Ask the Expert: Osteoporosis Symptoms & Prevention

Women with Weights

In honor of World Osteoporosis Day, we asked orthopedic surgeon Dr. Joseph Lane to answer questions on osteoporosis, a metabolic bone disorder in which bone tissue breaks down, leading to an increased risk of fracture.

Q1: What are the symptoms of osteoporosis?

Osteoporosis is a quiet disease. An individual might have osteoporosis if he or she suffers fractures after low-impact injury, a decrease in height of more than two inches, or a newly present curvature of the spine.

Q2: How much calcium and vitamin D is recommended in order to prevent osteoporosis?

Calcium intake should be around 1200 milligrams per day. Consider taking a calcium supplement if you’re not getting enough calcium in your diet. Calcium citrate (as opposed to calcium carbonate) is preferred as it is more easily digested and absorbed.

For those deficient in Vitamin D, a daily intake of 1,000-2,000 IU (international units) is necessary to reach a normal range minimum of 30 nanograms per milliliter, detected through a 25-hydroxy vitamin D test. When in normal range, 600 IU/day of Vitamin D is recommended. Consult with your treating physician before starting a new supplement regimen.

Q3: If I cannot get calcium from dairy foods and I do not want to take a supplement, how can I meet the requirements?

Non-dairy foods such as salmon, tofu, beans, kale and almonds are good sources of calcium. Some soy products such as soy milk are fortified with extra calcium.

Q4: Can exercise help keep my bones strong and prevent osteoporosis?

Exercise can help you retain bone mass and decrease your risk of fracture. Thirty minutes of a weight-bearing exercise, such as walking, five times a week and strengthening exercises using resistance three times a week are recommended.

Q5: How do menopause and hormones affect osteoporosis?

In menopause, estrogen production decreases, which leads to bone loss and fragility. Taking an estrogen supplement can help prevent bone loss.

Reviewed on August 28, 2018. 

Dr. Joseph Lane is an orthopedic surgeon and chief of the Metabolic Bone Disease Service. He specializes in malignant and benign bone tumors; metabolic bone disease; and fractures, non-unions and delayed healing.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. I am having a spinal fusion L4-L5 & was Just told i have osteoporosis -2.50. I am 53 year old female. Do i need to put off surgery until i get treatment for the osteoporosis? Can you recommend a physician who specializes in osteoporosis?

    1. Hi Fran, thank you for reaching out. Dr. Joseph Lane, Orthopedic Surgeon and Chief of the Metabolic Bone Disease Service and Dr. Linda Russell, Rheumatologist, both specialize in the treatment for osteoporosis. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance. They can assist with specialists and insurance questions!

  2. I have osteoporosis diagnosed few years ago. Not treated. I am 65 yo man stress fx bilateral tibia diagnosed 4 weeks ago. Rheumatologist wants to start Forteo inj orthopedist wants to wait till fx heals. Pl advise if I should start Forteo now

    1. Hi Jay, thank you for reaching out. Dr. Joseph Lane, Orthopedic Surgeon, says: “First, you should consult with your treating physician about adjusting the calcium and vitamin D. Then, start the forteo since it will enhance the fracture healing.” It would be best for you to consult with your treating physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  3. I am a 77 year old male and in need of a hip replacement. Unfortunately, my primary care doctor discovered that I have unexplained severe osteoporosis. My DEXA scan was -4.81 He said I would not be able to have the surgery until my bones were strengthened. I started on Forteo and after 20 weeks a repeat DEXA scan was a disappointing -4.86 He wants to switch me to Prolia but I am trying to persuade him to let me have the Prolia while still continuing the Forteo. I know Dr. Lane is aware of the clinical trial of this combination being conducted at Mass General.

    Can you give me any guidance as to what amount of improvement I will need in order to be able to have the hip replacement surgery? Although I am in FL, I plan to have it done at HSS.

    1. Hi Robert, thank you for reaching out. Dr. Joseph Lane, Orthopedic Surgeon, says: “It’s too early to see a change on DXA. However, the urinary NTX, serum P1NP, and bone specific alkaline phosphatase elevation would suggest a good result. I agree that combining Prolia with Forteo would lead to greater growth.” It is best to consult with your treating physician. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  4. Hi Dr.Lane,
    Please advise me. I am 71 yo woman,having osteoporosis for 20 years, had multiple times fractures throughout my life. Now taking boniva once a month and seems like its not helping . I was told i have severe case high risk for fractures.My last dexa scan showed worsening compare to previous.I also have spinal stenosis in my lumbar area, which makes me very difficult to walk and I know exercise and walking is very important for osteoporosis treatment. My pain management Dr said i can have hormonal epidural injection in my spine to relieve discomfort for my lower back. I am asthmatic and used a lot of hormonal sprays, now stopped (got some better), but sometimes using if wheezing happened. I am taking pills for high Blood pressure with diuretic(Hyzar) and toprol. I am just curious if that diuretic drain away my calcium from my body. I don’t know and desperate what to do.I am afraid to do spinal hormonal injection because its bad for bones, occasionally have to use asthmatic sprays and taking BP pills. Now is dilemma what is my other treatment option to make my osteoporosis slow down and whats is your suggestion for reclast or prolia, which my provider offered , but i know its a lot of side effects, including femoral neck breakage . I also would like to join to the classes your center offering for osteoporosis and physical therapy session. I have Medicaid/medicare insurance and I am a patient of HSS. Please reply your opinion. I appreciate your help and advise and would like to schedule an apptm. with you. THANK YOU. s
    Sincerely , Liza Sionova-patient

    1. Hi Ellen, Thanks for reaching out. Rheumatologist Dr. Linda Russell says, “There are two main types of kidney stones – uric acid and calcium stones. Calcium carbonate can worsen calcium kidney stones, but calcium citrate can help dissolve calcium kidney stones. In someone with a history of calcium kidney stones, we prescribe calcium citrate.” Consult with your physician before starting a supplement regimen.

If you’d like to consider HSS for treatment, please contact our Patient Referral Service at 888-720-1982. For general questions and comments, reach us on Facebook or Twitter.