce risk,\u201d said Suzanne M. Jan De Beur, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. \u201cMaking lifestyle modifications not only improves the risk of fracture but also helps individuals realize other health benefits,\u201d she added.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESmoking\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ESeveral studies have linked smoking with an increased risk for fractures; the risk is higher for both men and women, and the risk for hip fractures appears to be higher among women. Studies have also shown lower bone mineral density (BMD) in current smokers. There is gradation in the risk that is associated with smoking with the lowest risk for never-smokers, a greater risk for past smokers, and the greatest risk for current smokers.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EUsing the World Health Organization (WHO) Fracture Risk Assessment Tool (Frax; \u003Ca href=\u0022http:\/\/www.shef.ac.uk\/FRAX\/\u0022\u003Ehttp:\/\/www.shef.ac.uk\/FRAX\/\u003C\/a\u003E) to illustrate the effect of smoking, Dr. Jan de Beur calculated the fracture risk for a 65-year-old man with and without a history of smoking. Smoking increased the risk of hip fracture from 2.6 (a score below the treatment threshold) to 4.1 (a score above the treatment threshold). The increase in risk that was caused by smoking is equivalent to 10 years of aging.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAlcohol\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAlcohol is another factor that increases the risk of osteoporosis and fractures. High alcohol consumption (defined as more than 2 drinks per day) has been associated with lower BMD and osteoporotic fractures among both men and women, although there is variation according to gender and type of alcoholic beverage.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EUsing the same case scenario as with smoking, Dr. Jan de Beur showed that according to FRAX, 3 or more units of alcohol per day increases the risk of hip fracture from 2.6 to 3.9, again moving from below the treatment threshold to above it. The combination of smoking and high alcohol intake increased the risk of hip fracture to 6.2.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThere may be a benefit to moderate alcohol consumption, however. Several studies have shown that 1 or 2 alcoholic drinks per day was associated with a higher BMD among older women, but the evidence has been insufficient for women aged 40 to 60 years and has been inconsistent for men.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECaffeine\u003C\/h2\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EUnlike smoking and alcohol consumption, caffeine is not an established risk factor for osteoporosis, and there is no caffeine history question on FRAX. However, it is good clinical practice to ask patients about their caffeine intake as part of an overall assessment of osteoporosis risk. Some evidence suggests that the effects of caffeine are more pronounced with low calcium intake. For example, a modest increase in fracture risk was found with a daily intake of 330 mg of caffeine (1 cup of coffee contains 90 to 150 mg of caffeine; HR, 1.20; 95% CI, 1.07 to 1.23) among women (aged 40 to 76 years) with a low calcium intake [Hallstr\u00f6m H et al. \u003Cem\u003EOsteoporos Int\u003C\/em\u003E 2006]. Intake of calcium-rich foods may offset the effects of caffeine.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EOther studies have shown that the risk for hip fracture increases with an increasing amount of caffeine, and the effect appears to be greater among older individuals. However, several cohort and case-control studies have not demonstrated an association. Few studies have been done to evaluate the effect of cola, which typically contains 30 to 45 mg of caffeine, but in the Framingham Osteoporosis Study, BMD (at the hip) decreased as daily cola consumption increased but only among women [Tucker KL et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EIn summary, Dr. Jan de Beur advised a common sense approach to nonpharmacological interventions for the prevention of osteoporosis (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12287\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12287\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12287\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003ENonpharmacological Approach to Preventing Osteoporosis.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPhysical Activity and Fall Prevention\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EWith regard to bone health, regular physical activity has an effect on bone strength, helps to maintain bone mass, and may reduce the risk of falls. Clinicians should target efforts to increase physical activity among patients who are aged \u226580 years, as the rates of hip fracture are highest for this age group, said Wendolyn S. Gozansky, MD, Institute for Health Research, Kaiser Permanente Colorado, Arvada, Colorado, USA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EThe American College of Sports Medicine (ACSM) provides guidance on physical activities for older individuals (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E) [Nelson ME et al. \u003Cem\u003EMed Sci Sports Exerc\u003C\/em\u003E 2007]. The studies indicate that the osteogenic effects of moderate-intensity exercise can be maximized by integrating short bouts of high-intensity exercise. Short but frequent exercise is better for bone health. For example, 10 minutes of brisk walking 5 days a week is more beneficial than 50 minutes of brisk walking on 1 day.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12288\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12288\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12288\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EACSM Recommendations for Physical Activity in Older Individuals.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EActivities that promote balance and strength are also important for older individuals because of the high risk for falls in this population; one-third of community dwellers aged \u226565 years fall each year, and the rate is higher among older individuals in institutions. Among the strongest risk factors for falling are a prior fall; impairment of strength, gait, and balance; and some medications.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EIt is not only the number of medications but also the types of medications. Pain medications and antihypertensive agents are two types of drugs that increase the risk of falls and fall-associated fractures. \u201cAny medication that affects cognition, balance, and awareness are dangerous in our older folks,\u201d Dr. Gozansky added.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EAbout 50% of older individuals have a fear of falling, and this is a major issue. The fear of falling leads a person to be less active, which leads to a person being more likely to fall, which creates a greater fear of falling. \u201cIt\u0027s a vicious cycle,\u201d said Dr. Gozansky.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EDr. Gozansky encouraged clinicians to \u201cask, assess, and act\u201d as a way of paying greater attention to the risk of falls among their older patients (\u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E). Recommending exercise on a prescription pad can make an enormous difference in terms of patient adherence.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12289\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12289\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12289\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n               \u003Cp id=\u0022p-21\u0022 class=\u0022first-child\u0022\u003E\u201cAsk, Assess, and Act\u201d for the Prevention of Falls.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECalcium and Vitamin D\u003C\/h2\u003E\n         \u003Cp id=\u0022p-22\u0022\u003ECalcium and vitamin D supplementation has long been recommended as a strategy to prevent osteoporosis and decrease the risk of fractures. But, many questions remain about how much of each is required and whether insufficient or deficient intake affects bone health, according to John A. Eisman, MB BS, PhD, FRACP, Garvan Institute of Medical Research, Sydney, Australia.\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003ECalcium in bone mineral is a crucial component for bone strength. Vitamin D is essential for normal calcium homeostasis and also modulates the risk of fracture by preventing falls and increasing bone density. In a meta-analysis of studies that involved individuals aged \u226565 years, prevention of nonvertebral fractures with vitamin D was dose-dependent, with higher doses estimated to reduce fractures by around 20% [Bischoff-Ferrari HA et al. \u003Cem\u003EArch Intern Med.\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EThe best available clinical indicator of vitamin D status is serum 25-hydroxyvitamin D (25-OH D), but the level is influenced by vitamin D intake as well as sun exposure, and the optimal level has been difficult to define. Levels of 25-OH D \u0026lt;27.5 nmol\/L (11 ng\/ml) and \u0026lt;37.5 nmol\/L (15 ng\/ml) have been considered to be deficient and insufficient, respectively. However, 75 nmol\/L (30 ng\/ml) was recommended as a minimum threshold to maintain skeletal health on the basis of the lack of osteoid on biopsy specimens from the iliac crest at autopsy [Priemel M et al. \u003Cem\u003EJ Bone Miner Res\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-25\u0022\u003ETwo recent reports have made important statements about calcium and vitamin D. In 2010, an International Osteoporosis Foundation (IOF) position statement provided key evidence-based recommendations about vitamin D. The IOF estimated that for older adults, the average vitamin D requirement is 800 to 1000 IU\/day, with an increase of up to 2000 IU\/day for individuals who are obese and have osteoporosis or limited sun exposure [Dawson-Huges B et al. \u003Cem\u003EOsteoporos Int\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-26\u0022\u003EAn Institute of Medicine report that was published in early 2011 stated that evidence supports the key role of calcium and vitamin D in skeletal health and provided updated recommended daily allowances of calcium and vitamin D for bone health (\u003Ca id=\u0022xref-table-wrap-4-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T4\u0022\u003ETable 4\u003C\/a\u003E) [Ross AC et al. \u003Cem\u003EJCEM\u003C\/em\u003E 2011]. The Committee concluded that the prevalence of vitamin D inadequacy in North America has been overestimated and recommended reassessment of laboratory ranges for 25-OH D to avoid problems of undertreatment and overtreatment.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T4\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12290\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12290\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12290\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 4.\u003C\/span\u003E \n               \u003Cp id=\u0022p-27\u0022 class=\u0022first-child\u0022\u003E2011 Recommended Daily Allowances of Calcium and Vitamin D for Bone Health.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-29\u0022\u003EDr. Eisman made his own \u201cprudent suggestions\u201d for calcium intake and 25-OH D levels for the prevention of osteoporosis. For both women and men, he suggested that optimal calcium intake should be approximately 1000 mg\/day. He said that calcium supplements should be taken with meals to minimize peaks in serum calcium levels. He also noted that a total 25-OH D level (D\u003Csub\u003E2\u003C\/sub\u003E plus D\u003Csub\u003E3\u003C\/sub\u003E) of approximately 75 nmol\/L (30 ng\/ml) was \u201creasonable, bone protective, and likely safe.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/5\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn2h1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn2h1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}