Osteoporosis medications are the cornerstone of treatment for brittle bones. But nondrug approaches are important, too.

Some people with osteoporosis can’t or won’t take bone-strengthening medications. The reasons include the drugs’ side effects, cost, or inconvenience, and concern about potential long-term adverse effects. Fortunately, a variety of nondrug tactics can also help shore up or cushion fragile bones.

Extra help from braces and pads
Spinal braces can improve posture, reinforce the spine, and reduce pain among people who have had spinal compression fractures. These fractures occur when a weakened vertebra collapses, usually toward the front of the body. Multiple compression fractures weaken the upper spine and lead to a stooped posture.

Traditional rigid braces hold the body erect, but they can be constricting and uncomfortable. Newer types include weighted posture-training support braces that resemble a small backpack or are worn like a vest. Another type of brace relies on a back pad with a system of straps and fabric fasteners. These braces work by increasing the individual’s awareness of body position and by providing an ongoing reminder to straighten the spine.

Joseph M. Lane, MD, professor of orthopedic surgery at Weill Cornell Medical College of Cornell University in New York City, says braces must be fitted carefully so that they are tight enough to do some good but not so constricting that they interfere with normal range of motion. He advises patients to put on their brace when they begin to tire during the day or when they’re cooking, cleaning, or engaged in other activities that involve lifting. A brace should have all its attachments and fasteners in the front. Dr. Lane recommends that people try out a brace for a couple of weeks before purchasing it.

Hip protectors are undergarments with padding over the hips to absorb the impact of a fall. They are most appropriate for people who are recovering from a hip fracture and for those who have had a stroke. Hip protectors must be worn consistently, especially at home, where up to 80% of hip fractures occur.

Exercise for your bones’ sake
Regular exercise makes bones stronger by increasing bone mineral density. It also helps reduce the risk of falls by improving muscle strength, balance, and flexibility. The best exercise options for people with osteoporosis are osteoporosis fitness classes or personal instruction by a physical therapist. After people learn the appropriate exercises, they can continue their program in a regular gym.

Because of the risk of stress on brittle bones, Dr. Lane cautions those with osteoporosis not to do sit-ups or crunches, lift heavy weights, or lift any weight held in front of the body. Tai chi, with its slow, gentle movements, is an excellent choice for people with osteoporosis.

Getting your calcium and vitamin D
Keeping bones healthy also requires that you take in adequate amounts of calcium and vitamin D. The National Osteoporosis Foundation recommends that people age 50 and over get a total of 1,200 milligrams of calcium and 400 to 1,000 international units (IU) of vitamin D each day. Five to 10 minutes of sun exposure two or three times a week will boost vitamin D levels, but most older people will still need a supplement.

Avoiding falls
Each year about one-third of older adults take a fall. Gait and balance disorders, muscle weakness, episodes of dizziness or confusion, vision problems, and hazards in the environment all contribute to the risk. In addition, certain medications, such as sedatives and some blood pressure drugs, can make people unsteady on their feet. Those who have fallen in the past are likely to fall again. In contrast, people who practice tai chi have a reduced risk of falling.