Right now, in your bones, a process called bone remodeling is occurring. In essence, cells in your bones remove old, weak bone and replace it with new, strong bone. Thanks to this normal process, every 10 years, you’ll have a brand new skeleton to support your body. However, sometimes this remove/replace system falls out of sync, and bone will be broken down faster than it’s rebuilt. Your bones naturally have spaces and holes inside them, but when more bone is removed than rebuilt, these spaces and holes grow too large. Your bones become weak and are more prone to fracture. When this happens, it’s known as osteoporosis. Many different things can cause the bones to weaken, including age, some medications, inflammatory diseases, and hormonal changes like menopause. Fortunately, advances in osteoporosis research have opened up new treatments that can help keep bones strong and promote bone growth. As a rheumatologist for the past 18 years, it’s exciting to be able to offer these options to my patients and watch them get stronger and avoid breaking any bones. But managing osteoporosis isn’t just about medication. Here are the most common tips I share with patients for living well with osteoporosis. 1. Add calcium into your diet. Calcium helps strengthen the bones, so it’s important for people with osteoporosis to make sure they’re getting enough of this nutrient. In the past few years, research has shown it’s best to get your calcium naturally through your diet, rather than from supplements. Foods high in calcium include dairy products like yogurt and cheese; leafy greens like kale and collard greens; beans and lentils; and seafood like sardines, salmon, and shrimp. Some people, however, have trouble getting their calcium from food and will want to take supplemental calcium tablets. Different kinds of tablets get absorbed differently by the body, so ask your doctor for his or her recommendation when it comes to choosing the right calcium supplement. 2. Get moving. Along with diet, exercise is also crucial for managing osteoporosis. The more sedentary you are, the higher your risk for bone loss. I recommend patients get as much aerobic exercise as they can, whether it’s brisk walking, biking or time on the elliptical. Anything that gets your heart pumping will be helpful. These exercises are beneficial for osteoporosis patients since they help build and maintain bone density. 3. Quit smoking and limit alcohol. Smoking is a major risk factor for osteoporosis and bone fracture, so if your bones have already started to weaken, it’s important to stop smoking. Studies have found a direct relationship between tobacco use and weak bones, and it can also negatively impact how well your bones heal after a fracture. Ecessive alcohol hurts bone health as well, since it reduces how much calcium your body can store and can increase your risk for falls. Chronic heavy drinking can also cause hormone deficiencies, which can also increase osteoporosis and fracture risk. 4. Be prepared for doctor’s appointments. One of the hardest parts of my job is the limited amount of time I get to spend with my patients. This can be frustrating for both parties. I encourage my patients to use their appointment time wisely. Come prepared with questions you’d like answered, and keep a daily or weekly log of symptoms you can reference during your time in the doctor’s office. It’s also important to find a doctor you really connect with, who is available by email or phone when you need guidance in between appointments. 5. Trust your doctor’s treatment advice. It’s important to develop an open, trusting relationship with your doctor. Make sure you find someone you’re comfortable with, who will listen to your concerns and take them seriously. But you as the patient should also have an open mind and understand that, while the doctor is there to help you, he or she might not always agree with your opinions. As a rheumatologist, I’m dedicated to my patients. I try to keep up with the latest data and read rigorously peer-reviewed journals in order to know what’s best for my patients. That’s why I cultivate a trusting relationship with them, so they feel confident in my guidance and make changes to control their osteoporosis and live healthier lives. Dr. Allen Anandarajah is a board-certified rheumatologist and an associate professor of medicine at the University of Rochester Medical Center. He directs the Early Arthritis Clinic at URMC and has also authored several journal articles and textbook chapters focusing on rheumatoid arthritis and osteoporosis.