What advice should GPs give patients about nutrition and exercise?
Diet and nutrition
Specific information is given in other sections on use of calcium and vitamin D in patients with osteoporosis or patients living in residential or care homes.
The recommended daily intake of calcium is 700 mg for adults. A pint of milk a day or equivalent, together with a balanced diet of other foods should be sufficient.
Sources of dietary calcium are milk, cheese and yogurt (these can be reduced fat), certain types of oily fish that are eaten with the bones, such as sardines (which also provide vitamins D and K) and vegetables such as broccoli and cabbage.
Sunlight is the best natural source of vitamin D. Sufficient vitamin D can be made through 10 minutes of sun exposure to the face and arms without sunscreen once or twice a day, every day, between May and September. Care should be taken not to burn. From October to April, vitamin D supplementation can be considered.
Patients should also:
- Be encouraged to eat their 'five a day' of fruit and vegetables
- Aim for a healthy weight (a body mass index of 20-25 kg/m2)
- Take alcohol in moderation (less than 2-3 units/day for women and 3-4 units/day for men)
- Be advised to stop smoking
For further dietary information, refer to the Eatwell Guide.
A detailed examination of the importance of diet and safe sunlight exposure is reported in the Inquiry into the Role of Nutrition in Preventing Osteoporosis and Promoting Good Bone Health carried out by the All-Party Parliamentary Osteoporosis Group (APPOG).
Encourage both traditional weight-bearing exercise (any exercise where you are supporting the weight of your own body) and also exercise that involves pulling forces acting on entheses (tendon insertions) of long bones, even in the very elderly. Weight-bearing and resistive exercises are better for bone strength than non-weight-bearing exercises such as swimming and cycling. Care should be taken to avoid exercises that may lead to fractures, including high-impact exercises, exercises that include bending forward and twisting at the waist, and high-risk sports such as skiing. Patients should also make their exercise instructor aware of their condition. It should be noted that the benefits are only maintained as long as patients take exercise.
Sarcopenia (degenerative loss of skeletal muscle mass and strength associated with ageing) is commonly associated with frailty and co-morbidity, and muscle mass and strength can be improved by resistance training and increasing dietary protein intake.
The National Osteoporosis Society's leaflet Exercise and Osteoporosis provides more information about exercises for people with osteoporosis and the considerations that are important for people with high risk of fractures.