Everyone knows the importance of diet and exercise. But a balanced diet and regular exercise requires commitment and in some cases, a lifestyle change. So how important is diet, supplements, and exercise for postmenopausal women?
Osteoporosis affects one of every three postmenopausal women.  That is because menopause leads to bone loss - when estrogen production decreases, calcium absorption decreases and bone resorption increases. Resorption is the process by which osteoclasts, or bone cells, break down bone and transfers calcium from bone fluid to the blood. This loss can lead to osteoporosis in which weakened bones may fracture.
In the United States and Canada, calcium intakes are close to the Estimated Average Requirement for most gender and age groups. But women over 50 years fall below desirable intakes (>1,000 milligrams of calcium daily) when considering food sources of calcium.
That is why dietary supplements are an important source of nutrients for large segments of the population. Almost 70% of older females report supplemental calcium use. This use is associated with a higher prevalence of meeting the adequate intake recommendations for calcium. Unfortunately, older adults fail to meet the Vitamin D recommendations from diet alone and only marginally improve with dietary supplements.
Researchers found 29 trials that recruited people aged 50 years or older in which calcium, or calcium in combination with vitamin D, was used to prevent fractures and osteoporotic bone loss. A meta-analysis found that in trials that reported fractures, supplement treatment was associated with a risk reduction in fractures. Trials that reported bone-mineral density, supplement treatment was associated with a reduced rate of bone loss at the hip and in the spine. For best therapeutic effects, researchers concluded by recommending minimum doses of 1,200 mg of calcium and 800 IU of vitamin D .
Although some may think that calcium and Vitamin D alone are able to prevent bone loss and reduce fractures, exercise may be more effective. A recent case study found little improvement in a 57-year old woman’s osteoporosis after a year of calcium and Vitamin D supplements. Subsequently, she exercised two to three times per week for 70 to 90 minutes per session. After 3 years of exercise, her bone mineral density and content improved.
Although there are no clinical guidelines for the type, intensity and duration of exercise, this particular case showed that multi-component exercise training can be done easily, prevents expected bone loss, improves bone mineral density, and can increase/improve bone mineral content in a postmenopausal woman with osteoporosis.
The take-away for postmenopausal women: Adequate calcium and vitamin D, as part of a well-balanced diet, along with physical activity, may reduce the risk of osteoporosis. *
*This statement has been evaluated and approved by the U.S. Food and Drug Administration.
 Rizzoli R, Bischoff-Ferrari H, Dawson-Hughes B, Weaver C., Nutrition and bone health in women after the menopause, Women’s Health, p 599-608, November 2014
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 Bailey R, Dodd K, Goldman J, Gahche J, Dwyer J, Moshfegh A, Sempos C, Picciano M, Estimation of Total Usual Calcium and Vitamin D Intakes in the United States, Journal of Nutrition, April 2010
 Dr Benjamin MP Tang MD, Guy D Eslick PhD, Prof Caryl Nowson PhD, et al, Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis, The Lancet, Vol. 370 No. 9588 pp 657-666, August 25, 2007,
 Shenoy S, Dhawan N, and Sandhu JS, Effect of Exercise Program and Calcium Supplements on Low Bone Mass among Young Indian Women- A Comparative Study, Asian Journal of Sports Medicine, September 2012.
 Movaseghi, F and Sadeghi H, Effect of Three-year Multi-Component Exercise Training on Bone Mineral Density and Content in a Postmenopausal Woman with Osteoporosis: A Case Report, Iranian Journal of Public Health, May 2015.