Causes
The risk of osteoporosis is higher in people who have a low-calcium diet, are under weight, take little exercise, consume alcohol to excess, and smoke cigarettes. Osteoporosis does not usually occur until old age. What makes this disease particularly insidious is that the onset and early stages generally go unnoticed. Between the age of thirty and forty years, the development of bone mass ceases. Thereafter, bone mass slowly but steadily declines. Anyone whose calcium intake in the first half of life is too low can never make up for it later on. In women, the decrease in bone mass is more rapid from the onset of the menopause because from this point on they lose the hormone estrogen, which plays an important role in bone metabolism. Osteoporosis becomes manifest in women about 10-15 years earlier on average than it does in men.

The role of calcium
The most important component of bone is calcium. To ensure that skeletal development is healthy and stable or to ensure that age-related bone loss is delayed for as long as possible, the daily diet must provide a sufficient calcium intake. By far the best sources of calcium are milk and dairy products. Vegetables, pulses and wholemeal products also contain calcium. In mineral water, the content varies depending on the product, and in drinking water it varies depending on the region.

Source: Consensus Development Panel on Optimal Calcium Intake, NIH Consensus Conference, USA, 1994

	Daily calcium requirement according to age and sex	Requirement in mg per day
Adolescents, young adults (both sexes)	11 to 24 years	1200 to 1500 mg
Men	25 to 65 years	1000 mg
Men	over 65 years	1500 mg
Women	25 to 50 years	1000 mg
Women	During pregnancy and lactation	1200 to 1500 mg
Women	over 50 years, with supplementary estrogen replacement	1000 mg
Women	over 50 years, without supplementary estrogen replacement	1500 mg
Women	over 65 years	1500 mg

sources of calcium	Other sources of calcium
approx. 250 mg calcium are contained in: 2 dl (3/4 cup) milk 180 g yogurt 30 g hard cheese 60 g soft cheese 200 g quark	approx. 100 mg calcium are contained in: 100 g broccoli or fennel 100 g pulses (dry weight) 200 g wholemeal bread 60 g nuts 2.5 dl (1 cup) calcium-rich mineral water

Calcium is of optimum benefit and is deposited in the bones among those who:

1. engage in regular sporting activities or physical work
2. spend some time each day outdoors in the fresh air
3. do not smoke
4. do not drink alcohol to excess
5. take care to eat a balanced diet because - in addition to calcium - other nutrients and nutritional factors affect bone metabolism

Dietary recommendations for prevention of osteoporosis
Many factors affect our dietary behaviour: individual needs and desires, our day-to-day condition, the social environment, the food currently on offer, advertising etc. The following recommendations ensure a balanced and varied diet that provides an adequate intake of energy, nutrients and protective substances and thus a healthy approach to nutrition. The figures quoted are intended for the "average person", i.e. for adults who engage in normal physical activities and thus have an average energy and nutrient requirement. The figures would vary for other groups (such as children and adolescents, top athletes, pregnant women etc.). The quantities and portions given are likewise average values; they cannot be adhered to precisely every day. Those passages that appear in italics are particularly important for persons with a tendency towards osteoporosis

Fats and oils
Use 2 teaspoonfuls (10 g) of high-quality vegetable oil (e.g. sunflower oil, thistle oil, corn oil, olive oil, rapeseed oil) per day, unheated, e.g. for salad dressings.
Use not more than 2 teaspoonfuls (10 g) of cooking fat or oil per day (e.g. peanut oil, olive oil) for the preparation of meals. Do not eat more than 2 teaspoonfuls (10 g) of spreading butter or margarine per day on bread.
Do not eat more than one high-fat meal per day, such as deep-fried or breaded food, cheese dishes, fried potato, sausage, cream sauce, puff pastry, cakes, chocolate.

Sweets:
Eat sweets in moderation - many sweets contain hidden fat. Do not eat more than one small dessert daily - good sources of calcium are milk or yogurt desserts.

Meat, fish, eggs: Eat one portion of meat 2 - 4 times a week (1 portion = 80 - 120 g); more is unnecessary, less is no problem.
Do not substitute salted meat products, such as ham, sausage, or bacon, for meat more than once a week. Do not eat offal (liver, kidneys, tripe, sweetbreads) more than once a month (1 portion = 80 - 120 g).
Plan to eat 1 - 2 portions of fish a week (1 portion = 100 - 120 g).
Eat 1 - 3 eggs a week, including processed eggs e.g. in cakes and pastries, soufflés or creams.

Pulses, pulse products:
Eat 1 - 2 portions of lentils, chickpeas, kidney beans (1 portion = 40 - 60 g, dry weight) and tofu (1 portion = 100 - 120 g) per week.

Milk and dairy products:
Adolescents, young adults up to 24 years of age, and breastfeeding women: 3 - 4 portions per day
Adult: 2 - 3 portions per day
People over 65 years of age and women over 50 (who are not receiving estrogen replacement therapy): 4 portions per day (1 portion = 2 dl milk or 1 cup yogurt or 30 g hard cheese or 60 g soft cheese).
Choose low-fat dairy products.

Cereal products and potatoes:
Eat at least 3 portions of carbohydrate-rich foods per day (e.g. bread, potatoes, rice, cereal, pasta, etc.), preferably wholemeal products. The size of the portion depends on the degree of physical activity the person engages in.

Fruit:
Eat 2 - 3 portions of fruit per day (e.g. 1 apple, 1 banana, 3 plums or a dish of berries), ideally raw.

Vegetables:
Eat 3 - 4 portions of vegetable per day, at least one of them raw, e.g. as a dip or a mixed salad (1 portion = 100 g raw or 150 - 200 g cooked vegetable, 50 g lettuce or 100 g mixed salad).

Beverages and alcoholic drinks:
Drink at least 1.5 litres (6-7 cups) of liquid per day, preferably unsweetened and alcohol-free beverages, in particular calcium-rich mineral waters (such as Valser, Adelbodner, Aproz, Eptinger, Passugger).
Do not drink too much tea, black tea and cola beverages. Alcohol promotes the excretion of calcium. Healthy adults should not drink more than 1-2 glasses of wine or beer per day.

Osteoporosis - chief points to remember:

1. Consume three to four portions of milk or dairy products over the course of the day.
2. Do not eat meat too often.
3. Consume as little alcohol as possible.
4. Get a lot of outdoor exercise every day.