Osteoporosis is mainly a lifestyle disease. There's good evidence that exercise and diet alone can prevent it (J Bone Miner Res, 1988; 3:145-9). The following suggestions apply equally to men.

* Engage in regular weight-bearing exercise. More than 100 studies confirm that regular exercise such as brisk walking, running, aerobics, tennis and badminton strengthen bones and reduce the risk of fracture in premenopausal and postmenopausal women and in men. However, exercise must be reasonable among those of normal weight. Amenorrhea (cessation of periods) caused by heavy exercise in young women and an inadequate diet has been reported to cause hip fractures and scoliosis (a spinal deformity) (J Nutr Environ Med, 1995; 5:41-53).

* Eat a well-varied wholefood diet, rich in fruits and vegetables. Restrict meat and excessive protein. Extra calcium is required to process large quantities of protein. Some believe excessive protein is responsible for osteoporosis (See WDDTY vol I no 6). Also restrict salt and caffeine, which have been linked with brittle bones.

* Find out which nutritional supplements you need. Don't megadose on calcium. Calcium is essential for bone growth and maintenance, but research has shown that for maximum bone health the body relies on additional nutrients such as the B vitamins, vitamin C and D, phosphorus, magnesium and zinc. Not getting the balance right could be an expensive and possibly
dangerous waste of time. Dr Abrahams has advised no more than 500 mg of calcium citrate per day since excessive calcium can increase the risk of kidney stones. Consult a nutritionist therapist about supplementation and make sure to have your digestive function checked since low stomach acid can be responsible (see WDDTY Alternatives, vol 6 no 9 for more information on the role of vitamin D).

* Investigate boron. There is evidence that this mineral prevents calcium loss and bone demineralization. It also helps to convert cholesterol into vitamin D3, which is essential for calcium absorption. One study found that boron supplementation increased blood levels of estradiol to as high a level as women taking small amounts of HRT (J Trace Element Exp Med, 1990; 3:45-54.) However, high levels of boron have adversely affected fertility in rats, and more research into its effects on humans is needed. A small boron supplement (3 mg) may be beneficial to men and women with osteoporosis.

* Make sure your levels of essential fatty acids are high. Two EFAs, gamma-linolenic acid (GLA) and eicosapentaenoic acid (EPA), have been shown to improve calcium balance and bone calcium content (9th International Congress on Prostaglandins, Florence, June 4-9 1994).

* Quit smoking. Smoking can contribute to osteoporosis. At least 13 studies show that stopping smoking reduced the risk of osteoporotic fractures (BMJ, 1991; 303: 453-9); one showed that stopping smoking reduced the risk of hip fracture by 25 per cent (BMJ, Dec 5, 1992).

* Only drink moderately. High alcohol consumption increases the risk of osteoporosis by impairing bone formation, although it can return to normal within two weeks of abstention (Am J Med, 1992; 93: 642-50.)

* Avoid long-term use of steroids, a common cause of osteoporosis. In asthmatics, one study showed a 42 per cent incidence of vertebral and rib fractures (N Engl J Med, 1983; 309: 265-8).

* Don't cook with aluminium. Aluminium can inhibit the parathyroid gland, also leading to osteoporosis (Spec Top Endocrinol Metabol, 1983; 5: 201-26). Also, don't use thyroid replacement thyroxine unnecessarily. There is concern that this may promote osteoporosis in both pre- and postmenopausal women (Lancet, Dec 1, 1990).